Brief Answer:
It is not unusual to have short cycles in your 40's for hormonal reasons

Detailed Answer:
Hello, and I hope I can help you today.

I'm going to I'm going to try to answer what I believe your question to be as best as I can.

I am assuming that you are relating to me that since your surgery and other hormonal treatment for your fibroids you are concerned because your menstrual cycle that has resumed is very short- almost every 2 weeks. This is actually not unusual in your 40s due to hormonal changes, even without having fibroids.

I'm also assuming, because you had two separate surgeries three months apart, that the fibroids you had on the interior of your uterus were removed by a procedure called a hysteroscopy – a same day surgery that is performed through a camera that goes into your uterus that did not require an incision on your abdomen. It is indeed true that this type of surgery does only remove the fibroids that can be seen inside the uterus (called submucous fibroids). Fibroids that are located in the wall of the uterus or on the outside can only be removed with open surgery; meaning you would've needed to of have an incision on your abdomen.

Fibroids that are located on the outside of the uterus they frequently make it larger, but are unlikely to cause irregular bleeding or bleeding between your menstrual periods. They usually cause more symptoms related to enlargement of the entire uterus, which can cause pressure, cramping with your menstrual cycles, and heavier bleeding during menstruation.

Fibroids on the outside of the uterus do not interfere with fertility, and if you were otherwise to pursue pregnancy that would not be a contraindication to doing so. Of course, I assume also that you know already that with blocked tubes you would need to become pregnant through in vitro fertilization if you chose to do so in the future; and at the age of 45 most infertility specialists would recommend using an egg donor. Your short menstrual cycles may mean that you do not ovulate consistently or may be perimenopausal, and these possibilities may be detected by hormonal tests at your doctors office.

So in summary, the most likely cause of your short menstrual cycles are common hormonal change that happen to women frequently in their 40s. If you have not had recent test of your hormones that your gynecologist office, or if you want treatment for your frequent menstrual cycles, I would follow-up with your local GYN doctor who may be able to suggest a course of treatment. Having fibroids on the outer part of your uterus is not a contraindication to pregnancy, and as long as your symptoms are not bothersome there is no reason you would need to have any treatment or your uterus removed.

The way your doctor could determine whether or not you have additional fibroids is by performing a pelvic ultrasound. I am sure you have plenty of these before your surgery, and if it has been six months since your last ultrasound or if you've had not had one since the surgery I recommend discussing that with your GYN as well so that you have the most updated information about your condition.

I hope I was able to adequately answer your question today, and that this information was helpful. If you need any more specific information, please do not hesitate to contact me and please be very specific about exactly what information you seek so that I can help you most effectively.

Best wishes,

Dr. Brown

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Brief Answer:
The hormones you were given before are no longer in your system

Detailed Answer:
Hello again,

I am sorry that your access to gynecologic health care is limited.

I want to reassure you that the hormonal injections you received preparing for your surgery are long out of your system, and it takes 3-5 days for the noristerone to clear. So whatever your cycle is like now, that is the pattern that is happening naturally without hormones unless you took northisterone recently.

Just because your outward appearance is youthful it does not correlate well to your ovarian function. The major symptom of normally functioning ovaries is a regular, predictable menstrual cycle. If you were young and ovulating normally, tubal reversal surgery is successful in only about 20 percent of cases, and the surgery is most effective in women who have had a tubal ligation, rather than have their tubes scarred by previous infection.

You should have hormone testing if you ever do decide to pursue this further because if you do not ovulate well you will not get pregnant even with the surgery. Spontaneous pregnancy is unusual in women over 45 unless they already have been pregnant in the last 5 years. In most Western countries, because the success rate is so low, you would not really be considered a candidate for tubal reconstruction if you are over 35. That may be why your doctors did not recommend it earlier as an option.

Anyway, to control your bleeding, certainly your GP could fit you a hormonal coil, or prescribe progesterone or other medication. I would recommend that he/she also screen you for other diseases that can give you irregular cycles (if you haven't done so yet) such as diabetes, thyroid dysfunction and other abnormalities of your pituitary gland so that no health issue is missed.

If I can be of any other assistance, please let me know.

Take care, and thank you for using healthcaremagic.com

Dr. Brown

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Brief Answer:
I am terribly sorry you feel this way and about your history

Detailed Answer:
I am so sorry for the difficulties you had to live with all these years.

You should be proud of yourself that you managed to survive domestic abuse and sexual assault. Many women succumb to drug and alcohol addiction, depression, repeated abuse and even suicide in those situations. And no one else looks out of your eyes or has had your experiences, so there is nothing wrong for feeling bad about what happened to you and you should not be ashamed of being sad and angry.

I know none of this makes getting up and facing the world every day any easier. And I apologize if any of the medical information I gave you about pregnancy is discouraging; I just wanted to make sure you would not be taken advantage of by a physician who would actually do an operation on you that is unlikely to have any benefit.

Regardless, I do think you should see your GP anyway especially about your feelings of hopelessness and frustrations. The health system in England is different from XXXXXXX but I hope you might be eligible for some counseling? Nothing can ever change the circumstances of your life, but how you deal with them and learning how to cope is something you do have control over. Your doctor is supposed to be someone you can rely on and trust... I would discuss your feelings especially if you feel too discouraged to leave your home.

I really hope you feel better.

Take care, Dr. B

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Brief Answer:
Your are welcome, and i can certainly understand your position

Detailed Answer:
Of course I understand why you chose myomectomy and I am glad it gave you some relief, especially after such a rough Pre/post-op course.

And it is true, there is no way to know where life may lead in the future, and certainly there are options to help you get pregnant. Your success rate may be best through IVF but I know it is expensive and may not be an option for you, but the technology is always there and cost and access to fertility treatment may improve in the future, so choosing to keep your uterus was certainly not a bad decision.

I sincerely wish you the best for the future and thanks for using my services and healthcaremagic. com

Dr. Brown

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