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Have irregular periods after Mirena removal. Ultrasound shows ovarian follicles. Trying to conceive. Meaning?

Mar 2016
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Practicing since : 2011
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I had a transabdominal pelvic ultrasound done. I"m trying to have another baby with my husband and have been having irregluar cycles since 2011 when I had Mirena removed.

The report states:

The uterus measures 91.2 mm in length x 42.3 mm AP x 48.2 mm TRV. The uterus shows a normal configuration, contour and texture. The endometrium is secretory in nature, and measures 10.4 mm in thickness. No free fluid identified.

The right ovary measures 23.0 mm x 33.2 mm x 24.1 mm, for a volume of 9.6 cc's. No focal lesions are identified, only small, peripherally arrayed physiologic follicles.

The left ovary measures 38.7 mm x 19.7 mm x 29.3 mm, for a volume of 11.7 cc's. Small peripherally arrayed physiologic follicles are noted, with no focal lesions noted.

The bladder is fully distended, with no enoluminal lesions noted.

IMPRESSION: Peripherally arrayed small ovarian follicles, favor physiologic/nonpathologic versus other entities including polycystic ovarian syndrome in the appropriate clinical setting.

What does all this mean? I went to one doctor for an answer and don't feel confident in his answer being that the nurse told me to come in so the doctor could explain it to me. All I received was "you're fine". I have been trying to conceive for 8 months, with no luck.
Posted Mon, 12 Aug 2013 in Women's Health
Answered by Dr. S Patra 2 hours later

Thanks for writing to us. I am trying to explain all things one by one.

Your trans abdominal ultrasound scan reveals small physiological or functional (means able to ovulate) ovarian cyst in the both sides, resembling polycystic ovary with a normal uterus & endometrium thickness (10.4 mm) corresponds to secretory phase of menstrual cycle. To summarize, scan report is within normal range.

There are several reasons of prolonged irregular period like hormonal imbalance (by altering HPO axis or hypothalamus-pituitary-ovarian axis ), over weight or rapid loss, mental stress, non-functional ovarian cyst, irregular diet pattern, high prolactin level, pelvic infection (PID), thyroid disturbance, anemia, effect of certain medication etc.

As you are trying to conceive for last 8 months, you need to undergo some additional investigations to rule out underlying etiology for Secondary Infertility. Here, you can consult with an infertility specialist for proper guidance and management.

Additional Tests includes: 1) Husband semen analysis (freshly).
2) For proper ovulation- Serial follicular study in the mid cycle.
3) Tubal patency test- by HSG (hystero salpingography) or laparoscopy.
4) Complete hormone assay with thyroid profile, blood sugar & prolactin test.
5) Test for cervical factor- Post Coital Test (PCT), Anti-sperm antibody (ASA) etc.

Complete treatment depends on underlying causes. Here, you may require progesterone supplement to regularize the period with other supportive therapy. To maximize chance of pregnancy, you can use ovulation prediction kit (in mid cycle) to predict ovulation and prepare for that day. It is quite useful.

In preconception period, you both take Vitamin-E and folic acid supplements for at least 3 months. Along with you would take healthy diet, control body weight by regular physical exercise, try to avoid mental stress/ emotional upset by regular meditation/ yoga, drink more water and eat fresh fruits, maintain genital hygiene and take sound sleep with complete relaxation.

Hope, I have answered your query. If you need any clarification, you can freely ask me.

Wish your good health and take care yourself.

Dr Soumen
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