Brief Answer: detailed explanation provided Detailed Answer: Hello and welcome, I completely understand your concern. However the HPV was long ago and you do not seem to have had any symptoms after that. The current symptoms are due to a new pathology. It is most likely the fibroid and polycystic ovaries [ PCOD] that are producing this typical pattern. The polycystic ovaries lead to anovulation and also such women have higher estrogen levels leading to thickening of the endometrium. Fibroids also cause bleeding. So a thick endometrium and fibroid are most likely producing the irregular heavy bleed. Regarding the relation to hyper stimulation: It is surprising that a woman that has donated eggs has PCOD as mostly they are known to cause infertility and prevent egg release. Fluid collection in the abdomen is also not rare in hyper stimulation but it is transient and occurs mainly during the procedure and not years later. However having said all this, the ovarian hyper stimulation and egg donation are all still relatively new to medicine and we are still unaware of their long term effects. So the link may or may not be there as there is no research to substantiate this. About the complex fluid behind the uterus: 1. Since the tubes have been tied it may come form a collection of fluid in one of the tubes. This is common as the fluid is unable to drain out as tubes are tied and may collect inside giving the appearance of a collection. This is usually present at one or other side of the uterus but if adhesions are there, it may be seen behind it. 2. It may be a collection of infected fluid due to pelvic inflammatory disease in the past or present. 3. Fluid from peritonitis originating from colitis [ infection of intestine] or appendicitis. 4. fluid from ruptured ovarian follicle [ less likely in view of polycystic ovaries] 5. endometriosis and a collection secondary to it. The most important finding is the splenic lump in view of peritoneal fluid. This is the only finding that causes a bit of concern to me as a doctor. This may either come as a primary isolated lump or a spread of disease from other site. Spleen is rare site for spread of any cancer and by the time they spread to spleen they are usually present in other organs like liver etc. So this possibility is rare. It is most likely an isolated cyst due to either trauma or infection, or vascular disorder. As of now there are a few suggestions for you. It is better to investigate these things a bit further by a CT abdomen and a laparoscopy. This will help in establishing the origin of fluid and any other significant finding. A Ultrasound guided tapping of the fluid can also be done to determine its origin. A laproscopy will be able to take samples of fluid and study it to determine the cause and also rule out any abdominal or pelvic pathology. The treatment for fibroids and bleeding are mainly progesterone preparations like devery or oral contraceptive pills like cerazette or ginette at your age. If they fail then other options may be tried. PCOD has shown excellent results with lifestyle measures like healthy low fat and low sugar diet as well as daily exercise, meditation to decrease stress and weight loss. So please discuss all these with your doctor. Also please see a surgeon for the cyst. The findings are not leading to cancer as a diagnosis. So please do not worry. They appear to be mostly different conditions going on together. I understand that this is a long answer [ sorry for the inconvenience it may have caused to you] but it was needed in view of the different findings Hope this satisfies your query.I understand your concern Feel free to ask any more questions that you may have and I will be happy to help. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist

---