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Had chronic fever. Developed changes in menstrual cycle. Are these related? What should I do?

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Practicing since : 2007
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HI..I have had chronic fever 2 and 1/2 years, complete workups with body scans- a ot of issues that are not related including multiple ear infections, deafness, mastoiditis, post-op hardware removal from spine. (fever started shortly after) but I have had every work-up you can think of...long story short, I recall that over this whole 2.5 year period, I developed changes in my menstrual cycle, where the time in between was getting shorter. I chalked it up to age and illness but then in May, I missed a period. Now last normal period was April 23rd, started bleeding on XXXXXXX 15, and am still bleeding. First a pink watery discharge then blood with clots but not a real heavy flow. I got a sonogram that says this: Endometrium 11mm without increased vascularity, 4 mm cystic focus at the junction of endometrium and myometrium without obvious decidual reaction. Heterogenoneous and cyctic focus can be seen in patient with adenomyosis. Volume of right ovary 60ml, left ovary 4ml.
question- is the fever possibly related, and the crazy cycles to all of this? what is the next step? The doctor was supposed to call FRiday according to the nurse, but he didn't.
Posted Thu, 2 Aug 2012 in Menstruation and Miscarriage
Answered by Dr. Juhi 1 hour later

Thanks for the query.

The continuous fever and bleeding since XXXXXXX 15th may be related but even if it isn't, the bleeding is abnormal and must be investigated.

As the cause of bleeding differs according to age and the complete sonography report, you have not mentioned the size of uterus and other details about ovaries in the sonography report.

In my opinion you need a gynaecologic examination to see the condition of cervix and size of uterus. Accordingly you may need a Pap smear or biopsy of cervix. The thickness of endometrium is close to upper limit of normal, so a biopsy from endometrium should also be done. The reports of the biopsy will point out the cause of bleeding.

The sonography report shows adenomyosis; though this can lead to irregular cycles and excessive bleeding, but nevertheless other causes must be ruled out.

Volume of right ovary is much above normal (normal is about 8 ml). If any more details about the condition of ovary are given in the sonography report, I would be glad to know. If the report does not mention anything else, then get a transvaginal sonography of lower abdomen. It is more accurate.

Hope I have answered your query. If you have any further questions I will be happy to help.

Dr. Juhi
Above answer was peer-reviewed by
Follow-up: Had chronic fever. Developed changes in menstrual cycle. Are these related? What should I do? 20 hours later
thank you for your reply! the details in the report: uterus measures 9.5 x 4.8 x 5.7 cm. Uterus is heterogeneous in echogenivity and echotexture. Endometrium difficult to see due to heterogenity of the myometrium. right ovary:6.1 x 3.7 x 5.2 cm, simple appearing cyst is 4.6x 3.2 x 4.2 cm on right ovary. Left ovary is 2.8 x 1.5 x 1.8 volume 4ml.
this was done transvaginal because as report says endometrium and bilateral adnexa not well seen.

thank you- I had a negative blood hcg. a year and a half ago I had an abdominal sono 2' swollen spleen and my doctor was looking for cause of fevers. I had hepatomegaly with marked increased echogenicity of liver, but CT scan negative. Could these also be related to same problem and fever? No one ever did pelvic or transvaginal US since fever started. Also no one ever explained liver ultrasound results although noted I had a history of high LFTs with positive smooth muscle antibody and suspected aoutoimmune hepatitis. Again- I hope the added info helps you explain more but also, can the fever and liver and uterus problems all be connected? also I am a registered dietitian- if you want to use technical terms I get most of them!
Answered by Dr. Juhi 40 minutes later
Thanks for writing back.

Your sonography report shows adenomyosis in the uterus. The simple cyst in the right ovary is a normal finding.

Did you ever have abnormal bleeding episodes from any site in body since the liver problem started?

In my opinion the fever is related to your liver and spleen condition, more than it is to the abnormal bleeding from uterus ( as you mentioned hepatomegaly and suspected autoimmune hepatitis). The liver and uterus condition are not related most likely.

Still, since this bleeding is abnormal, go for a gynaecologic check up. If required your doctor will perform the biopsies of cervix and uterus, and then your treatment will be started accordingly.

Hope I have answered all your queries. If there are any more questions, I'll be glad to answer.

Get well soon,
Dr Juhi
Above answer was peer-reviewed by
Follow-up: Had chronic fever. Developed changes in menstrual cycle. Are these related? What should I do? 24 hours later
thank you again.
My doctor wants to do an endometrial biopsy through d+c. Is this the best option for me? I have read about hysteroscopy or MRI and am wondering if d+c is the best route.

thank you again.
Answered by Dr. Juhi 17 minutes later

Thanks for writing back.

The best option for you is hysteroscopic guided endometrial biopsy. In this, the doctor visualizes the inside of uterus by a hysteroscope and the takes biopsy from the region that looks abnormal.

If facility for hysteroscopy is not available, then D&C is better than simple endometrial biopsy.

MRI will not lead to final diagnosis. Even after doing MRI, you might need a biopsy. Therefore, MRI is not useful for you.

If you have any further questions, I will be glad to know. Else, please close the discussion and rate my answer.

Get well soon.

Dr. Juhi
Above answer was peer-reviewed by
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