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Having hot flushes, vaginal dryness, heavy bleeding during cycles, ovarian cysts,teratoma. What can be the reason for these symptoms ?

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Practicing since : 1999
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Hi,doctor. My girlfriend is 21 years old. Let me tell you her situation divided into two part. She had a history of masturbation from 2004 to 2007, and during 2004 to 2007, she had trouble in stomach and had sever pain in menstruation with heavy blood. She stopped masturbation , and the pain and stomach problem gradually became better. But her period was still irregular, sometimes 4 months each time. From 2007 to 2010, she suffered a kind of symptom every day: hot flush, vaginal dryness. It sometimes lasted up to 2 hours. From the summer of 2010 to summer of 2011, she went to other city to study. Within this year, her period became regular and symptoms became much slighter.
But a emotional frustration hit her in the summer of 2011, then she had a rapidly weight gain and hair grows like a male, all the previous reappeared more seriously. Then she went to hospital, and the doctor gave her birth control pill for 3 months' use, at the same time, many ovarian cysts and a teratoma in the left side were found on her ovary . In December 2011, the teratoma grew bigger rapidly and cause sever pain. And this month, she accept Laparoscopic surgery to remove the tumor( diagnosed as benigh)and some cysts were pierced( they did not remove part of her ovary) . It seemed everything would be better after the surgery except pelvic pain happened one month after the surgery. She has suffered pelvic pain since then, which appears in left , central, or right side of her pelvic.
Now, there are questions.
1:The result of her hormone test( day 3 blood test) of this month, which i will attach in this from shows there seem nothing wrong with her hormone. I think the hot flush is due to a sudden estrogen deficiency, which disrupt the function of pituitary. This assumption cannot be supported by this hormone test. Menopausal women suffered this kind of symptom too, but even for them , the duration is just minutes, not 2 hours!
2: Maybe she is PCOS. But she is relatively thin, and the result of insulin does not indicate insulin resistance.
3: Is the masturbation that cause sort of premature ovarian failure? She strongly believe so because everything went wrong since she did that. (After two days of when a orgasm was caused by masturbation , she always feel terribly exhausted and uncomfortably on her belly and stomach.)
4: Hot flush hit back sometimes after surgery( particularly days before menstruation. I worry about her pelvic pain. It happened throughout the period, and the location of the pain is always changed, the pain can be very severe) The doctor used ultrasound to check her abdomen, besides some cysts, they do not find anything wrong.
Posted Mon, 21 May 2012 in Pregnancy
Answered by Dr. Meenakshi Titoria Sahu 6 hours later

Thanks for posting your query.

1.     Features resembling hot flushes can occur in hypothyroidism, anaemia and smoking. If her female hormones are normal, consult Endocrinologist to rule out other possibilities.

2. Even a thin woman with normal insulin can have PCOS (Poly Cystic Ovarian Syndrome) so consult endocrinologist for proper evaluation.

3. Masturbation has no direct link with premature ovarian failure.

4. Regarding pain, make sure she is not having constipation and urine infection. If hot flushes are particularly occurring before menses they may be part of premenstrual symptoms. Seeking a help of endocrinologist might be helpful.

Hope I have answered your query. Let me know if I can assist you further.

Best wishes
Above answer was peer-reviewed by
Follow-up: Having hot flushes, vaginal dryness, heavy bleeding during cycles, ovarian cysts,teratoma. What can be the reason for these symptoms ? 4 hours later
Hi Doctor. Do you mean i should turn to consult Endocrinologist in this website?

1. She does not smoke and it does not seem hypothyroidism, because there are many evidences that she is affected by female hormone. what confuses me is the test told nothing. Do you think Day3 Blood test is not accurate for this case?

3 But she is really like premature ovarian failure. Is there ways to figure it out?

4 She does not have constipation. You mentioned urine infection, how can we figure it out? As i said, they used ultrasound to check her abdomen.

If you can remember, i queried you last year, and i have learned hard to understand her situation since then, i cannot ignore the pain, it is not like a side effect after surgecy. I need help.
Answered by Dr. Meenakshi Titoria Sahu 7 hours later

Thanks for the follow up.

You need to see Endocrinologist in person, one can not assess the case without clinical examination. To figure out premature failure of ovaries, FSH and LH hormones are checked, in your girlfriend's case this does not seems to be a case.

For urine infection tests are done like urine routine microscopy and culture. Post surgery pain could be due to adhesions and for confirmation, laparoscopy is the answer. Your girlfriend needs a good clinical evaluation including examination and investigations.

Hope I have answered all your questions. Please do write back if you additional queries.

Wishing your friend a speedy recovery.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Having hot flushes, vaginal dryness, heavy bleeding during cycles, ovarian cysts,teratoma. What can be the reason for these symptoms ? 5 hours later
Hi, doctor
sincerely thanks.
In fact, her situation is complicate. She is in China and has visited many doctors since years ago. It is not doubt that she is exhausted. I try my best to persuade her to be active in seeing a doctor, and she promised, later. But i cannot wait. There she does not have personal doctor who should be very familiar with her situation, and it is the problem. According to the vaginal dryness, the function of pituitary, and the emergence of cysts in ovary, there should be problems with her female hormone.But which comes first? hormone imbalance or cysts? The blood test on day3 did not indicate the hormone problem. And blood test seems to be the only way in many hospitals in china to check the female hormone. I think she should test her hormone immediately when the hot flush occurs. Will it helpful? To do that, is blood test helpful? I heard there is salivary test to record the change of hormone, what do you think of it?
Answered by Dr. Meenakshi Titoria Sahu 2 hours later

Thank you again for writing back.

I appreciate your concern.

In comparision to salivary test, blood hormones value of FSH, LH and AMH (antimulerian hormones) is of more importance and value. I do not think doing female hormone test at the time of hot flushes is going to help. But seeing a doctor at that time might help in making a diagnosis.
Hormonal imbalance and cysts, they may go together as well.

Hope this clarifies your doubts.

Please accept my answer if you have no other questions.

Above answer was peer-reviewed by
Follow-up: Having hot flushes, vaginal dryness, heavy bleeding during cycles, ovarian cysts,teratoma. What can be the reason for these symptoms ? 53 minutes later
Thank you. I love her, I want to do anything I can do.
As you mentioned, post surgery pain may be linked with urine infection or adhesion. Before she accepted the surgery, the teratoma has grown so big that there was adhesion between belly and ovary, but they did measures to deal with the adhesion. And as i know, laparoscopy may cause adhesion too.
It seems they have used all available tools to check her, ultrasound, blood test, but they did not find the problem. Do you know similar cases like hers?
Adhesion can be serious, days before the surgery, she suffered a kind of new severe hot flush, in which she sweated heavily, and last month the same situation appeared again. The circumstance of her abdomen increases before menstruation, and it decreases after menstruation. Can the new information i provide point out something?
Answered by Dr. Meenakshi Titoria Sahu 6 hours later
Thanks for writing back.
She may be suffering from premenstrual symptoms as your new information suggests and I would suggest that she consults a gynaecologist and an endocrinologist. I have seen lot of people with chronic pelvic pain getting relief after adhesiolysis via laparoscopy.
I hope I have addressed your concerns.
Above answer was peer-reviewed by
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