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Heavy, clotty periods, pelvic pain, done scan, history of ulcerative colitis, surgery complications. Interpretation?

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Hi, I am 35 year old mum of 3, and have had regular but heavy periods since teenagehood. For the past year periods have become even heavier (7-10 days) and very clotty and painfull. In the past six months I suffer from sever lower back pain, pelvic pain and groin pain also. My period now last about 18 days.
A recent scan has revealed midline eco 11.0mm (I was half way through my cycle at the time). Also the Rt ovary 50x44x46mm cystic area with a single septa and XXXXXXX echoes seen. A further cystic area with fine XXXXXXX echoes seen measuring 24x20x17mm. There is also a tubular area measuring 41x18x28mm. What does this all mean? Please advise?
Past medical history includes ulcerative colitis for 12 years for which on 40mg steroids for 2 years. Had total colectomy with illio-anal pouch in July 2010, and stoma reversal last March.
Not sure if this is relevent but had long and complicated surgery (12 hours) and pelvic wound infection after surgery. Could this be the cause of new problem? Please advise.
Many Thanks
Posted Tue, 8 May 2012 in Women's Health
Answered by Dr. Sujeet N Charugulla 31 minutes later

Thanks for your query.

I shall address your concern based on your current given information.

You certainly have a multitude of conditions as you have mentioned. Your foremost concern of Pain - severe, lower back/pelvic/groin region for which you have indeed undergone an ultrasound scan of your abdomen.

Now, those results of dimensions of cysts/septa/tubular are all the shapes that a radiologist would observe to be for your condition of what is called as Ovarian Cyst. Cysts are water/fluid filled pouches that are mostly harmless. Read more about them from WWW.WWWW.WW Less than 4 inches size, would be of no immediate concern roughly.

But, certainly may have caused a great contribution for your pain now. Your past medical history of anemia, total colectomy - may not directly contribute to the pain you have.

Wound infections are a risk that would have been outlined by your attending surgeon for the long operation duration. But, you would have been put on good antibiotic drugs subsequently for its subsidence.

New problems cannot be speculated in words in here, because evidence is any day better than intelligent guessing. No doctor in here would do that. So do not think much of new problems, and focus on the review treatment of the ovarian cyst problem at hand, for which many medical and surgical options are available and would be discussed in detail by your gynecologist depending on your clinical condition.

Work on raising levels of immunity, read good medical literature and build it on the basis of your diet, lifestyle, healthy practices etc.

Review your blood hemoglobin levels until you are normal. I presume your doctor is informed of your anemia review.

I hope I have answered your concern on a broad sense, now.

If you have additional questions regarding these recommendations, be free to write back to me, I will be glad to address them.

Above answer was peer-reviewed by
Follow-up: Heavy, clotty periods, pelvic pain, done scan, history of ulcerative colitis, surgery complications. Interpretation? 6 days later
Thank you for your detailed response.

I have just recieved my latest blood test results and wondering if they are cause for concern. My iron levels are low again (can't remember what they are) and my MPV level is very low at 3.5.
My doctor says that this unusual after having two blood transfusions for anaemia (one in March and one in July this year). He wants to do a repeat blood test next week but says that he doesn't think that my symptoms are due to blood loss as first thought. What does this mean? Please explain as I am finding it difficult to wait for another week to find out.

Many Thanks XXXXXXX
Answered by Dr. Sujeet N Charugulla 6 hours later

Thanks for the feedback.

You have to wait when the doctor says so. Because, if one needs to confirm when the cause is something unusual as he said.

I just suggested you earlier to check on everything that you already had. Now a blood test gave this. You would need patience.

And do find out the status of the ovaries too - did you ask your gynecologist yet?

Low Hb and Low MPV have to correlated with other findings even if they are true in the next week's repeat test. So, your doctor wants to find out if you are really loosing blood in the body in spite of transfusions.

Keep me updated of the abdomen scans as your doctor orders.

Wish you good health,

Above answer was peer-reviewed by
Follow-up: Heavy, clotty periods, pelvic pain, done scan, history of ulcerative colitis, surgery complications. Interpretation? 1 hour later

Thank you for your response. I am not due to see the gynecologist untill the 10th of October. I do appreciate that I need to be patient, however my question still remains.
Could the heavy period I had last month, or some other bleed in the body be enough to explain my low Hb and low MPV? As I said my doctor does not seem to think so. So what else would cause this then?
I am not expecting a diagnosis from you, as this would of course be imposible and inaccurate without further test results. However I am asking for your honest proffesional oppinion. What in your oppinion could be causing my current symtoms of anaemia? I am no longer experiencing sever lower abdominal pains (thank goodness). I am however feeling extremely tired, my face looks very pale, and I often feel breathless. I also seem to be suffering hot sweats and chills. Is this due to aneamia in your oppinion?

Many Thanks XXXXXXX
Answered by Dr. Sujeet N Charugulla 30 minutes later
Thanks for the follow up.

I want to answer you, based on assumption this time - as you want my opinion. The assumption that your blood tests are 100% correct the first time. And it would have helped me if you had put in the Haemoglobin count and MPV(mean platelet volume) in numbers down for me.

For that - your heavy periods seem to be hazy. In the first query you said you had them since teenage years, and now you say just last month. Anyway, considering (again assumption) that you had normal blood tests before you were fit for the colostomy surgery last March, 5 months since the last blood transfusion.

Your symptoms are beyond doubt due to anemia. Yes.

The only reason I can give for anemia is due to ?menstrual blood loss/rectal blood loss.

You can keep me informed of your tests to answer you further or let me know what the reason is after you XXXXXXX your gynecologist.


Above answer was peer-reviewed by
Follow-up: Heavy, clotty periods, pelvic pain, done scan, history of ulcerative colitis, surgery complications. Interpretation? 3 hours later

Thank you for your answer.
Yes, I have always had heavy periods since teenage hood, but last month I bleed for 18 days this has never happend before (usually 7 days).

Just to confirm my MPV is 3.5 and my Hb is either 7.8 or 8.7 (I can't remember which).

Many Thanks once again, XXXXXXX
Answered by Dr. Sujeet N Charugulla 5 hours later
Hi again Ms XXXXXXX

Your Hb is not that low. Even 7.8 is just 1.2 points below lower range of normal.(9.0)
However, yes MPV is way below the lower normal range of 7.5 Fl.

I was wondering of a really low Hb with you, which is not. I do not think 1 point of Hb should cause so much concern for you, it can be brought in 1 month of oral Iron therapy. And I think it is fine considering your menstrual history.

Your thrombocytopenia (low MPV) which means a drop in the production of new platelets needs review now and might need additional tests as per your doctor.

Do write whatever comes up in the consultation and tests.
Wish you good health.

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