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History Of Miscarriages. Had An Ultrasound That Said Bulky Uterus, Suggestive Of Possible Adenomyosis. Meaning?
Question: Hi, I have had two children and three miscarriages (para 2 + 3). I just had an ultrasound uterus scan 16 days after a 3rd miscarriage (10.5wks since LMP, embryo ceased progressing at 6.3wks). Report says "bulky uterus. Endometrial 8mm and changes suggestive of possible adenomyosis". What is a bulky uterus? Could this be the cause of my miscarriages? Could this prevent me from having another full term pregnancy? Or could the bulky uterus be due to the fact I was only 16 days post a spontaneous miscarriage
Hi,
Thanks for posting your query.
I would like to make the following comments:
1) Embryo ceased developing means it is called "missed abortion". Your gynecologist might suggest you to undergo abortion to remove the non viable embryo.
2) The term “Bulky uterus” is a general used by gynaecologists for describing the uterus which is little large than normal uterus. This does not mean that there is a problem with the uterus and has nothing to do with previous miscarriage or anything related to it. Majority of women would normally have this condition after child birth and with ageing. The uterus being a little large is absolutely fine and no problem. So don't worry about it. Your uterus is normal. This will not prevent you from having another pregnancy
3) Adenomyosis is a condition where endometrial tissue will grow inside the uterine muscle. It also gives the picture of bulky uterus. Since the report does not definitely say the diagnosis, there is nothing to worry about.
4) Please don’t worry about future pregnancies. You will definitely get pregnant. Since you already have children, it indicates that you are fine and will conceive. First trimester abortions usually occur due to chromosomal anomalies which occur due to a damaged ovum or sperm. Other causes include Hormonal problems, infections or maternal health problems, lifestyle issues (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances), implantation of the egg into the uterine lining does not occur properly, maternal age and maternal trauma.
5) Next time, please see a gynecologist when you get pregnant so that appropriate therapy can be started.
I hope I have answered your query. Please accept my answer if you have no further queries.
Regards,
Dr.Mahesh Koregol
Thanks for posting your query.
I would like to make the following comments:
1) Embryo ceased developing means it is called "missed abortion". Your gynecologist might suggest you to undergo abortion to remove the non viable embryo.
2) The term “Bulky uterus” is a general used by gynaecologists for describing the uterus which is little large than normal uterus. This does not mean that there is a problem with the uterus and has nothing to do with previous miscarriage or anything related to it. Majority of women would normally have this condition after child birth and with ageing. The uterus being a little large is absolutely fine and no problem. So don't worry about it. Your uterus is normal. This will not prevent you from having another pregnancy
3) Adenomyosis is a condition where endometrial tissue will grow inside the uterine muscle. It also gives the picture of bulky uterus. Since the report does not definitely say the diagnosis, there is nothing to worry about.
4) Please don’t worry about future pregnancies. You will definitely get pregnant. Since you already have children, it indicates that you are fine and will conceive. First trimester abortions usually occur due to chromosomal anomalies which occur due to a damaged ovum or sperm. Other causes include Hormonal problems, infections or maternal health problems, lifestyle issues (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances), implantation of the egg into the uterine lining does not occur properly, maternal age and maternal trauma.
5) Next time, please see a gynecologist when you get pregnant so that appropriate therapy can be started.
I hope I have answered your query. Please accept my answer if you have no further queries.
Regards,
Dr.Mahesh Koregol
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Thank you for your reply. My apologies I should have been clearer with my question and history.
I have some final questions
1. The 3rd miscarriage was a spontaneous abortion (on 30/12/11) at 10.5wks past LMP(18/10/11). There had been an earlier scan at 8wks showing No FHM and foetus of 6.3wks CRL. I had chosen to wait for spontaneous abortion rather than D&C but I was given both options by my obstetrician. Therefore, my understanding is that this was not a missed abortion and I did inspect the aborted foetal products which showed normal anatomy, cord and placenta for 6.3wks. My obstetrician said there was no need to scan after this miscarriage or have a D&C as it was a spontaneous abortion due to foetal demise and took my description of products that it had gone to completion (no retained products). I have been seeing the same obstetrician for all my pregnancies and deliveries and have always followed his advice. He said there are no problems just keep trying.
2. The most recent scan was done due to history of "multiple miscarriage" so was not specifically done to check for retained product (the report made no comment about a sack or foetus, that was my added background info). It was done to inspect my uterus for problems that might explain multiple miscarriage.
My question was: Could the "bulky uterus" be because I was only 16 days post a spontaneous abortion and thus my uterus from being pregnant had not shrunk back down to normal size or would it be back to the size it will now remain when in non pregnant state?
4. Both the first two miscarriages were missed abortions because I didn't want to wait for spontaneous abortions as I was further alone (foetus 12-14wks) and so I had D&Cs. The products of pregnancy showed normal number and structural of chromosomes.
As far I know chromosomal anomalies have not been detected in the first two foetuses, my hormone tests have been normal, I have no infections, do not smoke, do not take drugs, I'm not on any medication, do not drink, or have any other problems (normal LH, FSH, TSH, Vit D etc), not exposed to excessive caffeine, radiation or other toxic substances.
The only reasons left for my miscarriages seems to be "implantation of the egg into the uterine lining did not occur properly and lead to foetal demise" or due to an undetectable small lethal mutations of chromosomes, or some other unknown cause yet to be described in literature.
I am worried that I will continue to miscarry because none of the medical tests can detect a fault and therefore nothing known can be fixed. I'm not worried about conceiving, that has never been a problem. I obviously hold the pregnancy well even when foetus has died but its keeping the foetus alive beyond 1st trimester that's the problem.
Anyway, apologies for the length of this email. I thank you very much for your faith that trying again will result in a full term pregnancy and for your encouragement not to worry.
Regards
XXXXXXX
I have some final questions
1. The 3rd miscarriage was a spontaneous abortion (on 30/12/11) at 10.5wks past LMP(18/10/11). There had been an earlier scan at 8wks showing No FHM and foetus of 6.3wks CRL. I had chosen to wait for spontaneous abortion rather than D&C but I was given both options by my obstetrician. Therefore, my understanding is that this was not a missed abortion and I did inspect the aborted foetal products which showed normal anatomy, cord and placenta for 6.3wks. My obstetrician said there was no need to scan after this miscarriage or have a D&C as it was a spontaneous abortion due to foetal demise and took my description of products that it had gone to completion (no retained products). I have been seeing the same obstetrician for all my pregnancies and deliveries and have always followed his advice. He said there are no problems just keep trying.
2. The most recent scan was done due to history of "multiple miscarriage" so was not specifically done to check for retained product (the report made no comment about a sack or foetus, that was my added background info). It was done to inspect my uterus for problems that might explain multiple miscarriage.
My question was: Could the "bulky uterus" be because I was only 16 days post a spontaneous abortion and thus my uterus from being pregnant had not shrunk back down to normal size or would it be back to the size it will now remain when in non pregnant state?
4. Both the first two miscarriages were missed abortions because I didn't want to wait for spontaneous abortions as I was further alone (foetus 12-14wks) and so I had D&Cs. The products of pregnancy showed normal number and structural of chromosomes.
As far I know chromosomal anomalies have not been detected in the first two foetuses, my hormone tests have been normal, I have no infections, do not smoke, do not take drugs, I'm not on any medication, do not drink, or have any other problems (normal LH, FSH, TSH, Vit D etc), not exposed to excessive caffeine, radiation or other toxic substances.
The only reasons left for my miscarriages seems to be "implantation of the egg into the uterine lining did not occur properly and lead to foetal demise" or due to an undetectable small lethal mutations of chromosomes, or some other unknown cause yet to be described in literature.
I am worried that I will continue to miscarry because none of the medical tests can detect a fault and therefore nothing known can be fixed. I'm not worried about conceiving, that has never been a problem. I obviously hold the pregnancy well even when foetus has died but its keeping the foetus alive beyond 1st trimester that's the problem.
Anyway, apologies for the length of this email. I thank you very much for your faith that trying again will result in a full term pregnancy and for your encouragement not to worry.
Regards
XXXXXXX
Hi XXXXXXX
Thanks for reverting. I would like to make the following comments:
1) Your obstetrician was right in seeing that there was no need for dilation and curettage (D&C) or a scan after spontaneous expulsion
2) Yes, a bulky uterus could be because it has not yet shrunk to normal size. Even if it shrinks after few weeks, it will be little bulky due to the reasons I told you last time. A bulky uterus is not something that you need to worry about.
3) You are exactly accurate about reasons for missed abortions. The reason for all 3 abortions could possibly be an undetectable small lethal mutation in the chromosomes, or some other unknown cause yet to be described in literature.
4) I don’t think there is any problem with implantation. You would have not have possibly had missed abortions. It has more to do with unknown mutations.
5) Please get an APLA (anti phospholipid antibody) profile done. Based on this, your gynaecologist may want to start you on empirical low molecular weight heparin for your next pregnancy. This helps with antiphospholipid antibody syndrome (who frequently experience recurrent pregnancy loss).
I am sure you will conceive and hold the baby till term. Don’t get disheartened by these 3 abortions. All the best to you.
Please accept my answer if you have no further queries.
Regards,
Dr.Mahesh Koregol
Thanks for reverting. I would like to make the following comments:
1) Your obstetrician was right in seeing that there was no need for dilation and curettage (D&C) or a scan after spontaneous expulsion
2) Yes, a bulky uterus could be because it has not yet shrunk to normal size. Even if it shrinks after few weeks, it will be little bulky due to the reasons I told you last time. A bulky uterus is not something that you need to worry about.
3) You are exactly accurate about reasons for missed abortions. The reason for all 3 abortions could possibly be an undetectable small lethal mutation in the chromosomes, or some other unknown cause yet to be described in literature.
4) I don’t think there is any problem with implantation. You would have not have possibly had missed abortions. It has more to do with unknown mutations.
5) Please get an APLA (anti phospholipid antibody) profile done. Based on this, your gynaecologist may want to start you on empirical low molecular weight heparin for your next pregnancy. This helps with antiphospholipid antibody syndrome (who frequently experience recurrent pregnancy loss).
I am sure you will conceive and hold the baby till term. Don’t get disheartened by these 3 abortions. All the best to you.
Please accept my answer if you have no further queries.
Regards,
Dr.Mahesh Koregol
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Dear Dr Koregol
Thank you for your reply and further clarification. I have had anti phospholipid antibodies tested, along free androgen, with Blood group (o -ve, I have no Rhesus sensitivity or Abs even though husband is rhesus positive), cardiolipin, and lupus anticoagulant, activated protein C resistance, Protein S, homocycsteine, factor V leiden, prothrombin gene mutation G0000A, MTHFR, HbA1c, XXXXXXX anti endomysial Abs and Anti gliadin Abs. All came back normal (or negative for such antibodies) so I am being taken very good care of.
Thank you for clarifying and settling my concerns about bulky uterus and carrying to term.
I shall take your advice and look forward to one day getting an embryo that will progress to term as my first two boys did.
I am very grateful to you for reducing my anxiety in this way.
XXXXXXX
Thank you for your reply and further clarification. I have had anti phospholipid antibodies tested, along free androgen, with Blood group (o -ve, I have no Rhesus sensitivity or Abs even though husband is rhesus positive), cardiolipin, and lupus anticoagulant, activated protein C resistance, Protein S, homocycsteine, factor V leiden, prothrombin gene mutation G0000A, MTHFR, HbA1c, XXXXXXX anti endomysial Abs and Anti gliadin Abs. All came back normal (or negative for such antibodies) so I am being taken very good care of.
Thank you for clarifying and settling my concerns about bulky uterus and carrying to term.
I shall take your advice and look forward to one day getting an embryo that will progress to term as my first two boys did.
I am very grateful to you for reducing my anxiety in this way.
XXXXXXX
Hi XXXXXXX
I am happy to hear that Antiphospholipid Antibodies are negative. Then there is nothing to worry about future pregnancy. The possibilities for recurrent miscarriages could be
1) Chromosomal mutations yet to be reported.
2) Aging of oocytes which normally occur with your age. Oocytes in women about 40 years or more have certain DNA and chromosomal malformations. Hence embryo quality will be little poor. It has nothing to do with implantation or bulky uterus.
I suggest you to take one Folic acid tablets daily while you are trying to conceive. The therapy is called periconceptional folic acid therapy. It helps in some women
I am pleased to know that my answers have been helpful to you. Please accept my answer if you have no further queries. You are welcome to ask me queries in future too.
All the best to you
Regards,
Dr.Mahesh Koregol
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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