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    What causes spotting when with a history of ovarian tumor?

Posted on Wed, 1 Jun 2016 in General Health
Question: Good morning Doctor,

How are you doing? I hope all is well. I hope you remember me, as I was in regular touch with you around in 2014.

A short re-cap of my history is that I was diagnosed of borderline ovarian tumor in the year 2013 and underwent surgery to remove the effected ovary (right one). Since then I follow up regularly with scans and CA 125 blood test.

Also, in year 2014 I suffered from a uterine polyp and fibroid and hence underwent D&C.

Year 2015 was the best year, as I had no any complaints. However, year 2016 has started with little bit of shake-ups. I went for my regular scan on 24th Mar 2016 and all is normal. Please find attached the Ultrasound report and blood test report. However, on 27th Mar 2016 I was surprised to see spotting...!! The whole day I spotted. This morning I have not seen any spotting yet, but I'm afraid that it may come up some time during the day.

I really cant understand what could be the reason for this spotting in spite of having a normal scan.

Please also advice to me if I have to rush to my Gyn. immediately or should I wait.

Thanking you in advance for your feedback and support.

Best regards
Answered by Dr. Aarti Abraham 25 minutes later
Brief Answer:
As below

Detailed Answer:
Hello Abagtha
Of course I remember you.
Hope you have been well.
Thank you for getting in touch again.
I am unable to see the uploaded report of the ultrasound and blood tests.
Please review and attach them accordingly.
Also, tell me a bit about your periods.
When was your last period, and are they fairly regular ?
Are your TSH levels fine ?
Looking forward to hearing from you.
Take care.
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Aarti Abraham 19 minutes later
Dear Doctor,

My last period was on 6 March 2016. They are regular, in the sense, I get my period every month. However, my cycle is always varying between 26 - 31 days. I have not checked my thyroid in a very long time (almost a year). I will be doing that this month.

I have uploaded the report, however I am copy-pasting the result in this mail.

CA 125: 6.41

Ultrasound report:

Clinical Indication: Status post right ovarian tumor resection (borderline tumor). Findings:
Liver is of normal size and echogenicity . CBD and intra-hepatic biliary radicals are of normal caliber, with no obstructive changes. CBD measures 6 mm . Portal vein measures 1.1 cm.

Gallbladder is clear, no intraluminal calculi or changes of cholecystitis .

Pancreas and para-aortic regions look clear, no fluid collection in and around pancreas. There are no lymph node mass lesions along para-aortic area.

Spleen is of normal size, shows smooth texture, no focal parenchymal lesions. Spleen measures 8.7 cm in longest dimension.

Both kidneys are of normal size, shape and axis. Normal echogenicity of kidneys seen with intact corticomedullary differentiation .

No renal calculus, hydronephrosis or mass lesions seen on either side. No evidence of hydroureter.
Right kidney measures 11.2 cm x 3.9 cm in length with cortical thickness of 1.6 cm.
Left kidney measures 11 cm x 5 cm in length with cortical thickness of 1.6 cm.

Urinary bladder is of normal shape and capacity. Normal wall thickness seen with no evidence of mass lesion or diverticulae formation.

A normal sized anteverted anteflexed uterus is noted with intact midline endometrial echo. Uterus measures 7.7 cm x 4.2 cm x 5 cm in size. The endometriurm is 1.1 cm in thickness. Normal cervix is noted. A 7 mm size Nabothian cyst is seen in the cervix. No fluid is seen in cul-de-sac.

Left ovary shows maturing Graafian follicles and appears normal in size. Left ovary measures 4.7 cm x 2.8 cm x 2.6 cm in size. Matured 2.2 cm size Graafian follicle is seen in left ovary.

Right ovary is not identified in keeping with previous resection. No evidence of residual or recurrence lesion in right adnexa.


1.     Status post right ovarian resection for borderline tumor.     
2.     Rest of the ultrasound examination of abdomen and pelvis is within normal limits
Answered by Dr. Aarti Abraham 2 hours later
Brief Answer:
As below

Detailed Answer:
Welcome back.
Thank you for the update.

The CA - 125 report is within normal limits.
The ultrasound scan is also normal, just that the endometrium measures 1.1 cm, so that is slightly more.
It could mean that your period is near.
Maybe, this is the beginning of your period ?
A bit earlier than usual, which is nothing to worry about.
Get your usual TSH levels checked, a slight aberration in TSH can lead to a deviant period.
Also, let me know in a couple of days how the flow goes.
If it progresses into a proper period, you need not worry about the polyp.

Take care.
Above answer was peer-reviewed by : Dr. Deepak
Follow up: Dr. Aarti Abraham 21 minutes later
Dear Doctor,

Thank you for your reply. It sure does have the same symptoms as of last time when I got the uterine polyp.

The spotting hasn't progressed into period. I am still only spotting.

I have some thoughts and fears....

1. My last period was on 6th Mar.2016. From the ultrasound report it reads that I have a matured follicle? So does it mean I didn't ovulate till 24th Mar (the day of scan)? Can this spotting be ovulation spotting? I have also slight pain on the left side of the pelvis.

2. I don't know but can the spotting be due to any ovarian cysts???

3. If the diagnosis happens that it is a uterine polyp again.....what is my prognosis? I mean, why is it recurring?

I am so worried. Your inputs will help.

Thank you,
Answered by Dr. Aarti Abraham 7 hours later
Brief Answer:
As below

Detailed Answer:
Let me clear your doubts.
Yes, it could be ovulatory spotting, but do you experience that regularly ?
It means that you did not ovulate until the 24th of March, when the scan was done.
The left sided pain could be related to ovulation.
And ovarian cysts can cause spotting, but none showed up in the scan that was done.
If it is a uterine polyp again, prognosis is the same as earlier.
Uterine polyps are notorious for recurrence, and you would have to undergo a polypectomy ( removal of polyp again ).
But no polyp was seen in the scan on 24th of March, so that likelihood is remote.
Take care.
Keep me posted.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Aarti Abraham 15 minutes later
Dear Doctor,
I really don't know if I ovulated or not. Pl could you advise me what is "mature Graffian follicle"? I thought that a mature follicle means I need to ovulate. That is why I asked. Does it mean that there can be a mature follicle even after the egg is released?
I never had ovulation bleeding before.
Looking forward for your inputs.
Answered by Dr. Aarti Abraham 12 hours later
Brief Answer:
As below

Detailed Answer:
Okay let me explain.
Ovulation means the release of a mature egg / mature follicle from the ovary.
Mature Graffian follicle means a ready mature egg in the ovary, that means it is not yet released , and you have not yet ovulated.
Even after ovulation, there would be no mature follicle seen in the ovary.
So, it is confirmed that you had not ovulated until the 24th of March.
Since you have never had ovulation bleeding before, it is unlikely right now.
Is the bleeding still going on ?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Aarti Abraham 3 hours later
Dear Doctor, I have visited the gyneac that I am consulting.
There seems to be multiple problems.
First with the ovary. The follicle which was stated in previous ultrasound scan is still there. Also the gyneac zoomed in a lot and noted that it has a small solid part too. So she said that needs to be watched.
Second the endometrium is thick and it does show some polyp like growth.
Third the opening of the cervix looks unhealthy. So she asked me if I had sex recently. However we didn't. She took a sample to get it tested.
So no one knows why this bleeding since I have multiple issues.
I need to visit her after my period.
I just hope it is not a borderline recurrence.
Best regards
Answered by Dr. Aarti Abraham 19 minutes later
Brief Answer:
As below

Detailed Answer:
I do not think it would be a recurrence of the borderline tumour.
It is more likely a polyp.
If the cervix looks unhealthy, then a Pap smear should be taken.
That too could cause spotting.
The unruptured follicle is called a cyst, if it has a solid component, it needs close monitoring.
Let me know the result of the Pap smear, and what do they plan to do about the polyp now ?
Keep me posted dear.
Best of luck.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Aarti Abraham 2 days later
Dear Doctor,
I have no new news about myself.
My thyroid results have come in and they are normal. So that is ruled out.
I still don't know about the pap smear. I hope to know something early next week.
I spotted for 4-5 days straight. Didn't notice anything today but I am expecting that I may spot tomorrow.
I think the cyst / cysts in ovary have caused the bleeding. Is spotting a common symptom for ovarian cysts?
Answered by Dr. Aarti Abraham 9 hours later
Brief Answer:
As below

Detailed Answer:
Yes, spotting is common with ovarian cysts.
And most of these so called ' cysts ' disappear with the period.
When the follicle fails to rupture, it persists as corpus luteum.
Sometimes, a small component of blood maybe inside, due to hemorrhage within the follicle, that appears as a solid component.
So do not worry much about that.
If the spotting has stopped, that is a good sign.
Lets wait until you hear from the hospital.
Take care.
Above answer was peer-reviewed by : Dr. Prasad
Answered by
Dr. Aarti Abraham


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