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What does my transvaginal ultrasound scan report indicate?

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Posted on Mon, 18 May 2015
Question: Hi I am 32 years old and have had 3 pregnancies. After pregnancy number 2 I began to have very heavy periods and abnormal pap caused me to have a LEEP done. After pregnacy number 3 cramping and heavy bleeding continued. My Dr recommended Novasure. I had it done in 2010 after 6 months after my 3rd pregnancy. Since then I have no periods but the last 3 years my cramping lower abdominal pain and pain in my left ovary has gotten worse. I spoke to my GYN he ordered a transvaginal ultrasound. The results came in today. The results posterior intramural fibroid measuring 1.2 x 1.2 x 1.0 cm, Endometrial stripe 5mm in thickness and demostrates nonspecific 3 mm calcification, and left ovaarian dominant follicles vs simple cyst largest measuring 2.3 x 1.9 x 1.6 cm. I am waiting to hear back from my GYN in the next few days. Can you shed some light on my report. Will I need removal of my uterus? Thank you
doctor
Answered by Dr. Sameer Kumar (31 minutes later)
Brief Answer:
endometrial cyst with calcification and posterior wall fibroid

Detailed Answer:
Hello,
Thanks for the query to HCM,
The Ultrasound typically depicts a posterior intramural fibroid and a possible uterine cyst which is 3mm and calcified. These are the possible causes of severe dysmenorrhoea or painful cramps that you are experiencing. The posterior fibroid can cause irregular uterine contractions during menstrual cramping and can cause pain where as a uterine polyp/ submucousal cyst or fibroid inside the uterus can also cause severe pain with an attempt to extrude it out naturally , causing the pain.
As XXXXXXX sure is an endometrial ablation procedure to ablate the endometrial ling, calcification in the uterine wall is a possibility and hence can be a case of pain. It is advised that a hysteroscopic examination may be opted for and if required the cyst/ polyp can be removed under vision.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sameer Kumar (9 minutes later)
what is calcification in the uterine lining mean? Also does the size of the left ovary seem to be normal? Removing the cyst/ polp will give pain relief? What about the fibroid?
doctor
Answered by Dr. Sameer Kumar (5 minutes later)
Brief Answer:
Answered

Detailed Answer:
Hello,
Thanks for the follow up.
A calcification is calcium deposition in the scarred endometrial lining post ablative XXXXXXX sure procedure and that is sometimes seen after such procedures after few years. The pain can be because of both the posterior fibroid which is intramural and the uterine cyst . If the pain is not relieved by NSAIDS or after removal of the uterine cyst by hysteroscopy then condsidering your age firstly you would be offered a myomenctomy procedure for removal of fibroid and and then if still not relieved hysterectomy can be contemplated.
The left ovary is enlarged but there are normal dominant follicles and a simple cyst which is again a possible follicular cyst and shouldn't be the cause of pain, however you may experience pain during mid cycle during ovulation which can last for 2-3 days and is called ovulation pain and is normal to experience.
Another possibility is presence of endometriosis but it is again unlikely as you have been amenorrhoeic since last 3 years.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar (11 minutes later)
Thank you for the quick reply. Could this be the reason for pain during intercourse? Is the fibroid in the measurements given fairly small? Thank you.

I also forgot to ask does the endometrial stripe appear normal in thickness after having Novasure. I have been on NSAIDS for chronic Costochondritis. I have been taking them for several months but I am still having pain in my lower pelvic. I agree the hysteroscopy is the way to go. Thank you
doctor
Answered by Dr. Sameer Kumar (17 minutes later)
Brief Answer:
Answered

Detailed Answer:
Thanks for the follow up again,
The posterior fibroid as i mentioned being intramural , lies in the substance of the uterine wall and during intercourse or orgasm, when the uterus contracts can definitely cause shooting pain sometimes due to irregular contraction.

The endometrial lining of 5mm if fine for a post XXXXXXX sure case after 3 years as your oestrogen production by ovaries is still intact and one can expect some estrogenisation even though baseless layer has been burnt but a complete ablation is almost never possible , so its fine.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar (4 minutes later)
Thank you for the information. It was very helpful. I will hopefully hearing from my doctor soon about this report to discuss what the next step will be.
Thank you,
doctor
Answered by Dr. Sameer Kumar (2 minutes later)
Brief Answer:
Thank you.

Detailed Answer:
Thank you . I hope i have been able to address your concerns.
In case you need further clarifications then please feel free to contact me directly . If you have no further query then you may please please close this query.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sameer Kumar

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What does my transvaginal ultrasound scan report indicate?

Brief Answer: endometrial cyst with calcification and posterior wall fibroid Detailed Answer: Hello, Thanks for the query to HCM, The Ultrasound typically depicts a posterior intramural fibroid and a possible uterine cyst which is 3mm and calcified. These are the possible causes of severe dysmenorrhoea or painful cramps that you are experiencing. The posterior fibroid can cause irregular uterine contractions during menstrual cramping and can cause pain where as a uterine polyp/ submucousal cyst or fibroid inside the uterus can also cause severe pain with an attempt to extrude it out naturally , causing the pain. As XXXXXXX sure is an endometrial ablation procedure to ablate the endometrial ling, calcification in the uterine wall is a possibility and hence can be a case of pain. It is advised that a hysteroscopic examination may be opted for and if required the cyst/ polyp can be removed under vision. Regards