Brief Answer:
Hormone imbalance may be associated.

Detailed Answer:
Hello,

Thanks for trusting us with your health concern.

Small intramural fibroids are not of much concern unless they tend to increase in size and cause symptoms.

The current symptoms are likely to be related to hormone imbalances as evidenced by the endometrial thickness. A complete hormone profile that includes thyroid profile, serum Prolactin, E2,FSH, LH may help. It is also true that a liquid cytology pap smear and an endometrial biopsy will help to detect uterine and cervical causes.

In any advanced gynecological care, this protocol is followed. Based on the findings, hormone replacement, endometrial ablation, laparoscopic hysterectomy and open hysterectomy are the available procedures of treatment.

It is also likely that she is into perimenopause considering her age. Menstrual disturbances of all sorts are seen is such instance. Maintenance of a healthy weight, healthy diet and regular exercise are necessary.

Hope I have answered your query. Please feel free to contact for further clarifications. I will be happy to help.

regards,
Shanti.V.

---

Brief Answer:
Hysteroscopy is better.

Detailed Answer:
Hello,

Thanks for writing back.

You are right. Hysteroscopy is a better option than fractional curettage and/or biopsy, but, it should be done in expert hands to obtain good results. Surgical intervention also can be done during the same sitting. Usually, endometrial biopsy is preferred.

If the endometrial hypertrophy is marginal and no irregularity is seen, hormonal implant may be considered until menopause.

The use of Mirena IUD at this stage needs regular monitoring and is usually helpful. Other alternatives are use of oral progestins, use of styptics etc.

If histopathology or frozen biopsy shows any evidence of malignancy, or if there is no response to treatment, endometrial ablation or hysterectomy should be considered.

As mentioned earlier, I would also suggest having a thyroid profile, coagulation profile, other hormone assays to see if any hormone replacement is needed. Hypothyroid states, anemia, stress and the weather in general, can all lead to this intolerance to cold. Also, depression is a component of perimenopause and to alleviate, practice of yoga, pranayama and meditation is suggested almost always with very good result.

Please get counselling from a clinical psychologist if the depression is not relieved with simple measures. Please see that she gets a healthy diet, regular exercise when she is not bleeding and maintains a healthy weight. Please do not worry, most often such issues clear with time and simple hormone treatment.

Hope I have clarified your query. Please contact if you need any more help. I will be glad to do so.

regards,
Shanti.V.

---

Brief Answer:
Can upload reports.

Detailed Answer:
Hello,

Thanks for writing back.

It is very impressive to see the concern you have for your wife. I have given two of the names with addresses I felt would be helpful. In fact, Dr. XXXXXXX is an elite panelist on healthcaremagic.


Dr XXXXXXX Naik- Laparoscopic Myomectomy,Hysteroscopic Surgeon,Colposcopy,Gynae Cancer Specialist XXXXXXX Super Speciality Hospital- 1 & 2, Press Enclave Road, XXXXXXX
New XXXXXXX XXXXXXX 110017

Dr XXXXXXX Jain-
Address: Block F, Gol Chakkar,Palam Vihar, XXXXXXX XXXXXXX 122017
Phone:0124 398 9896

I was talking about Mirena when I meant hormone device. It is mostly safe to treat conditions where there is no gross pelvic pathology like infection or cancer. She can also be put on regular oral hormone supplements instead.

Either way, cycle disturbances are seen in the initial 3 months of treatment which later on settle down. Many people may not experience any period while on Mirena.

The present symptoms, especially the spotting, can be cleared immediately with progesterone oral supplements. Results are observed within a couple of days. The medication is usually continued for 10-14 days and withdrawal bleeding ensues 3-7 days after completion of the treatment.

You have to contact the customer care service to know if this discussion can remain open. If not possible, you can post me a direct query when you get the reports. I will be happy to help you.

Wish you good health.

regards,
Shanti.V.

---

Brief Answer:
Suggestive of infection.

Detailed Answer:
Hello,

Thanks for writing to us.

I have gone through the reports. These are my observations-
---There is a decreased white blood cell count, low absolute neutrophil count but still within safe zone of 500-1500, rise in monocyte count. The platelet count is low normal.

Low ANC (absolute neutrophil count) can be seen in several conditions like folate or B12 deficiency, bacterial infection, certain medications etc.

Increased monocyte count can be seen in chronic infections, autoimmune diseases and also leukemia while low white blood cell count may be seen in severe infections, leukemia, aplastic anemia and autoimmune disorders. This can also be seen in viral infections.

---The serum Prolactin levels are high.

I presume that she has fever now. There is likely to be a viral infection. Going by the blood picture and also the history, I have the opinion that there was some viral infection at that stage, which may have resulted in the subsequent symptoms. Along with the abnormal Prolactin levels, this is perhaps the reason for the current menstrual disturbance.

Please see the specialist as suggested earlier. She would need Bromocryptine to correct Prolactin levels and also progesterone to regularize the cycles in addition to nutritional supplements.

If the hematological report, i.e., the W.B.C., differential and platelet counts do not improve in a repeat test after a couple of days, you must get the physician opinion for further management. Since this is an online portal, I cannot prescribe exact medication with dosage.

Hope I have answered your query. Please contact if you need any further help. I will be glad to do so.

regards,
Shanti.V.

---