What does this ultrasound report indicate?

Posted on Mon, 15 Jun 2015 in Vaginal and Uterus Health
Question: I am 45, 2 babies and been on Micronor 10+ years pre and post babies. In past suffered intense migraines that have now calmed down to 1 or 2 episodes / month.
irregular bleeding for last 10 months, multiple bleeds a month and none some months, change in appearance of bleed- looks abnormal. Due to have Mirena coil tomorrow as well as camera investigation to severe lower right side pain ongoing for 10 months. Pain also in the inner groin and lower back, sometimes fast onset other times slow and continues dull pain.
previous evidence of fibroids show on ultrasound .
I am really worried about the coil as I do not thisnk this is the best problem
Answered by Dr. Ramadevi Wani 41 minutes later
Brief Answer:
Mirena coil is a good treatment option for you.

Detailed Answer:
Welcome to Healthcare magic.
I am Dr Ramadevi Wani. I will be answering your concerns today.

Most of the times such bleeding is due to hormonal alterations with age and no abnormality is detected.
Endometrial polyp (mass of uterine lining) or fibroid polyp protruding into uterine cavity, thyroid disorders can cause such bleeding.

I presume the ultrasound did not show evidence of any endometrial polyp and your thyroid function tests are normal. What was the result of the last pap smear? How big are the fibroids and where are they located?

For this irregular bleeding you need to first have lining of the uterus biopsied and examined under microscope to find out the cause. Probably along with the camera investigation your doctor will do this tomorrow.

Mirena coil is a good treatment option for you. Don’t worry. It contains Progesterone hormone which is released locally at the lining of uterus. Besides being effective contraception, it is useful in the treatment of heavy periods. With its use periods gradually become lighter and by one year 20 % of women will stop having periods. It also helps in relieving endometriosis pain (there is a small possibility that the abdominal pain you are suffering could be due to endometriosis). With its use fibroids also reduce in size to some extent.

Most women tolerate this coil very well. But in some women it can cause irregular bleeding and spotting per vagina for the first 3-6 months (It does not cause heavy bleeding). Once the body adjusts to the coil things will be fine. If you are not aware of this, in case you have this side effect you may think that Mirena is not working well. So I wrote this.

I hope this helps. If you have further concerns, do write to me. I will be happy to answer.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Ramadevi Wani 27 minutes later
I had CIN 3 8years ago, since then pap smear has been clear, they did detect a polyp in the last scan as well as fibroids.
The largest fibroid is actually on the right ovary and 6cm in size, the others are smaller.
funny enough for me the pain is a bigger worry as this is not right as the bleed is still a worry but not so much as I accept body will make changes.
the concern with coil is the possibility of intensifying migraines, I have read a lot of negative feedback about it over the last month or so.
I am not keen on spotting either, additionally I have friends who have had the coil cause more problems, dislodged, rejection and severe mood swings.
the pain that I have in the right side can sometimes be so bad that I cannot walk or stand up, this is not a period pain.
I have experienced heavy pain in the past as did most of the birth with my son until I had to proceed to an emergency c section. The pain I am experiencing now is on par with labor pain. I don't think this is caused by my current contraceptive.
Answered by Dr. Ramadevi Wani 36 minutes later
Brief Answer:
Removal of polyp with curettage of lining of uterus may be enough.

Detailed Answer:
I am happy to know that your follow up Pap smears are all normal.
If the ultrasound has shown polyp, I am of the opinion that hysteroscopic removal of the polyp along with curettage of the lining of the uterus should in all probability solve your problem of irregular bleeding.
Tomorrow when they look into your abdomen through camera, it will give us a clear picture for the pain abdomen and that will help in appropriate managent.
Since you tolerated microgynon I feel Mirena may not exaggerate your migraine attacks.
Most of my patients are happy with Mirena. very few suffer side effects.
I hope this helps. If you have further queries I will be happy to answer.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Ramadevi Wani 23 minutes later
Thank you, and to see what is going on with my lower abdomen is this done with the patient fully sleep or sedated?
Answered by Dr. Ramadevi Wani 3 hours later
Brief Answer:
Usually done under general anaesthesia.

Detailed Answer:
Welcome back.
Laparoscopy is usually done under general anaesthesia ( fully asleep).
Some centres perform it under spinal anaesthesia ( Patient does not feel the pain of surgery but is not asleep ).
Your anaesthetist will discuss about it before surgery.
Good luck.
With best wishes,
Dr Rama.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Answered by
Dr. Ramadevi Wani


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