Women's Health Community

Dear Shaiel: Gosh, that was a lot of difficult information to have to absorb on a first visit to a GYN. Still it sounds like you have understood what was said, as your questions are excellent. Let's take the easy one first, OK?

Provera taken monthly or every other month will prompt any built up uterine lining ("endometrium") to shed. This should prevent an endometrial environment where abnormal cells can develop (a precursor to endometrial cancer). Provera pills taken for a week or so will not interfere with you having an ovulation on your own--if that happens you might have two flows in one month. If you should accidentally conceive, Provera will not disrupt a pregnancy. Bottom line, it is pretty safe medication when used in the fashion you have mentioned.

You have at least two concerns regarding your future fertility. One is chronic non-ovulation (from the PCOS). The other is a uterine septum. One can either have a partial septum (wall down the middle of the uterus) or a more complete complete septum. Some women will even have more than one cervix. Obviously the more complete the septum, the greater the problem with pregnancy.

A uterine septum is not a great place for a fertilized embryo to implant because there may not be an even layer of uterine lining and blood vessels on the septum (as compared to the walls of the uterus). As the pregnancy grows there may not be adequate room for the enlarging baby to develop--or there may be a premature delivery if the infant outgrows the available space. Again much depends upon your specific anatomy--there can be many variations.

Here is a study on this from the National Library of Medicine:

J Hum Reprod Sci. 2010 Sep;3(3):143-5.
Reproductive outcome of septate uterus following hysteroscopic septum resection.
Selvaraj P, Selvaraj K.
Source

Fertility Research Centre, G G Hospital, 6E - Nungambakkam High Road, Chennai - 600 034, India.
Abstract
OBJECTIVE:

To evaluate the reproductive outcome following hysteroscopic septum resection in patients with primary and secondary (recurrent pregnancy loss [RPL> and bad obstetric history [BOH>) infertility.
STUDY DESIGN:

Retrospective study.
MATERIALS AND METHODS:

Hysteroscopic septum resection was performed on 26 patients with a history of either recurrent pregnancy loss, BOH or infertility. The septum resection was performed using a bipolar versapoint system. Reproductive performance of these patients after septum resection was analyzed. The main outcome measures were clinical pregnancy and live birth rates.
RESULTS:

Hysteroscopic septum resection was performed on seven patients with the history of secondary infertility. Post operatively, the pregnancy rate was 86% (n=6), and the live birth rate was 67% (n=4). After septum resection in 19 primary infertile patients, 6 (32%) patients conceived which resulted in live birth rates of 67% (n=4).
CONCLUSION:

Hysteroscopic septum resection using bipolar versapoint system is an effective and safe approach for the removal of septum. Hysteroscopic septum resection in women with septate uterus significantly improves the live birth rates and future fertility is not impaired.

Shaiel, PLEASE go back to your GYN with your excellent questions. Since she has seen your septum she can give you a more precise answer.

Yours,
Jane

Thank you VERY MUCH. That explains why I am currently having my second period. I was very worried as I thought it was from the Provera or I miscarried or I got pregnant or something.

The septum they found was only partial. I was actually depressed at first esp. because I learned PCOS is a lifelong condition and the other, a congenital malformation. Well, I guess at least it isn't really an immediate condition.

Thank you again for answering as well as for the reference, I've been reading online about my condition and I've been asking around at work (I'm a speech pathologist) about it, which is why I have so many questions. You were able to answer them. Thanks!

Dear Shaiel:Ah, I wondered if you had a career in healthcare by the excellent history you posted. ...Yes, a partial septum is less of a problem and can be excised. Sometimes such surgery is not done until there is a history of pregnancy losses. In your case, if the PCOS persists, you may need ovulation induction to conceive. In that instance, one would not want to wait through several miscarriages before thinking about removing the septum.

PCOS is a constantly shifting diagnosis (as I am sure you have been reading). In some women, weight loss of 10% of current body weight will restore ovulatory function (probably via improvement in insulin resistance). Yet, we do have some thin women who have PCOS (but not overt insulin resistance). And I recently read a study which suggests that PCOS metabolic issues do continue after menopause. The author concluded that PCOS was not primarily a disorder of the ovaries.

It seems that you have found a good GYN. Do not hesitate to ask them your excellent questions; you are asking all the right things.

Yours,
Jane

Thank you very much ma'am! I will see her soon I guess. I will have the oral glucose tolerance test this week to check for the insulin resistance you mentioned.

I'm so sorry you have this condition! Thankfully, Jane was able to provide you with information.

I just wanted to comment on hysterectomy. Even though it sounds like you aren't considering one, it's very possible that it will be suggested at some point in your life since hysterectomy is inappropriately recommended about 75% of the time (per ACOG) -
http://www.ncbi.nlm.nih.gov/pubmed/10674580

The uterus has lifelong functions; it's much more than a baby bag. Here's a video describing the functions of the female organs - http://www.youtube.com/watch?v=Ff5IOSj1l7w

The non-profit HERS Foundation - www.hersfoundation.com - has a lot of info about female conditions and treatment options.

Wishing you the best!

Shaiel - Since septum resection is a fairly safe procedure when done by a skilled surgeon, I'd be concerned that your gyn said a hysterectomy is the only way to remove the septum. That's like throwing out the baby with the bath water! I'd be searching for a gyn who uses conservative treatments (preserves organs). I made the mistake of staying loyal to my gyn who I'd respected for 20 years. It cost me my healthy uterus and ovaries and rapid aging.

There's a post on the HERS Foundation's blog by a woman with a bicornuate uterus who had a hysterectomy because her gyn said an ablation wouldn't work (for heavy bleeding?). AFTER her hyst, this same gyn told her that an ablation probably would have worked. I've been on a number of forums since my hyst and I hear these kinds of tactics all the time.

HERS may be able to refer you to a doctor who can treat your PCOS and septated uterus and improve your chances of conceiving and carrying to term. Give them a call; you're worth it!

Thank you very much!

I am 23 and i was diagnosed with pcos and a septum. I decided to have the surgery, after much debate and research. It's a personal decision that takes a lot of thought. I wish you luck.

Dear iwish: OMGosh, that you were able to find Shaiel's discussion is amazing! Hopefully her questions and experience were helpful input for you. Congrats on making a decision for the surgery. If you have any updates for us please do not hesitate to write back. It may be your experience that helps another woman in the future.

In Gratitude,
Jane