Women's Health Community

Dear An: Let's start with the spotting first then move to the cramping pain second. Generally speaking there can be a number of causes for vaginal bleeding after hysterectomy:

1. If you had a supracervical hysterectomy (cervix left in place), there is still enough glandular tissue (same as uterine lining) lining the cervix to respond to estrogen from HRT, or ovaries left in place. This would not apply to you because the cervix was removed.

2. If you have known endometriosis, there are case reports in the literature of endo growing into the scar at the back of the vagina where the cervix was removed.

3. If one's ovaries are gone and there is no estrogen use, the vaginal tissues can become so thin and fragile that they can bleed. In this same scenario, a prolapsed urethra can cause spotting when the delicate tissues are rubbed by under wear.

4. If your surgery was for cancer there is a VERY remote chance that the bleeding is from a return of the cancer

5. My best GUESS would be some granulation tissue at the site of the scar in the back of the vagina. This is a more common problem sooner after surgery. It can be easily treated in the GYN's office with silver nitrate.

In terms of the cramping/pain you MIGHT have an ovarian cyst on the right side. Normal hormone production and ovarian cysts can continue to occur even without a uterus. Another possibility would be adhesions (filmy bands of scar tissue). Adhesions arise from surgeries,infections (eg PID, ruptured appendix, etc), or endometriosis.

Yes, I would recommend that you see your GYN to see if there is an obvious source of the spotting and pain. Having examined patients with concerns similar to yours I would have to say that sometimes we are never able to find out what prompted that isolated bleeding incident. An ultrasound can identify an ovarian cyst, if present.

Yours,
Jane

I have had an ovarion cyst before. Does this make me more likely for another?

Dear LABROW: Thanks to the attentiveness of our Moderator Caprice, your question was pulled back out of the queue and sent to me. Sorry for the delay in replying.

While virtually all women will have an ovarian cyst (often undetected) at some time, there is a smaller number of women who have chronic and bothersome ovarian cysts. Many small ovarian cysts will go unnoticed. Yet if a woman develops large cysts, or multiple small cysts at one time (eg polycystic ovarian syndrome) we tend to either try and suppress the ovaries (ie birth control pills) or order more frequent ultrasounds. If your cyst history fits into one of these categories, then you MIGHT be more prone to repeated, problematic cysts..

Hopefully your GYN can quickly rule out a cyst using an in office ultrasound. If that is not the overt cause, they can give you a more "for sure" answer from some of the other possible causes of the cramping pain.

Yours,
Jane