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What else can this be?
chivivor posted:
I have had No period the Month but I've cramped off and on all month but no period I'm have issues prior to this of eltremly heavy periods and the dr has'nt found fibroids durring my transvasaginal ultrasound ....Soooo now I'm scheduled for an MRI (which I hate because i claustraphobic) but its an open MRI Worried about the outcome!!!!
Remebering my first birth.
Jane Harrison Hohner, RN, RNP responded:
Dear chivior: The easier question first, OK? As you may have read, the most common reason for a menstrual pattern like you have described is not having an ovulation every month. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month.

In a normal cycle, progesterone production increases following ovulation and release of an egg.. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period.

So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—your missed period. Alternatively, the built up lining can begin to shed on its own creating erratic bleeding patterns which are usually "too-light" or super heavy and prolonged.

Causes for not ovulating can include: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with boyfriends/girlfriends, finances), increased body weight, anorexia, rotating shifts at work, etc. Even the worry about the outcome of the MRI could be enough stress to interfere with this month's ovulation.

In terms of the possible causes of your extremely heavy bleeding, it sounds like fibroids were ruled out with an ultrasound. If you had a super thick uterine lining or an irregularly thickened area that likely would have been visualized on an ultrasound. An ovarian cyst or mass would usually be seen on ultrasound as well.

Perhaps your GYN Is thinking about ruling out adenomyosis as a cause of the heavy bleeding. Here is a citation on the use of MRI to visualize this difficult to diagnose condition:

Am J Obstet Gynecol. 2012 Aug;207(2):114.e1-7. doi: 10.1016/j.ajog.2012.06.027. Epub 2012 Jun 19.
Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification.
Kishi Y, Suginami H, Kuramori R, Yabuta M, Suginami R, Taniguchi F.

Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan.

The aim of the present study was to differentiate and specify the subtypes of adenomyosis.

Surgically treated adenomyosis (n = 152) was subcategorized retrospectively into 4 subtypes on the basis of magnetic resonance imaging geography. Subtype I (n = 59) consisted of adenomyosis that occurs in the uterine inner layer without affecting the outer structures. Subtype II (n = 51) consisted of adenomyosis that occurs in the uterine outer layer without affecting the inner structures. Subtype III (n = 22) consisted of adenomyosis that occurs solitarily without relationship to structural components. Adenomyosis that did not satisfy these criteria composed subtype IV (n = 20). Stepwise logistic regression analysis was used for specification of the subtypes.

Subtypes I-III were suggested as a product of direct endometrial invasion, endometriotic invasion from the outside, and de novo metaplasia, respectively. Subtype IV was a heterogeneous mixture of far advanced disease.

Adenomyosis appears to consist of 3 distinct subtypes of different causes and an additional subtype of indeterminate cause.

I would urge you to ask your GYN for the most "for sure" answer as to what they are seeking with your MRI evaluation.

Let us all know how it goes for you.


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Below the Belt: Women's Health - Jane Harrison-Hohner, RN, RNP

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