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Includes Expert Content
25 year old female, thick endometrium, left ovary cyst
pupipaw posted:
Hello and good day!

I just turned 25 this month. I had my menstruation last December 30 and it has been going on for weeks. I felt week and tired all the time. I went to get my CBC (complete blood count) and low and behold my Hemoglobin was only 8.8. I went to the doctor the next (still bleeding). She advised me to take Iron supplements and was prescribed with Althea (combined low-dose oral contraceptive pill with antiandrogenic properties) for a month. My doctor also suggested that I should have a transvaginal ultrasound before my return check-up, which is a week after.

I also have had a history of bleeding way back last 2005 and after I took an oral contraceptive pill my menstruation went back to normal. My mother was diagnosed with cervical cancer last 2010 and she had a Total Abdominal Hysterectomy Bilateral Saphingo-Oophorectomy (TAHBSO). And now she is cancer free but still has regular check-up. My mother's sister had a benign ovarian cyst and she had it surgically removed last 2011. Both my mom and aunt are doing fine and have been doing their regular activities ever since. I hope this will enlighten you, readers, a little bit of my history.

I had my transvaginal ultrasound today. The ultrasound report is as follows:

FINDINGS: Prolonged Menses (From Dec 30 to Jan 18)

Uterus: 5.79 x 4.93 x 4.40 cm, Anteverted
Endometrium: 2.19 cm, Hyperechoic
Cervix: 2.36 x 2.66 cm, without Nabothian cyst
Right Ovary: 2.73 x 2.04 cm, Lateral
Left Ovary: 3.28 x 2.54 cm, Lateral

COMMENTS: The myometrial echoes appear homogenous and intact with no evident abnormality seen. The endometrium is thick and hyperechoic with an irregularly shaped echogenic density within measuring 2.54 x 1.53 cm. The subendometrial halo is intact. The right ovary is unremarkable. Within the left ovary is a thin-walled, unilocular, anechoic cystic structure measuring 2.66 x 2.36 cm. No free fluid in the cul-de-sac.

I went to my doctor after I got my results and showed it to her. I can't seem to remember all the things she said because I was bothered somehow. What she told me was to continue with Althea for another 2 cycles and take Iron supplements for a month. If I have any spotting or bleeding while taking those pills then I should see her right away. She also said that I'll have another transvaginal ultrasound soon after I finish taking the pills.

Sorry if this is too long but I want to give out proper details. If anyone has any idea what this may be or any suggestions on what I'll do please do not hesitate to post a reply. And I don't think I'm pregnant because I didn't experience any of the symptoms. I do have irregular menstruation every month, sometimes late and sometimes early, but this time it was different because it was just too long than my previous periods and it was too heavy too.
Jane Harrison Hohner, RN, RNP responded:
Dear pupipaw: You are correct, the best explanation will come from the GYN who ordered your ultrasound, but I can give you some general information about terms on the ultrasound.

In terms of the measurements, everyhting looks normal except the lining of your uterus ("endometrium") is thickened at almost 22 mm. The time when we expect to see the thickest lining (usually betwenn 7-16 mm) is on cycle day 21. Also, in your case there was a small density seen in the otherwise uniform, thick lining. This MIGHT represent a polyp in the uterine lining.

There are two types of small ovarian cysts which can be considered "normal". During the first half of the menstrual month ("follicular phase") estrogen stimulates the growth of a dominant follicle. This follicle fills with fluid which is spilled out when the ready egg is ejected ("ovulation"). After the egg is released, its former follicle closes off and becomes the "corpus luteum" which produces progesterone during the following two weeks ("luteal phase").

If, in either of these phases, larger than normal amounts of fluid collect, one can develop ovarian cysts that will cause pain or menstrual bleeding changes. A normal ovary is about 2 x 3 cm (almond sized). A follicular ovarian cyst, if the egg is not ejected and the amount of fluid continues to increase, can reach sizes of up to 10 cm. Fortunately most follicular cysts are smaller and will resolve within one to three months.

In terms of your left ovarian cystic structure, often, when women get copies of their pelvic ultrasounds there is no definite diagnosis. The ovarian mass may only be described by location, size, and other attributes. The importance of size has been discussed above. The descriptors used can give an indication of the type of cyst that might be present. A cyst described as fluid filled with regular borders is often a simple follicular cyst. The ultrasound term anechoic (no echos) may be used to describe fluid, either cyst fluid or fresh blood.

Bottom line, the most common cause of a too thick lining which begins to shed in a prolonged/heavy fashion is a month(s) without an ovulation. A common cause of missed ovulations is an ovarian cyst.

Please ask your GYN for the your exact diagnosis. It sounds like they are doing a very thorough job in working up your bleeding. The prescribed birth control pills (because of the synthetic progesterone they contain) will help shrink the thickened lining over the next few months. The prescribed birth control pills can also decrease hormonal stimulation which can increase the size of an ovarian cyst. The follow up ultrasound should show a thinner lining, a stable or decreasing cyst size, and get another look at the possible density. It is possible to have polyps of the lining as a younger woman.

pupipaw replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

Thank you so much for the quick reply. I'll be on pills for the next 3 months and then by that time I'll have my next transvaginal ultrasound. I'm very hopeful that everything's going to be fine. I'll update you very soon.

Thanks again so much. I enjoy reading your expert opinions on different posts. Take care.

Warmest Regards,

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