Abnormal Uterine Bleeding and Its Impact on Fertility

Abnormal bleeding

Hello Dr.
Tsao, I would like to ask why there can be uterine adhesions even without previous surgery? I have a thick endometrium, and the angle of my cervix is somewhat large, which made it impossible to use a suction catheter to extract the endometrium during the hysteroscopy.
Additionally, it seems that my uterus is tilted.
Will this affect my ability to conceive? The doctor prescribed me 5 mg of Provera to take for 14 days, and I have been taking it for 9 days now.
Since I started the medication, I have experienced some dull pain on the left side of my abdomen, sometimes in the middle, and occasionally it shifts to the right side, but the left side is more frequently affected.
There has also been very light bleeding, which is only noticeable when wiping, and the color resembles that at the end of a menstrual period.
On the 7th day, I forgot to take the medication in the morning and switched to taking it at night.
That afternoon, it seemed like my menstrual cycle started.
After finishing the medication, there was some contraction, but there was still very light bleeding.
On the 8th day, I accidentally drank some brown sugar ginger tea, and the bleeding increased to what seemed like the end of a period, but it was bright red.
Today, on the 9th day after finishing the medication, the amount of blood has been more than in the previous days.
Is this normal? Should I finish the medication? Thank you.

Nìmíng, 30~39 year old female. Ask Date: 2016/03/27

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is possible that a tilted uterus is causing difficulties in inserting the suction catheter into the uterine cavity during hysteroscopy to retrieve the endometrium.
Whether this affects fertility needs to be monitored.
If menstruation occurs, there is no need to take the medication.
Wishing you good health.

Reply Date: 2016/03/27

More Info

Abnormal uterine bleeding (AUB) can significantly impact fertility and overall reproductive health. Understanding the causes and implications of AUB is crucial for women who are trying to conceive. In your case, it appears that you are experiencing a combination of symptoms that may be related to hormonal imbalances, structural issues within the uterus, or other underlying conditions.

Firstly, AUB can manifest in various forms, including irregular menstrual cycles, heavy bleeding, or bleeding between periods. The causes of AUB can range from hormonal imbalances, such as those seen in polycystic ovary syndrome (PCOS) or thyroid disorders, to structural abnormalities like fibroids, polyps, or endometrial hyperplasia. In some cases, even without prior surgical history, conditions such as endometriosis or adhesions (often referred to as Asherman's syndrome) can develop, leading to uterine scarring and abnormal bleeding.

In your situation, the thickening of the endometrium and the difficulty in performing a hysteroscopy due to the angle of the cervix and uterine tilt may indicate that there are anatomical factors at play. These factors can indeed affect fertility by disrupting the normal implantation of an embryo or causing issues with ovulation. For instance, if the uterine cavity is not conducive to implantation due to scarring or irregular shape, it may lead to difficulties in achieving or maintaining a pregnancy.

Regarding the medication you are taking, Provera (medroxyprogesterone acetate) is often prescribed to help regulate the menstrual cycle and manage abnormal bleeding. It works by mimicking the effects of progesterone, which can help stabilize the endometrial lining. The side effects you are experiencing, such as abdominal discomfort and slight bleeding, can be common when starting hormonal treatments. It is essential to monitor these symptoms closely, as they can indicate how your body is responding to the medication.

The fact that you are experiencing some bleeding after taking the medication could be a sign that your body is adjusting to the hormonal changes. However, if the bleeding becomes heavier or is accompanied by severe pain, it is crucial to consult your healthcare provider. They may need to reassess your treatment plan or investigate further to rule out any complications.

As for your concerns about the impact of these issues on your ability to conceive, it is important to understand that while AUB can complicate fertility, many women with similar conditions can still achieve successful pregnancies. The key is to address the underlying causes of the abnormal bleeding. This may involve lifestyle changes, further hormonal treatments, or surgical interventions if necessary.

In conclusion, it is vital to maintain open communication with your healthcare provider regarding your symptoms and treatment. They can provide personalized advice based on your specific situation and help you navigate the complexities of AUB and its impact on your fertility. Regular follow-ups and possibly additional diagnostic tests, such as imaging studies or hysteroscopy, may be warranted to gain a clearer understanding of your uterine health and to optimize your chances of conception.

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