Uterine Adenomyosis and Pregnancy Concerns: Your Questions Answered

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Niming, 20~29 year old female. Ask Date: 2018/09/29

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On 2/22-4/6, there was unprotected external ejaculation (Person A).
The ovulation period was on 3/26, and there was unprotected external ejaculation (Person A).
On 4/8, menstruation arrived early, but a few days after it ended, there was a slight return.
In May, two pregnancy tests were conducted, and menstruation was normal in May and June.
At the end of June, there was a brief unprotected encounter followed by protected ejaculation (Person B).
On 7/16, menstruation was late, and a urine test showed no pregnancy.
A transvaginal ultrasound revealed that the uterus was larger than that of a woman who had never given birth, leading the doctor to diagnose adenomyosis.
Menstruation arrived on 7/19, but the flow was light.
In August, menstruation was late, and a pregnancy test showed no pregnancy.
Menstruation arrived on 8/23, but the flow was still light.
From 9/10-9/13, there were one or two instances of starting without a condom and then putting one on for ejaculation, while other instances were all protected ejaculations (Person B).
On 9/26, menstruation was late and has not yet arrived, and a pregnancy test has not been conducted.
Q1: You mentioned that on 7/16, the transvaginal ultrasound showed that my uterus was larger than that of a woman who had never given birth, and the doctor diagnosed it as adenomyosis.
What does this mean? Could there be other reasons for the enlarged uterus?
A: A diagnosis of adenomyosis requires blood tests for confirmation.
Q2: Is it necessary to use first morning urine for pregnancy tests? I have taken multiple pregnancy tests in the afternoon or evening and all were negative, but I have been testing for several months with no pregnancy, and my menstruation is just late with a light flow.
Does this confirm that I am not pregnant? I am worried that the enlarged uterus detected at that time could indicate pregnancy.
If I were pregnant, would it definitely be Person B's child? (I had relations with Person B at the end of June.) I read online that sperm can survive in the fallopian tubes for a long time, and I am concerned it could be related to Person A (who I have not contacted since mid-April).

A: Pregnancy tests do not necessarily need to be done with first morning urine.
Q3: What is the likelihood of pregnancy in September? If I were pregnant, would it definitely be Person B's child? I read online that sperm can survive in the fallopian tubes for a long time, and I am concerned it could be related to Person A (who I have not contacted since mid-April).

A: If you are pregnant, it would definitely be from Person B.
Q4: I am worried because Person A had unprotected external ejaculation, which feels riskier than protected intercourse with Person B.
Can the date of sexual activity help determine who the father is? Is it possible to determine in October that I am one month pregnant, but the father is from the unprotected intercourse in March, not from the protected intercourse in September?
A: If you are one month pregnant in October, the father would be from the September intercourse.
Q5: Is it possible to be pregnant and not test positive for several months, while still having regular menstruation?
A: It is not possible.

Reply Date: 2018/09/29

More Info

Understanding uterine adenomyosis and its implications for pregnancy can be complex, especially when considering various factors such as menstrual irregularities, potential pregnancy, and the timing of sexual encounters. Let's address your questions systematically.

Q1: What does it mean that my uterus is larger than that of a woman who has never given birth, and what could cause this?
Adenomyosis is a condition where the endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus. This can lead to an enlarged uterus, which may be detected during a pelvic ultrasound. The enlargement can cause symptoms such as heavy menstrual bleeding, painful periods, and pelvic pain. However, other conditions can also cause an enlarged uterus, including fibroids (benign tumors), pregnancy, or other uterine abnormalities. It’s essential to have a thorough evaluation by a healthcare provider to determine the exact cause of the enlargement and to discuss any symptoms you may be experiencing.

Q2: Do I need to use morning urine for pregnancy tests? Can I trust negative results if I test in the afternoon or evening?
While morning urine is often recommended for pregnancy tests because it typically contains the highest concentration of the hormone hCG (human chorionic gonadotropin), testing at other times of the day can still yield accurate results, especially if you are well into your cycle. If you have tested multiple times and received negative results, it is likely that you are not pregnant, particularly if your menstrual cycle is only slightly delayed and the flow is lighter than usual. However, if you continue to have concerns about a possible pregnancy, it may be worth consulting a healthcare provider for further evaluation.

Q3: What are the chances of becoming pregnant in September, and if I do, can I be sure it is from B?
The likelihood of becoming pregnant depends on several factors, including the timing of ovulation and the viability of sperm. Sperm can live in the female reproductive tract for up to five days, so if you had unprotected intercourse with B in early September, there is a possibility of pregnancy. However, if you had unprotected intercourse with A in April and have not had any contact since, it is unlikely that this would result in a pregnancy now, as the sperm would not survive that long. If you do become pregnant, it is most likely from the most recent sexual encounter with B.

Q4: Can I determine the paternity of a child based on the timing of sexual encounters?
While it is possible to make educated guesses about paternity based on the timing of sexual encounters, the most reliable way to determine paternity is through genetic testing after the child is born. If you are concerned about paternity, discussing this with a healthcare provider or a genetic counselor can provide you with more information on your options.

Q5: Is it possible to be pregnant and have regular periods for several months?
It is generally uncommon to have regular menstrual periods while being pregnant. Some women may experience light bleeding or spotting during early pregnancy, which can be mistaken for a period, but this is not the same as a regular menstrual cycle. If you suspect you might be pregnant despite negative tests, it is advisable to consult with a healthcare provider for a blood test or ultrasound to confirm your status.

Conclusion
Given your concerns about adenomyosis, potential pregnancy, and the implications of your sexual history, it is crucial to maintain open communication with your healthcare provider. They can offer personalized advice, conduct necessary tests, and help you navigate any emotional or physical challenges you may be facing. Regular check-ups and discussions about your reproductive health are essential, especially when dealing with conditions like adenomyosis, which can affect your menstrual cycle and overall fertility.

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What is "uterine adenomyosis"? What problems can it cause?

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