Delayed Menstruation After Chocolate Cyst Surgery

The future menstrual cycle after taking Liu Pulin?

Hello Doctor: I underwent laparoscopic surgery for a unilateral chocolate cyst at the end of April this year, followed by six doses of Leuprolide, with the last injection on September 23.
On that day, the doctor advised me to return for a follow-up within seven days after my menstrual period resumes.
However, it has been nearly two months, and my period has not returned.
Additionally, in the past two weeks, I have experienced occasional dull pain near the ovarian area on the side of the surgery, which lasts for a short time and then subsides, reminiscent of the ovulation pain I used to have.
I would like to know if it is normal for my menstrual period not to resume two months after completing Leuprolide treatment.
Should I schedule an earlier follow-up appointment?

Mimi Xiaojie, 30~39 year old female. Ask Date: 2020/11/23

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, please wait for about two more weeks.
If it still doesn't arrive, I recommend returning to the original hospital for a consultation.
Wishing you good health.

Reply Date: 2020/11/23

More Info

After undergoing laparoscopic surgery for a chocolate cyst, it is not uncommon to experience changes in your menstrual cycle, including delayed menstruation. Chocolate cysts, or endometriomas, are a result of endometriosis, where endometrial tissue grows outside the uterus, often affecting the ovaries. The surgical removal of these cysts can lead to various hormonal and physical changes in the body, which may impact your menstrual cycle.

In your case, you mentioned that it has been nearly two months since your last menstrual period, following the completion of six doses of leuprolide (Luprolide). Leuprolide is a GnRH agonist that is often used to treat endometriosis by suppressing ovarian function and reducing estrogen levels, which can help shrink endometriomas and alleviate symptoms. One of the side effects of this medication is amenorrhea (the absence of menstruation), which can persist even after the treatment has ended.
The absence of your menstrual period for two months post-treatment can be attributed to several factors:
1. Hormonal Changes: After stopping leuprolide, your body may take time to resume normal ovarian function and hormone production. It is not unusual for the menstrual cycle to be irregular or delayed for a few months following such treatment.

2. Surgical Recovery: Your body is still recovering from the surgery, and this can also impact your menstrual cycle. The healing process can cause fluctuations in hormone levels, which may delay the return of your period.

3. Underlying Conditions: If there are any residual effects from the endometriosis or if there are other underlying hormonal imbalances, these could also contribute to the delay in menstruation.

Regarding the intermittent pain you are experiencing near the surgical site, it is not uncommon to have occasional discomfort or pain in the area where the cyst was removed. This could be due to residual inflammation, healing tissues, or even the normal functioning of your ovaries as they resume their cycle. However, if the pain becomes severe or is accompanied by other symptoms such as heavy bleeding, fever, or significant changes in bowel habits, it would be prudent to seek medical attention.

As for whether you should return to your doctor sooner than the scheduled follow-up, it is advisable to consult your healthcare provider if you have concerns about the absence of your menstrual period or if you experience any unusual symptoms. They may want to perform an ultrasound or other tests to ensure that there are no complications, such as the recurrence of endometriosis or other issues that could be affecting your menstrual cycle.

In summary, while a delayed period after treatment for a chocolate cyst can be normal, it is essential to monitor your symptoms and maintain open communication with your healthcare provider. They can provide personalized advice and reassurance based on your specific situation and medical history.

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