Menstrual Issues After Uterine Fibroid Surgery

Menstrual issues

Hello Dr.
Wu: Last July, I underwent surgery for uterine fibroids.
After the surgery, the doctor recommended that I receive six months of Lupron injections, which theoretically should have concluded with the last injection in December.
My menstrual period was expected to return in January, but by early March, it still hadn't come.
However, my body is showing various symptoms that typically precede menstruation.
I consulted with the surgeon who performed my operation, and within six days, I received two injections to induce menstruation, but my period still did not arrive.
Given that I have experienced four failed IVF attempts, I am also concerned that I may be entering menopause, although my blood tests from December and March were within the normal range.
Subsequently, my gynecologist prescribed "Cinna" tablets, advising me to take them for 21 days, and to continue taking them if my period arrives.
I would like to ask if taking Cinna tablets will affect my menstrual cycle, and whether I still have the possibility of becoming pregnant?

Anita, 40~49 year old female. Ask Date: 2021/03/21

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Taking the contraceptive pill theoretically should not result in menstruation; menstruation occurs only if ovulation takes place.
2.
Is pregnancy possible? Please consult a fertility specialist for evaluation and examination.

Reply Date: 2021/03/21

More Info

After undergoing surgery for uterine fibroids, it is not uncommon for women to experience menstrual irregularities. The situation you described, where you have not had a menstrual period for several months following the completion of a medication regimen (in this case, Leuprolide), can be concerning and warrants further exploration.

Leuprolide is a GnRH agonist that is often used to shrink fibroids and manage symptoms associated with them. It works by suppressing estrogen production, which can lead to a temporary cessation of menstruation. After stopping Leuprolide, it may take some time for your body to resume normal ovarian function and menstrual cycles. The timeline for the return of menstruation can vary significantly among individuals, and factors such as age, overall health, and the presence of other hormonal imbalances can influence this.

Given that you have not had a menstrual period since January and are experiencing premenstrual symptoms, it is possible that your body is preparing for menstruation, but hormonal fluctuations may be preventing it from occurring. The administration of two injections to induce menstruation indicates that your healthcare provider is actively trying to manage this situation. However, if these injections have not resulted in a menstrual period, further evaluation may be necessary.

Regarding your concerns about early menopause, your blood tests showing hormone levels within the normal range suggest that you are not in menopause. However, it is essential to consider that perimenopause, the transitional phase leading up to menopause, can also cause irregularities in menstrual cycles. Symptoms of perimenopause can mimic those of premenstrual syndrome (PMS), which may explain the symptoms you are experiencing.

As for the medication "Xinna" (likely referring to a form of hormonal therapy), it is designed to help regulate menstrual cycles. If you take this medication for 21 days, it is expected that you may experience a withdrawal bleed, which can resemble a menstrual period. This is a common response to hormonal therapy, and it does not necessarily indicate that you cannot become pregnant in the future. However, if you are actively trying to conceive, it is crucial to discuss this with your healthcare provider, as they can provide guidance on the best approach for fertility following fibroid surgery and hormonal treatment.

In summary, while the absence of menstruation after fibroid surgery and hormonal treatment can be concerning, it is not uncommon. It is essential to maintain open communication with your healthcare provider, who can monitor your hormone levels, assess your overall reproductive health, and provide tailored recommendations based on your specific situation. If you continue to experience irregularities or have concerns about fertility, seeking a second opinion or consulting a fertility specialist may also be beneficial.

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