Managing Abnormal Bleeding and Pain After Ovarian Surgery: Expert Insights

Abnormal bleeding from the ectopic pregnancy and post-operative internal vaginal pain?

Hello Doctor, my menstrual cycle has always been regular.
I underwent laparoscopic surgery for ovarian cysts two years ago, and since then, I have been taking Danazol.
The size of the cysts has been well controlled, and the light bleeding I experienced almost every month would usually stop within a week.
However, starting in August, I had three weeks of continuous spotting, and later my doctor prescribed me a 10-day course of Medroxyprogesterone, which stopped the bleeding.
I would like to ask:
1.
The doctor mentioned that if the spotting continues, I would need to have a transvaginal ultrasound.
I am a bit worried since I have not had sexual intercourse, and I had a pelvic exam and Pap smear at the end of last year, both of which were normal.
If this abnormal bleeding can be stopped with medication, can we rule out the possibility of cancer?
2.
After the abnormal bleeding started in August and stopped with Medroxyprogesterone in early September, I had a few drops again in early October.
That day, I immediately took the backup Medroxyprogesterone prescribed by my doctor, and after one day of taking it, the bleeding stopped, so I did not continue.
However, a week later, the spotting started again.
Should I take Medroxyprogesterone immediately when I notice spotting, or should I wait a week to see if it stops before taking it?
3.
Is it normal to have very light bleeding resembling a menstrual cycle after taking Danazol for one or two years?
4.
Since my surgery, I often feel a slight pulling pain deep on the left side of my vagina, especially after eating spicy food.
I have undergone a colonoscopy, urinary tract X-ray, CT scan, pelvic exam, Pap smear, and regular abdominal ultrasounds, but no cause has been found.
The first doctor said this is normal, while the second doctor speculated that it might be due to adhesions from the surgery affecting the intestines (the surgical site is also on the left side).
Does this mean that aside from taking pain medication, there is no way to improve this issue? The pain is not severe enough for me to feel I need pain medication, but the persistent pulling sensation without a clear cause makes me anxious.
I am concerned about taking medication for this minor issue and the potential harm it may cause, so I would like to hear your opinion.
5.
My mother has a history of colon cancer and uterine fibroids.
I read online that having a family history of colon cancer increases the risk of gynecological cancers.
In the absence of sexual intercourse, how often would you recommend I have check-ups, and what kind of tests should I undergo? Thank you!

Niming, 20~29 year old female. Ask Date: 2022/10/10

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, you may try stopping the medication to allow your menstrual cycle to resume, and then restart the medication, which often leads to improvement.
If the bleeding does not stop, it is advisable to consider changing the medication or discussing other options with your physician.
Regarding the pain, it is recommended to take medication only if the symptoms persist or worsen.
If relevant examinations have already been conducted, you may observe the situation and follow up regularly, as the recommended intervals for each type of examination may vary.
If symptoms intensify, please consult your physician for further evaluation.
Thank you! Wishing you safety and health.
Dr.
Zhang

Reply Date: 2022/10/10

More Info

Managing abnormal bleeding and pain after ovarian surgery can be a complex issue, especially when considering the history of surgery and the medications involved. Here’s a comprehensive response to your questions based on the information provided and general medical knowledge.

1. Abnormal Bleeding and Cancer Concerns: It’s understandable to be concerned about the possibility of cancer, especially with a history of ovarian surgery and abnormal bleeding. However, if your healthcare provider has conducted thorough examinations, including pelvic exams and Pap smears, and found no abnormalities, the likelihood of cancer is significantly reduced. Medications like the ones you mentioned (e.g., hormonal treatments) can often regulate bleeding. If the bleeding can be controlled with medication, it is less likely to be cancerous, but it’s essential to follow up with your doctor for further evaluation if the bleeding persists.

2. Managing Breakthrough Bleeding: If you experience breakthrough bleeding after stopping the medication, it’s advisable to consult your doctor before taking any additional medication. While it may be tempting to take the medication immediately upon noticing bleeding, it’s often better to observe the pattern of bleeding first. If the bleeding continues for an extended period or becomes heavy, then taking the medication as prescribed would be appropriate. Always communicate with your healthcare provider about your symptoms and follow their recommendations.

3. Post-Surgery Bleeding Patterns: Experiencing light bleeding that mimics a menstrual cycle while on hormonal treatments like the one you mentioned is not uncommon. Hormonal therapies can sometimes lead to breakthrough bleeding, especially in the initial months of treatment or if there are changes in dosage. If this continues for an extended period, it would be wise to discuss this with your healthcare provider to ensure that the treatment is still appropriate for your condition.

4. Pain After Surgery: The discomfort you’re feeling on the left side of your vagina could be related to adhesions, which are scar tissues that can form after surgery. These can sometimes cause pain or discomfort, especially when certain movements or activities (like eating spicy foods) trigger the sensation. While pain management is essential, it’s also crucial to explore non-pharmacological options, such as physical therapy, which may help alleviate discomfort without the need for continuous medication. If the pain persists or worsens, further imaging studies or consultations with specialists may be warranted to rule out any underlying issues.

5. Family History and Screening Recommendations: Given your family history of colorectal cancer and uterine fibroids, it’s prudent to maintain regular check-ups. While having a family history can increase your risk for certain cancers, the absence of sexual activity and regular screenings can mitigate some risks. It’s generally recommended to have a gynecological exam annually, and depending on your age and risk factors, your doctor may suggest additional screenings, such as a colonoscopy, especially if you have a family history of colorectal cancer. Discuss your concerns with your healthcare provider, who can tailor a screening schedule based on your individual risk factors.

In summary, managing post-operative symptoms requires a collaborative approach with your healthcare provider. Regular follow-ups, open communication about your symptoms, and adherence to prescribed treatments are key to effectively managing your health. If you ever feel uncertain or uncomfortable with your current treatment plan, seeking a second opinion is always a valid option. Your health and peace of mind are paramount, and you deserve to feel confident in your care.

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