Post-Abortion Menstrual Irregularities and Hormone Levels

Blood test values inquiry?

Hello, I underwent a surgical abortion on March 27, and since then, I have experienced irregular menstruation.
I have not had my period for a long time, so I returned to the original surgical hospital at the end of May to seek treatment for inducing menstruation (I have not had any menstrual bleeding since the surgery).
The doctor recommended a hysteroscopy because the ultrasound showed a few suspected blood clots.
After the surgery on May 30, I had my period on June 17, which followed my pre-surgery menstrual cycle of about 35 days (ovulation on day 18).
I expected my period on July 21, but due to the delay, I went to the obstetrics and gynecology department for medication to induce menstruation.
The doctor mentioned that my endometrium was thin, which might make it difficult to induce menstruation.
My next period was on July 27.
I started testing for ovulation on day 12 and continued until day 20, but the ovulation test strips did not show a positive result (the two lines were equally dark, and the second line was faint).
Before pregnancy, I had used ovulation test strips for conception and always detected T>C.
As of today, August 31, my period still has not arrived, and I expected it to come today.
Additionally, I had a Pap smear on August 22, during which an ultrasound showed that the endometrium is still thin.
On day 35 of my menstrual cycle (August 30), I had blood tests with the following results: LH: 14.580 mIU/ml, FSH: 3.090 mIU/ml, E2: 153.3 pg/ml (the blood test was self-paid at the laboratory).

1.
Are these blood test values normal? Is there any concern regarding ovarian function abnormalities?
2.
How can I determine if the surgery has caused damage to the endometrium, leading to the delay in my two menstrual cycles and the thin endometrium?
3.
What examinations or medical treatments can be done regarding the thin endometrium?
4.
Since my menstruation has been irregular since the miscarriage, how long is this situation likely to continue, and what improvements do you recommend? I am currently actively trying to conceive.

PENG, 20~29 year old female. Ask Date: 2023/08/31

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, your blood test results are normal.
You may consider taking contraceptive pills for a few months.
Wishing you good health.

Reply Date: 2023/08/31

More Info

Post-abortion menstrual irregularities and hormone levels can be a complex issue, often influenced by various factors including hormonal changes, the physical effects of the procedure, and individual health conditions. Based on your situation, let's break down your concerns and provide some insights.

1. Hormone Levels: Your recent blood test results show LH (Luteinizing Hormone) at 14.580 mIU/ml, FSH (Follicle Stimulating Hormone) at 3.090 mIU/ml, and E2 (Estradiol) at 153.3 pg/ml. These values can provide insight into your ovarian function. Generally, elevated LH levels can indicate that your body is trying to stimulate ovulation, especially if they are higher than normal for the follicular phase of your cycle. FSH levels are relatively low, which is typical in the early follicular phase. Estradiol levels can vary widely depending on the phase of your menstrual cycle, but your level seems to be within a reasonable range for the time of testing. However, the interpretation of these values should be done in conjunction with your menstrual cycle history and symptoms. If you are experiencing irregular cycles and thin endometrial lining, it may indicate some degree of ovarian dysfunction or hormonal imbalance.

2. Endometrial Health: After an abortion, it is not uncommon for the endometrial lining to take some time to return to its normal thickness and functionality. The presence of suspected blood clots as seen on ultrasound could indicate retained products of conception or other issues that might affect the endometrial lining. A thin endometrium can hinder the ability to conceive and maintain a pregnancy, as it may not provide a suitable environment for implantation. A hysteroscopy, which you underwent, is often performed to directly visualize the uterine cavity and can help in identifying any abnormalities.

3. Management of Thin Endometrium: If your endometrial lining remains thin, there are several approaches that may be considered. Hormonal treatments, such as estrogen therapy, can help stimulate the growth of the endometrial lining. Additionally, lifestyle factors such as maintaining a healthy weight, managing stress, and ensuring adequate nutrition can also play a role in improving menstrual regularity and endometrial health. Some practitioners may also recommend supplements like vitamin E or omega-3 fatty acids, which have been suggested to support endometrial health, although more research is needed in this area.

4. Duration of Irregular Cycles: After an abortion, it can take several months for menstrual cycles to normalize. The duration varies significantly among individuals. Some may experience a return to regular cycles within a few months, while others may take longer. Factors such as your overall health, hormonal balance, and any underlying conditions can influence this timeline. If you are actively trying to conceive, it is advisable to maintain regular follow-ups with your healthcare provider to monitor your progress and adjust any treatment plans as necessary.

In summary, your hormone levels suggest some ovarian activity, but the irregularity of your menstrual cycles and the thin endometrial lining warrant further investigation and possibly treatment. It is essential to maintain open communication with your healthcare provider, who can guide you through the next steps based on your specific situation and fertility goals. Regular monitoring and possibly hormonal treatments may help in restoring your menstrual cycle and improving your chances of conception.

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