Menstrual Irregularities and Sexual Health After Childbirth

Sexual function or menopausal symptoms?

Hello Dr.
Tsao,
I am 33 years old, and I had my first child at 29.
My husband and I have not been using contraception, but we have not been able to conceive again, so I would like to ask a few questions:
1.
After giving birth to my first child, I experienced heavy bleeding a week later due to retained placental membranes, which led to a dilation and curettage (D&C) procedure.
I had never undergone a D&C before.
Will this affect my ability to conceive in the future?
2.
My menstrual cycle has been irregular since puberty, occurring every 40 to 50 days, with varying flow each time.
I do not have any unusual symptoms, and I have heard that menstruation may become more regular after having children, but my situation remains the same.
I have undergone ultrasound and hysteroscopy, and my ovaries are normal, but I have a 2.5 cm uterine fibroid, which has been deemed not to affect my fertility.
Could I be entering menopause? Can these tests indicate if my ovarian function has declined, or do I need to undergo additional tests?
3.
I have been experiencing a lack of sexual desire, which was not an issue before I became pregnant.
My husband and I had a good sexual relationship, but since giving birth, I have lost interest.
I thought it might be due to the fatigue of parenting, but my child is now being cared for by my mother-in-law and does not live with us, yet my situation has not improved.
I have heard that a deficiency in certain hormones could be treated with injections to improve the situation.
Is this true, or could I actually be experiencing menopause?
4.
Some people have suggested that my irregular menstrual cycles are related to my hormone levels, claiming that excessive body hair indicates higher levels of male hormones and insufficient female hormones.
However, I have had this condition since childhood.
Is there any basis for this claim?
I apologize for asking so many questions, and I appreciate your help.
Thank you!

fenxiang, 30~39 year old female. Ask Date: 2006/06/30

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello! In response to your questions, I will answer them one by one.
A dilation and curettage (D&C) procedure generally does not affect future pregnancies.
Considering your age of 33 and the fact that you still have menstrual periods, it is unlikely that you are in menopause.
Menopause refers to the symptoms experienced during the period surrounding the cessation of menstruation, which typically occurs around the age of 50.
Therefore, your age and symptoms do not suggest that you are in menopause.
A lack of sexual interest may be related to hormones, mood, and environment.
Improving the latter two factors may help improve the situation, so it might be worth trying.
If you have further questions, you can consult your obstetrician-gynecologist.
Wishing you good health!

Reply Date: 2006/06/30

More Info

Understanding menstrual irregularities and sexual health after childbirth is a multifaceted issue that can be influenced by various factors, including hormonal changes, physical health, and psychological well-being. Let's address your concerns one by one.

1. Impact of D&C on Future Pregnancies: A dilation and curettage (D&C) procedure, which you underwent due to retained placental tissue, can have implications for future pregnancies. Generally, if the procedure was performed correctly and there were no complications, it should not significantly affect your ability to conceive. However, if there were any complications, such as infection or scarring of the uterine lining (Asherman's syndrome), this could potentially impact future fertility. It's essential to discuss your specific case with your healthcare provider to assess any potential risks.

2. Menstrual Irregularities: Irregular menstrual cycles, especially those lasting 40-50 days, can be attributed to several factors, including hormonal imbalances, stress, or underlying medical conditions. While it is common for some women to experience more regular cycles after childbirth, this is not universal. The presence of a uterine fibroid (2.5 cm) may not necessarily affect your menstrual cycle, but it can contribute to irregularities depending on its location and size. To determine if you are approaching menopause, hormone level tests (like FSH and estradiol) can provide insight into your ovarian reserve and function. If you have concerns about perimenopause, discussing these with your doctor is crucial.

3. Decreased Libido: A decline in sexual interest after childbirth is not uncommon and can be attributed to several factors, including hormonal changes, fatigue, stress, and the physical demands of caring for a newborn. It’s important to consider that postpartum hormonal shifts can lead to decreased estrogen levels, which can affect libido. If you suspect hormonal deficiencies, consulting with a healthcare provider about potential treatments, such as hormone replacement therapy or other interventions, may be beneficial. Additionally, psychological factors, including anxiety or depression, can also play a significant role in sexual desire, so it may be worth exploring these aspects as well.

4. Hormonal Imbalances and Hirsutism: Irregular periods and symptoms like hirsutism (excessive hair growth) can indeed be linked to hormonal imbalances, particularly elevated levels of androgens (male hormones). Conditions such as polycystic ovary syndrome (PCOS) are often associated with these symptoms. If you have had these symptoms since childhood, it may indicate a long-standing hormonal imbalance rather than a recent change. A thorough evaluation by an endocrinologist or a reproductive specialist can help clarify your hormonal status and guide appropriate treatment options.

In summary, your concerns about menstrual irregularities, fertility, and sexual health after childbirth are valid and warrant a comprehensive evaluation. It is advisable to have an open discussion with your healthcare provider about your symptoms, medical history, and any tests that may be necessary to assess your reproductive health. They can provide personalized recommendations and treatment options based on your specific situation. Remember, you are not alone in experiencing these changes, and many women face similar challenges after childbirth. Seeking support and guidance can help you navigate this period more effectively.

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