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February 22, 2006
Myomas,Fertilization,Pregnancy after Endometriosis
By Ma. Luisa T. Mangubat, MD
Dra. Malu Mangubat takes time out to answer readers’ questions. This issue, she answers questions about myomas, fertilization, and pregnancy after endometriosis.
From Dorothy:
I have discovered just recently that I have a myoma and it’s already in big size. I read your article about myoma and I would like to ask on what were the medicines that can reduce the myoma’s size. My OB told me that only the removal of it is the only remedy but my instinct is telling me that there is a certain medicine that could posible reduce its size.
Dear Dorothy:
There are some medicines that can be used such as danazol, luprorelin and goserelin. Although they are from different classes of drugs their effect is to induce a sort of false menopause (pseudomenopause). These are primarily used for endometriosis but they have some effect in making myomas smaller. However, they can be effective only if the myoma is not too big. The general rule of thumb is if the myoma makes your uterus bigger than in a four--month pregnancy, it requires surgical removal.
Dra. Malu
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From CC:
I underwent a surgical removal of a myoma in June, 2005. The doctor advised that I need to allow for some time for the wound to heal before getting pregnant. I would like to find out how long I need to wait before getting pregnant.
Dear CC,
There is no hard and fast rule on how soon one can get pregnant after a surgery involving the uterus.Although the wound itself heals in a matter of days, we usually allow a few months or even years to make the scar stronger. It is best to get the opinion of your surgeon himself/herself as he/she is more knowledgeable about the integrity of the operative scar he/she has done.
Dra. Malu
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From anonymous:
1. If you have a tubal ligation how does an egg can reach the uterus (through menstruation) but sperm cannot reach the egg?
2. What are the odds of a woman conceiving and carrying a baby to term with a tubal ligation (clamped and burned)?
Dear anonymous,
Question #1 -- After a tubal ligation, the egg cannot reach the uterus and the sperm caanot reach the egg since the fallopian tube where they are supposed to travel towards each other has been blocked or cut--off. Menstrual blood is from the endometrium and not from the ovary.
Question #2 -- I have no actual figures on this but it should be almost 0% if the BTL was properly done. There is a probability of the tubes spontaneously reanastomosing (joining together) but this is a very rare probability.
Dra. Malu
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From Jessy:
I was operated due to cyst in my both ovaries (one in each) last August 2004. I was then diagnosed of having endometriosis, stage 4. My husband and I still want to have more children since we only have one. After operation, I got better. I was prescribed pills. Then I stopped taking for more than a month hoping to conceive since my husband arrived from abroad. I took again the pills because I was again having a lot of pain --.abdominal, buttocks and in my legs. It was again hard to walk(I had this before my operation).
Last month, I felt worse even if I continued the pills. My doctor injected me with depo... she said it’s for three months no menstruation ( it was last dec. 27, 2005). I got worse. I kept vomiting and even finding it hard to breathe if I stood for long periods. I’m having a lot of back pains also. Last january 13, my doctor again injected me with luprolex. As of now, I’m getting better. I can now eat without vomiting. My doctor told me that it was just a one--shot trial for me because it would damage my bones in the long run. She will only continue the depo. By the way, I just turned 36 last December.
I hope you can give me your advice, Doctora. These past weeks, I thought it was already my end. My friend, a neurologist, advised me to go Manila (I’m here in Cebu) since according to her she has a friend in PGH who is specializing in my case. I was very weak then to travel. Though I’m feeling better now, I’m wondering how much would it cost me if I will go there. I meant maybe you can advise me how much i need for medical tests and doctor’s fee there. Thank you very much Doc. May God bless you and your family always. More power
Dear jessy:
Being a stage 4 endometriosis, you have extensive adhesions in your pelvic area making it quite difficult to conceive. But if you do get pregnant, it would affect your endometriosis for the better. Your recent symptoms shows your endometriosis is getting worse. Luprolex is given for six to nine months. Yes, there is danger of osteoporosis as this drug pushes you into pseudomenopause (false menopause) that is why it is important to weigh your options. Talk to your doctor to get a clearer perspective of your choices. If you plan to come to Manila for the tests, the cost would depend on where you’ll have them done.
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From Josie:
I’ve read your article in the internet and would like to ask about fundal myoma.
I’m 48 years old and was diagnosed in the ultra sound result as having fundal myoma measured at 3.2 x 3.6 cm.This is the first time that I have a heavy bleeding that I have to go to the emergency and was given dicynone 500 (2) at 12 hrs. and mafepain 1 tab. 2x a day.
My doctor informed me that it is natural to have heavy bleeding due to my menopausal stage. and i have to have an ultrasound again after three months to be sure that the myoma have not grown big in size, as of now surgery is not required yet.
Dear Josie:
Heavy bleeding can indeed be due to your impending menopause. However, I personally would do a fractional dilatation & curettage (D&C) to be certain there is no danger of cancer or even precancerous changes. After I’m sure there is no cancer/precancerous changes, then I’ll just treat my patients symptomatically and do serial ultrasound every three months or as needed. The good news is that your myoma is still small enough not to warrant an operation but there is no assurance on how fast it can grow or regress in size.
Dra. Malu
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From Anna:
I enjoy reading your articles on the website. It provides insights that doctors don’t seem to have the time for.
I had an endometrioma cyst on my left ovary last year. I had ultrasounds done on a monthly basis for four months. Each time it was day seven to eleven of my menstrual cycle. Each time, only the endometrioma cyst was noted on the U/S report. I then had surgery to have it removed.
Now, I’ve just had another U/S and it revealed another cyst (likely an endometrioma according to the report) on my left ovary, but smaller -- about 2.8 cm. However, it was day 14 of my menstrual cycle. I did have my next menstrual cycle as usual at day 28 so I imagine I did ovulate. My question is since that was the height of my ovulation timeframe wouldn’t the U/S report have shown an additional ovulating cyst if this wasn’t it? Or do "what’s normal" not end up on U/S reports, only what is unusual?
Dear Anna,
An ultrasound report will contain all the observed features whether they are normal or abnormal. Sometimes, a larger cyst (like your 2.8 cm cyst) can obstruct the view of a smaller cyst (like a follicle cyst which contains your egg) that is why the sonologist will take several angles. Ovulation can occur even when there is endometrioma.
Dra. Malu
The views expressed herein are solely those of the author. For more information, consult a gynecologist.
If you have any questions for Dra. Malu, e-mail
DR. MALU TORRALBA--MANGUBAT is a fellow of the Philippine Obstetrical and Gynecological Society and the Philippine College of Surgeons. For personal consultations, her clinic hours are as follows:
At the Medical Center Manila
Room 337, 1122 Gen. Luna cor. U.N. Avenue, Ermita, Manila
Mondays through Saturdays, 10:00 a.m. to 12:00 nn
Mondays through Thursdays, 3:00 p.m. to 6:00 p.m.
Tel. (632) 528--1173
At the Asian Hospital and Medical Center
Filinvest City, Alabang
Room 722, Medical Office Building
Mondays, Wednesdays, Fridays, 8:00 a.m. to 10:00 a.m.
Tel. (632) 722--9340
February 22, 2006
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