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August 18, 2005

Menstruation; Pap Smear and Fertility

In this column of Healthdesk, Herword.com’s resident women’s health expert, Dra. Malu Mangubat, answers readers’ questions.

I’m Therese, going 23 this year but still haven’t experienced menstruation since birth. Maybe you could help me with my problem?


Hi Therese,
Your case is called Primary Amenorrhea. Unfortunately, it will be difficult to give a diagnosis without extensive laboratory work-up which includes hormonal, ultrasound and even chromosomal studies. This will entail a lot of expenses. The sooner you see your gynecologist, the better.

Dra. Malu


This is strange for me, asking a menstrual question on my wife’s behalf, but if you could provide any insight I would be most appreciated.  My wife has Bi-Polar, or that is what the doctors say; however, her mom had the same problems/issues that my wife is having now and it was resolved by taking a pill when she felt “nervous or a lot of anxiety” due to her menstrual cycle. My wife and her mother are both from Brazil and my wife is not sure off hand what medicine she takes to calm her anxiety but my question to you is, could extra anxiety lead a woman into a psychotic manic attack?  And my wife also mentioned about menstrual blood going to her head, is that really a threat? Thank you for any insight,


Dear Sean,
A lot of women with psychiatric problems will have menstrual problems. This is not due to menstrual blood going to their heads but a result of the effect of the brain on the woman’s hormonal levels. There is what is called a HYPOTHALAMIC-PITUITARY-OVARIAN axis, which means that the stimuli for the ovaries to produce the necessary hormones come from the brain (hypothalamus and pituitary). The hypothalamus is the center of emotion therefore if there is a disturbance here, it can lead to disturbance in the menstrual cycle. It is high time your wife consult a gynecologist aside from a psychiatrist to correct her menstrual problem and its psychologic cause.

Dra. Malu


I was wondering about the Pap Smear. I was wondering, what if you are not sexually active and the doctor did a Pap Smear? What can I do? Was it a mistake? Or was it necessary for it to be done even if I haven’t been sexually active? I just wanted to check for cyst. Thank you.


Dear Claudia,
We used to think that virgins are not in danger of cervical cancer for which Pap Smear is done. However, there are reported cases of cervical cancer in genuine physical virgins (those with intact hymens). Therefore, although the risk is quite low, it would still be for your good to have that Pap Smear

Dra. Malu


I am 31 years old and never had a child. I am trying, but my problem is I am not ovulating. I was diagnosed in April 2004 that I have a cyst in my right ovary. My doctor told me that the cyst is considered hemorrhagic vs dermoid cyst. My doctor told me to take femenal for three months. After that, I had my TVUS and the cyst is still there. So I went to another doctor for a second opinion. Now, my second doctor gave me an instruction to get Luprolex which I will have to take this month. My question is, if that Luprolex works, will I get pregnant? Thanks.


Dear Jheg,
Hemorrhagic ovarian cyst due to endometriosis can be conservatively managed with oral contraceptive pills (i.e. femenal), gonadotrophin inhibitors (i.e. danazol) and GnRH agonists (i.e. Luprolex). Luprolex is given as injection once a month for six months with a cost of about P8,000 per shot.  As I wrote in a previous column in Herword (Feb 2003, Myoma Concerns), that is a small price to pay for keeping your options open for a future pregnancy.

If the cyst is a dermoid cyst, these medications will not work.  Surgical removal is treatment of choice.

Dra. Malu


Hello! I am a young Filipina wife who has been diagnosed of endometriosis found in my external ovary. My OB decided to gave a Luprolex for three months. What is my chances of getting pregnant? I already got pregnant four years ago but got a miscarriage.

Please see previous reply.


Good day to you Doctor! I’m Michelle, 30 years old. I’ve been married for six years now, and my husband is a seaman. We’re still waiting for our bundle of joy. We underwent check ups three years ago. I just want to ask you if you’re handling cases like ours. i hope you can find time to answer my email. He will be home November of this year and i want to have check ups before he comes home. Thank you in advance and God bless!

Hello Michelle
I can do initial work-up for you and your husband to find out if there really is something wrong with one or both of you. However, you mentioned that your husband is a seaman and comes home only at certain periods of time. You might both be normal and it may be just because you don’t have enough time together. If you want to consult me, please bring the results of your previous work-up so that we don’t have to repeat these tests.

Dra. Malu

The views expressed herein are solely those of the author. For more information, consult a gynecologist.

DR. MALU TORRALBA-MANGUBAT is a fellow of the Philippine Obstetrical and Gynecological Society and the Philippine College of Surgeons.

For comments, e-mail .


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2 comments so far (post your comment)

Dear Jackie,

In my private practice, I may give Luprolex until 9 months. I have an ultrasound done every 3 months while the patient is undergoing these injections to see if the intended result is being attained. If there is no improvement, then surgery may be resorted to.

Posted by Dr. Malu on Monday, 03.19.12 @ 15:45pm

Good day to u dra.
i was diagnosed as having endometriosis last april before im taking depo provera every 2 weeks for 1month,every month for 3 months then every 3months for 1 year..then when i started the 3 months injection i do have bleeding for 3 months but not much..so i decided to go back to the philippines to my ob-gyn doctor.she gave me this luprolex 3.75mg/IM inj every 28 days...is this helpful for my endometriosis...and she told after the 6 months treatment we are finish already just follow check up..

Posted by jackie on Wednesday, 03.14.12 @ 15:42pm

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