What causes missed periods after a laparotomic myomectomy surgery?

Question

Hello doctor.

Please assist with my below question. I am 34-year-old and I recently had a laparotomic myomectomy five years ago due to presenting primary infertility and a multi-fibroid uterus and the operation went well. There was no mitotic activity observed, no atypia, and no areas of necrosis. I then did HSG on the day of surgery itself and my results were within the normal limits.

A week prior to the operation I had my periods and then they started again about 10 days post-surgery, which was slightly heavy. I had another cycle early after the surgery just before HSG. The next cycle felt slightly different and slightly more painful. The flow itself had a slightly clear mucus-like texture and I assumed it was normal.

Since then in between that cycle and when the next one was supposed to start I was spotting very light and the color was not even deep red for about two days with minor pains which went away. I have missed two-period cycles with no period. I feel the pains and have all the symptoms like feeling bloated, slight period pains, and a small pimple on my face however no period. I do not know if this is normal or a cause for concern and if I should go back to the hospital and see my doctor. I am not pregnant as I have not had coitus post-operation.

The only complication I had post-operation was my chest closing at night which started when I was home about a week or so after being discharged. I did a lung capacity test and I have now been diagnosed with asthma but the specialist says it's mild and manageable since even prior to being put on the pump I was able to sleep and now that I have been on the pump my recent lung capacity test has shown radical improvement.

I am still taking iron tablets (one tablet of 75 mg) and folic acid (one tablet) a day.

To assist with asthma and sinus I also take the following medications since the operation:

-Beclate 100 HFA (two puffs twice a day)

Be-Tabs Prednisone 5 mg (four once a day. I took these for a month and the doctor took me off them now).

Fluticasone propionate aqueous nasal spray (two puffs once a day).

Mylan Metformin 850 mg (one tablet twice a day) was prescribed by the asthma doctor, though I am not diabetic but rather to assist with weight management and weight loss. At the time of surgery, I weighed 143 kg and I have been on a weight management program to get it down, which is progressing well this far.

Nozer Omeprazole 20 mg one a day. I have stopped taking these after about a month as I hardly suffer from acid reflux anyway.

All the tablets and pumps should not have any adverse reaction to my periods but I've included them to give you as much information as possible to assist with my question.

Am I panicking for nothing or is there room for concern and action should be taken for my lack of period for the past two cycles? I know the one thing my doctor was concerned about was my uterus closing which considering the HSG results has not but I do not know what are the tail signs of that if that would be the case leading to an absence of a period.

Answer 1

Hello,

Welcome to icliniq.com.

You had a myomectomy and laparotomy for multi fibroid uterus five years ago have been treated for infertility and were advised to reduce weight as well. Postoperatively you had irregular or no periods and some allergic or asthmatic attacks as well for that had symptomatic treatment. You also had acidity. It would be better for you to send me your last scan before surgery and ur surgical notes so I could understand the severity and complication of surgery. In complicated surgery with hemorrhage and lots of blood loss and multiple complications during and after surgery body needs time to get normal and maintain hemostasis. Multiple fibroid removal in patients with higher BMI is not an easy task as there are chances of hemorrhage, internal bleeding, infection post-operatively, and difficult healing, etc. Some stitches absorbable need 120 days to completely absorb locally. In the uterus too many inflammatory, healing process has been occurring that is still under process, and hormonal imbalance is unable to be normal to give you regular cycles. Have you been advised of any hormonal support post-surgery? My advice for your general and long-term health is to have a healthy life with normal fertility actually based on some long-term healthy lifestyle and habits. Have daily walks, exercise, and yoga, or better join a gym and take advice from the instructor to have a balance weight and BMI. Have a healthy nutritious diet and get help from a dietician to balance your weight and take more vegetables, fruits, and water. It is better to take home cooked with the least oil (olive oil), spice, sugar, and salt. Have recreational activities better physical with your partner for better physical and emotional health. Having complete checks and treatment of any health issue if you have weight reduction will reduce the risk of many diseases. Try to avoid steroids for your asthma as steroids also have side effects on long-term or frequent use. You can have a healthy diet like boiled eggs, ginger tea, honey with ginger, gargles, steam, etc to increase immunity against asthma. Have cold low-fat milk at bedtime and in the morning after waking up before breakfast to reduce acidity, and have frequent short meals and lots of water to reduce acid production .try to have less spice and citrus. To regulate cycles and to support hormonally have combined oral contraceptive pills for three months Cyclically to regulate cycle (it is better to have lower or the least dose of estrogen hormone). It is better to give time to the body to heal and prepare for pregnancy. If you do not want to take it for three months you can have it for two months.

Thank you.

What causes missed periods after a laparotomic myomectomy surgery?

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