Dr. Silvio Aladjem Answers Your Questions ~ March/2014

The doctor is in!

This past December we announced that Imperfect Women would be partnering with Dr. Silvio Aladjem to bring you a column featuring Dr. Aladjem answering your questions of medical interest related to pregnancy.  We are excited to bring you this new feature and hope that you are able to benefit from it.

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Question from C.R.:  My question is not about pregnancy but about bruising when you are having a period. Is that normal?

Dr. Aladjem:  No it is not normal. You should see your doctor or an Internal Medicine specialist without delay.

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Question from K.E.: Just under 2 years ago I had a laparoscopy due to an ectopic pregnancy. Nearly two years on I am still bleeding very irregularly and heavily. I am on the contraceptive pill at the moment which must be working as I have not fallen pregnant. Why would I still be bleeding (in between what I thought were regular periods but now seems to be whenever, wherever!) Will this affect my chances of becoming pregnant again? Is something wrong or is this normal?

Dr. Aladjem: If you are on the pill and you bleed irregularly, in the absence of any other health problems, it is not normal. You may have to change the pill with a different dosage. Talk to your doctor and first of all make sure nothing else is wrong. He/she will be able to adjust your pills, if that is the problem. It should not prevent you from  getting pregnant after you stop the pill if your other tube is normal.  However, wait till your periods become normal before attempting pregnancy.

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 Question from S.S.: Hi, I have irregular periods. In almost one and a half years into my marriage, we have never used any kind of protection. But I am not able to conceive. What should I do in this case as I am 26 now?

Dr. Aladjem: If you have irregular periods, you need to have an evaluation and make sure that you ovulate. Sometimes the reason for not getting normal periods and have irregular bleeding, may be related to the fact that your ovaries do not release an egg every month. In such cases your period becomes irregular and bleeding occurs at any time. This is known as an “anovulatory period”, which means  ovaries do not release an egg and therefore bleeding starts.  See a Gynecologist who specializes in gynecologic-endocrinology or see a Fertility specialist.

I wish you well.

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Question from K.: I had a inter uterine ablation. The inner lining of my uterus burned to stop excessive bleeding and pain. I know this sterilized me. Is there any reversal? Getting pregnant would be impossible? How long might my eggs be good for a surrogate womb?  Thanks k~

Dr. Aladjem: I assume you were told before the ablation, that you will not be able to be pregnant. I am not aware of any reversal procedure for an ablation, whether it was freezing, heat or laser. If you are contemplating a surrogate-womb event, you should see a Fertility specialist. He/she, will be in the best position to guide you to the best alternative for your case. With advancing age, eggs may have problems and pregnancies have a higher chance of resulting in an infant with chromosomal abnormalities.

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Question from S. : I had a tubal ligation four years ago and regret it…can you get pregnant after a tubal with no reversal?

Dr. Aladjem: You cannot get pregnant without a reversal, unless the tubal ligation fails After four years, this possibility is very, very remote. I am sorry. .

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Question from M..Z.M. : How long after a m/c do the pregnancy hormones last?

Dr. Aladjem: I assume that by m/c, you mean miscarriage. There are various pregnancy hormones. They all decrease their levels very rapidly, because the placenta –which generates these hormones – is gone. In some abnormal circumstances if placental tissue was left behind or is abnormal, the placental hormones, in particular hCG (human chorionic gonadotropin) may persist and even increase. Placental tissue may become  cancerous, (choriocarcinoma).and the hormone skyrockets.

If you have any suspicion that your hormones are still present after a miscarriage, you should check with you doctor without delay..

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Question form S.O.: I had all the signs of a miscarriage when I was 16, but never knew I was actually pregnant due to having irregular periods or spotting. I never went to a doctor afterwards to 100% find out. If I did have a miscarriage (I would’ve been around only 2/3 months when I miscarried) is it possible that I’m unable to have children now? Going to the doctor and asking for a fertility test at age 18 would get looked down upon even though I do not want to have kids until later in life.

Dr. Aladjem: From what you tell me, there is no way to make a judgment call if that was really a pregnancy (miscarriage) or just another irregular period. I would suggest that you see your gynecologist to make sure that you do ovulate. Bleeding in itself is not a sign that you ovulated. To properly answer your question you need to be examined and most likely have some test. No one is going to look down at you. You may have a problem and you seek medical advice. That is the proper Route to go.

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Question from L. : I am sure many people can benefit from these questions and answers. I have a question too. My period sometimes occurs twice in one month. I also get shooting pains sometimes in my ovary during intercourse. Do you know why I might be experiencing these issues?

Dr. Aladjem: This is not a pregnancy related question. As a courtesy, I will answer it this time.

You do not mention your age. This is important information in the evaluation of irregular periods. These may occur for a number of reasons. Assuming you do not take birth control pills, which may cause it, the most likely is an inconsistent ovarian function, which needs evaluation. Your pain sounds like a pelvic pathology. You may have adhesions, either from a past infection or a past pelvic surgery, if you ever had one. You should see your gynecologist to rule out any ovarian pathology, like cysts, endometriosis and other potential ovarian or tubal pathology.

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Question from A.R.: I do not want to be pregnant ever again. It’s sad to say but it’s because I have a rare genetic disorder. If I wanted to have another child it would be adopting or fostering. I was told there are ways I could by pairing and doing a test and a bunch of other things but I don’t remember the term or what the way to go about it so I can have a child with out a genetic disorder I want to say IVF or something but I have no clue. I can’t remember the term. Is it possible to have a operation or procedure to make a child with out passing on a rare genetic condition I have 22q11.2 Digeorge syndrome.

Dr. Aladjem: I am not aware of any procedure or surgery that would prevent DiGeorge syndrome. As you know this is a chromosomal abnormality, manifested by the loss of a piece of chromosome 22, which is known as deletion.

My suggestion would be for you to consult with a genetic counselor who would be in a better position to advice you face to face.

Fertility treatments may be of help if you consider pregnancy. You could seek an egg donor, fertilize it with your husband/father sperm, and the fertilized egg can be implanted inside your uterus, for you to carry the pregnancy. Since under those circumstance you are just the incubator of the pregnancy and not the natural mother,  your genetic problem would not be an issue. I suggest you consult a fertility specialist, who can advise you about this alternative, should you be so inclined to pursue.

In such circumstance it would also be advisable to see a psychologist. Since you will not be carrying your baby, but your husband’s baby, sometime emotional conflicts may surface. A psychologist would be able to support and guide you through the pregnancy.

I wish you well.

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Question from M.: I’m on the depo shot and I have been bleeding a lot. It’s like a heavy period. Could my birth control fail and cause me to become pregnant because of the bleeding?

Dr. Aladjem: Contraception failure may happen, even if it is not common. The best I can suggest is to see your doctor, be examined, and get back your peace of mind. Also, you may need a different type of contraception. Some women do not respond well to Depo.

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Question from N.N.: I have had 3 successful C-section births with my sons. 2 years later I had two miscarriages within a 6 month time frame, the second being a tubal. I had to have emergency surgery in which case the tube was removed. I was told i could become pregnant and carry successfully again but I bled for almost 6 months after. I finally stopped and started having regular period for 2 months, December/2013 and Jan 2014. My Feb period was 3 weeks late and now here I am in March with no period. I have taken several different pregnancy tests that all show negative but I am having every pregnancy symptom imaginable. Doctors in my area refuse to see you without a confirmed pregnancy test. I really think I may be somewhere between 2 and 3 months pregnant and am worried with these past two miscarriages. Any advice/ help please. I don’t know what to do anymore.

Thanks, scared mom!

Dr. Aladjem: I don’t understand why the doctors refuse to see you. I never heard that an obstetrician refuses to see a patient unless she has a commercial positive pregnancy test. You seem to have a medical problem –irregular periods, delayed periods, no periods. I suggest you see a gynecologist because of abnormal periods. Let them decide what the problem is. If you indeed are 2 to 3 months pregnant, a simple pelvic examination would be able to diagnose it.

Do you have an insurance that requires having a pregnancy test before seeing a doctor? Never heard of that either.

See a gynecologist and when you make your appointment tell them that you have irregular bleeding. They’ll see you.

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Question from D.M.: I had my son 9/11/13 and had two periods and haven’t had a period since December, I breastfeed and have always had an irregular period; I’ve taken tests but all were negative. Could I still be pregnant?

Dr. Aladjem: How could you still be pregnant? You mean, could you be pregnant again? There is always that possibility, although breast feeding is a contraceptive, even if it is not one of the best. The question should be resolved by having a pelvic examination. See your obstetrician that delivered your previous baby.

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Question from M.A.: I just found out that I have a cyst in my uterus. The nurse that did the ultrasound says it’s nothing to worry about but I get really bad pains during my ovulation. Should I get a second opinion? She mentioned that the cyst is “hemorrhaging” and looks like it will eventually “dissolve.” I just am not reassured. The pain that I mention started right after I miscarried last March.

Dr. Aladjem: Didn’t you see the doctor after the ultrasound? That’s most unusual. The person that does the ultrasound, unless the doctor does it him/herself, is not supposed to make diagnosis or give opinions. Only your doctor should do that. By all means seek another opinion.

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You can read more of Dr. Aladjem’s posts here.

Do you have a question for Dr. Aladjem that you would like to see answered in our next “Ask Dr. Silvio Aladjem” feature? Please submit your questions below.

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This column is for the purpose of education and information only. It is not medical advice and should never be used instead of your doctor’s or other health care professional’s advice. Please note that you will find the answer to your question identified by your initials only and confidentiality will be maintained.

 

Dr. Silvio Aladjem, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem is published extensively in Scientific Medical Journals and wrote several textbooks in the specialty.