I Have Endometriosis With Blocked Tubes & A Previous Ectopic

Dear Dr. Ramirez,

A few years ago, I had an IUD inserted to which my body never adjusted to.  I bled the entire time until it was removed months later to discover that it caused an infection.  This year I became pregnant in January, and in February the ectopic pregnancy was removed by a laparoscopy procedure.  At that time, I learned that I have/had endometriosis, my left fallopian tube had been scarred completely shut, and the right fallopian tube was where the pregnancy had occurred.  The endometriosis had attached my uterus to my bowel, but was removed in the same surgery.

Since then, I have had long and inconsistent cycles.  Every cycle, I experience spotting for the first 2 weeks after my period.  For example, my last full cycle started with my period on September 4, 2013.  I bled the first week, then spotting until September 24 when I thought I had ovulation symptoms.  I had ovulation symptoms again on October 18 or 19, and had a normal luteal phase with my next cycle starting November 1, making a 58 day cycle with 3 weeks of bleeding/spotting at the beginning of the cycle.  Before the surgery, I had a fairly consistent 32 day cycle.

My fear is that my right fallopian tube is not healing properly, and like the left scarred from the IUD, is scarring beyond repair.  Or, perhaps there is another reason for the abnormal spotting and long cycles?  My husband and I have been trying to conceive since the ectopic pregnancy with no luck. 

Any help or insight is appreciated. L. from the U.S.

Answer:

Hello L. from the U.S.,

I don’t know of anything that a laparoscopy would cause irregular or abnormal bleeding short of impeding the blood supply to the ovaries thereby causing an ovarian shut down.  I don’t think that is what is happening here.  So, in essence, I’m not sure that the laparoscopy and abnormal bleeding are related necessarily.  The most common reasons for abnormal bleeding are hormonal and anatomical.  Therefore, you need to have your hormones analyzed to make sure that the ovaries are functioning normally.  Anatomy is evaluated by ultrasound and hysteroscopy to rule out structures such as fibroids or polyps that can cause abnormal bleeding.

In terms of your fertility, the ectopic may have been the death knell for a natural pregnancy.  You have Stage IV endometriosis (severe) which by itself can prevent pregnancy but in addition, you have a tubal factor where one tube is blocked and the remaining one now injured, possible beyond repair.  I think that any reproductive specialist would advise that you will need to proceed to IVF in order to achieve pregnancy.

At the very least, your answers cannot come from the internet, rather, you need to see a competent gynecologist to do an evaluation.

Good Luck,

Edward J. Ramirez, MD FACOG