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What is the reason for heavy, irregular periods after delivery?

Q: I am 24 years old female with a 2 years 2 months old son. I had a caesarean delivery and my appendix was also removed 4 years back. I have a problem of delayed and painful period from the beginning. After my delivery I got my first period after one year (around a year ago). Then the periods were coming almost regularly. But since a couple of months they have again become irregular and the last time they came were after the doctor prescribed some tablets. This time also it is delayed by 3 weeks. Also, the periods are painful. Presently, I am having pain in the lower abdomen quite often. I have seen a doctor and she has prescribed several tests including US for lower abdomen and pelvis. The reports are as follows: Ultrasound (Lower Abdomen and pelvis) - Uterus measures 66x34 mm, Endometrial thickness of 7.3mm, Left ovary normal, Right Adenexa reveals 23x31mm T.O. mass. No free fluid in pelvis, Urinary bladder shows no filling defect, No wall thickening or echogenic debris seen. So the opinion is - A small right Adenexal T.O. mass. Is it a tumour which needs surgery? How can it be treated? Will it ever get dissolved? The other blood tests done were for thyroid which was normal, Montoux test was negative, ESR - 38 (normal is 0 to 20), S. Prolactin - 5.2 (normal is 8.4 to 20.2). So kindly advise me whether it is a very serious problem and how it can be treated?

A:You seem to have many complaints which may or may not be related. Heavy periods and irregular periods generally have different reasons. If you have this problem after delivery at your age, heavy periods are more likely to be due to infection of the lining of the uterus called endometritis and a course of antibiotics is all you may need. Endometritis is the commonest complication of a caesarean section and as many as 70% women who have a caesarean section have some infection in the lining of the uterus. I suggest you take a course of broad spectrum antibiotics if your gynaecologist agrees with the possibility of infection. These infections can be persistent and can be very nagging and a repeat course of antibiotics may be required a few months later. If you have pelvic infection of any sort probably the most classical sign is painful sex and I wonder if you have it. If you do it is almost certainly due to an infection (the only other cause is endometritis which needs to be looked into). The ultrasound report you have written is not very precise. By definition, to call a mass an adenexal mass it should be at least 5 cm thick and generally anything smaller than 3 cm (30mm) is not due to a disease. So I do not know what to make out of it. 30 mm of around that size water filled cysts are common and occur all the time in a woman's life and they disappear on their own. They are of no consequence and do not need an ultrasound to make a diagnosis. The cause of delayed periods will have to be looked into. By the way are you still breast feeding the child (which may cause irregular periods and heavy ones)? Long cycles are rarely due to a serious disease and please get investigated only if it persists more than 6 months or so. Chronic ill health and stress can cause delayed periods. And if your periods are delayed they would be a little heavy. For example if you have periods after two months they would be one and a half times heavier than you periods if they come monthly (if not twice) because the lining of the uterus accumulates inside and you will have a heavier prolonged period. Since your thyroid is normal and there is no evidence of any other cause on ultrasound like PCOS you should not worry too much about delayed cycles at this point.

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