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Infertility/Fertility/Bleeding 6 weeks after hysterectomy

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QUESTION: I am a 60 year old woman who had a Da Vinci robotic total hysterectomy (overies and cervix removed) for stage 1 endometriod cancer of the endometrium on April 10/2013.  I had a 6 week post-op appointment and was doing great. However, yesterday I had cramping on the lower right side and some in the  vaginal cuff area. I also had some  minor bleeding. The blood was red and did not seem to be as a result of dissolving sutures possibly common at this time . Previously, I only had bleeding for a few days post-op and nothing since yesterday. I may have Ehler's Danlos (awaiting genetic testing) and have friable tissue. I am completely following the oncologist's  post-op instructions relating to exertion, sex, etc. I am not to have "relations" until 12 weeks post-op.
The cramping is only mild today and the bleeding stopped. I haven't been able to reach the oncologist or his nurse today. That is why I'm on "all experts". I find your site extremely helpful.

Do you have any thoughts on this matter? I would greatly appreciate it.
Thank-you

ANSWER: Hello Harriet from Canada,

At 1 month from surgery you should not have any type of bleeding.  Bleeding means that something in the vagina is not right.  The most common problem is "granulation tissue" formation, which is benign overgrowth of healing tissue and it bleeds easily.  Another possibility is separation of the incision in the vagina.  Since you had surgery for cancer, there is also the worry of cancer in the vagina.  My recommendation is to see your gynecologist or gyn oncologist for an examination.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: Thank-you for your prompt response. i really appreciate it. Slight correction: my post-op was at 3 weeks , not 6 weeks. Also, histopathology was done and no evidence of cancer found outside of the uterus. Five small incisions were made in the abdominal area; however, the uterus was removed vaginally. There was only ~ 30% invasion of the adenocarcinoma  in the myometrium. I am only scheduled for a follow-up  with the gyno-oncologist in one year. How could secondary cancer present itself in the vagina only 6 weeks post-op, particularly since none was detected previously, and the cancer was well-differentiated? Would granulation necessitate incisional revision? Since the bleeding stopped after ~ 24 hours, could granulation still be an issue. On April 10, I also had surgery for abdominal adhesions and a repair to an incision from a previous umbilical hernia repair.I don't heal well and previous incisions (varicose vein stripping, abdominoplasty, carpal tunnel surgery) show hypertrophy.
Best wishes

Answer
Hello Again,

I don't thing that cancer is likely but it is something that has to be considered.  It could be a new cancer or a metastasis but based on the description you provided, it is unlikely.  Granulation tissue is the most common cause of vaginal bleeding and although the bleeding has stopped, granulation tissue will continue to grow and cause bleeding off and on.  A simple vaginal examination can detect this and it is easily treated using chemical treatment.  Recent studies show a very high risk of vaginal wound/cuff dehiscence or opening.  This could also be a cause.  In many cases it will close on its own, but again, I would recommend an examination to make sure.  You don't need to go see the Gyn oncologist, but in the U.S., complications or problem are usually care for by the doctor that did the surgery.  You can have an exam done by your regular gynecologist for find and treat the problem.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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