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Infertility

Why Am I Not Menstruating After 15 Months?

09/12/2008

Question:

I am a 36 year old non smoking woman with no known medical problems. I had a normal birth delivery at the age of 18. I had a missed abortion about 2 years ago and another loss at 6 months in May 2007 due to an "unspecified disorder of the uterus", claimed by my physician. After the delivery, I was given a D&C and hysteroscopy. Tissue samples were sent to the lab and the results being called placenta accreta. My menstruation has not returned to this day. I recently went for a physical and my doctor claimed I have scarred tissue from the surgery which could be one of the reasons why I have not been menstruating. The doctors seem to be guessing about my condition leaving me with unexplained answers to my questions. Could I have been misdiagnosed or do I need a second opinion from a specialist?

Answer:

Because of your history, you could have Asherman's syndrome (intrauterine scarring).  An easy way to evaluate the uterus and tubes would be a hysterosalpingogram or HSG.  This is an x-ray test in which dye is injected into the uterus; x-ray pictures are then taken which demonstrate whether the uterine cavity is normal, as well as whether the fallopian tubes are open.  A pelvic ultrasound can be performed before the HSG to determine if there is a collection of blood in your uterus. 

Finally, I would recommend that you have hormonal testing to rule out hormonal causes for your lack of periods.  This can either be done through your physician, or using a reproductive endocrinologist-infertility specialist. 

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Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati