QuestionQUESTION: I am 47 yrs old and had a tubal ligation 10 years ago. My last menstral cycle started on August 20th and was not out of the ordinary. About a week after my period ended, I began bleeding again and did not stop until Sept 20th. On Sept 20th I went in for a routine pap (already scheduled before the unexplained bleeding) and the doctor noted an enlarged uterus. I then went in for a ultrasound which also included internal. The ultrasound results showed a corpus lutem cyst on one or my ovaries, a nabothian cyst, and a cystic lesion that resembled a gestational sac with no baby. I then had a blood pregnancy test; it was negative. Both the ultrasound and pregnancy tests were done before any missed period. Although my last period was long, I have not started my period for this month. I know that the probability of pregnancy is very low and if there was a pregnancy that it would most likely be etopic.
My question is what can resemble a gestational sac but isn't a gestational sac? Could it be a cyst too? Or could the tests have been too early and I could be pregnant? I am scheduled for more testing in October, but I would like to have some answers or opinion prior to that if at all possible.
I also was diagnosed about 5 yrs ago with HPV and had laser surgery on my cervix. Another question... can HPV lie dormant for 20+ years? I have been married for 27 years and have never been with anyone but my husband. I asked if he cheated and he said no, but it just seems weird to be diagnosed with a sexually transmitted disease when I have only been with one man and he says he has not cheated. He has been with other women before we got married though.
Any answers or opinions that you can offer would be most helpful and very much appreciated.
Thank You for your time and willingness to help others out of the kindness of your heart.
ANSWER: Dear Jeanine,
As far as the enlarged uterus/cysts, etc,..., I would really want to withhold any opinion. There is just too much missing information and potential variables. You are right in that your chances of it being a pregnancy are low (approximately 1% or less of tubal ligations fail). On a sonographic image, I really do not know if there are any other possibilities that would resemble a gestational sac. That would be a question for a doctor or radiologist.
I can tell you that if you had a normal period on 8/20, a potential pregnancy would be at 4 weeks, 3 days on 9/20. In a healthy pregnancy, the gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks. However, if this was seen on an ovary rather than within your uterus, your doctor will want to keep a close eye on it to make sure that it is not actually an ectopic pregnancy.
Now, as to the HPV - Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.
Approximately 20 million people are currently infected with HPV. At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80% of women will have acquired genital HPV infection.
There are many kinds of HPV and not all of them cause health problems. Some kinds of HPV may cause problems like genital warts or cervical cancer. HPV types 16 and 18 cause about 70% of cervical cancers. HPV types 6 and 11 cause about 90% of genital warts. Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis.
So, yes, because most people who have a genital HPV infection do not know they are infected, you can have HPV for many years before ever being diagnosed. Most women are exactly like you and are diagnosed through an abnormal Pap smear.
I hope this information has helped you and answered your questions. I wish you well.
Brenda
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QUESTION: My August menstral cycle started normal and ended I thought normal until a few days later I started bleeding again. I bled until Sept. 19th in which I went in for a scheduled pap smear that just happened to coincide with this unusal period. This was the first time I have ever had a period or any bleeding between periods. I have not had another period since then. Does having a long period or bleeding for that long make the next cycle not occur on time? I have always been 28 days a part and my periods are 5 to 7 days long.
During the pap is when the dr. noticed an enlarged uterus. During the ultrasound a nabotian cyst was found, a cyst on one of my ovaries and this "gestational sac" in my uterus. I have taken a blood pregnancy and a urine test and both came out negative. So, So, I guess I am not pregnant. I just do not know what else could resemble a gestational sac?
I have had regular pap smears my whole life; might not be every year but within a reasonable amount of time. I was never diagnosed with HPV until I had an abnormal pap. I do not have the wart kind and it is the kind that can cause cancer because the cells on my cervix were precancerous. I just do not understand how I could have a sexually transmitted disease when I have only been with one man and we have been faithful to each other for 27 years? My husband has never had any symptoms and my only symptom was that one pap smear in which I had laser surgery to remove the cells.
So what you are saying, is that my husbans since he was with other woman before me that he was infected and then he infected me and for 20 years it lay hidden within me and then just showed its ugly face one day and then went in hiding again? I just don't see how something could be in me for 20 years and then cause problems. But at least it makes me feel better knowing that my husband could have been faithful and did not cheat on me after our marriage.
I guess you basically answered my first questions it just seems weird that I have something that resembles a gestational sac but it isn't and you do not know of anything that can resemble/mimic a gestaional sac but a gestational sac.
AnswerDear Jeanine,
I know - the HPV thing is confusing. And before we actually found the HPV virus and started linking it with abnormal Pap smears, women just had bad Paps and didn't think it had anything to do with anything else. If the HPV strain is type 16 or 18 or another that causes the cervical dysplasia, then a male probably wouldn't exhibit any symptoms at all.
As far as the gestational sac - or what they thought looked like one - I'm sorry I cannot answer that question for you. It is simply beyond my expertise and I am not the kind that gives fudging-type answers when I really don't know. I will research questions that I need more specifics on and give information as I can find it, but this one I just don't know. It will be easy for them to answer within a few weeks. After the 6th week, if it is actually a gestational sac and hCG levels were simply too low to read positive before, development would be enough that heart activity should be noted. Otherwise, as I said, as to what else it could be... that is something you'd need to ask your doctor or radiologist.
As for the bleeding, yes. Because the previous month's bleeding lasted so many days, it would not be unusual for your cycle to "re-set" so to speak. Your period may not come again for a few weeks unless the cysts are now going to cause some menstrual irregularity.
Hope that helps. Be well.
Brenda
