Will I be able to have another child?

Saturday, November 07, 2009 4:49 PM

All Woman

By Dr Sharmaine Mitchell

Monday, April 20, 2009

Dear Dr Mitchell,
I am a 32-year-old mother of a 10-year-old child. About a year ago, I started having very strange coloured menstruation. Recently it cleared up a bit but there is still a lot of clotting on the fourth day (end) of the cycle.

At the end of 2005 and 2006 I had to visit the doctor with the same complaint as well as irritating itching. In 2007 the itching came back and this time I went to a different doctor and he gave me something different. The itching did not reappear in 2008. I want to have another child but I am wondering if this discolouration and clotting will cause a problem for me along with my age.

The problem that you have been experiencing with the abnormal colour of your menstrual flow may be due to an infection in the lining of the uterus (endometriosis). This can also result in heavy menstrual periods with excessive clots. Other causes of heavy periods include uterine fibroids, excessive thickening of the lining of the uterus (endometrial hyperplasia) or endometrial cancer. However, endometrial cancer tends to be rare in women of your age group whilst fibroids are extremely common especially in black women.

The vaginal itching that you experience may be due to a bacterial infection or a yeast infection. Bacterial vaginosis is one of the most common vaginal infections and presents with itching, a greyish white discharge and a fishy odour from the vagina. This is not necessarily sexually transmitted but if it is a recurrent then your partner should be treated. Trichomonas vaginalis is also a bacterial infection but this is definitely sexually transmitted. It presents with vaginal itching, a frothy greenish-coloured vaginal discharge and a fishy pungent odour. The treatment of this infection is similar to that of bacterial vaginosis. Metronidazole (Flagyl) is the drug of choice and can be given in the form of tablets by mouth, a vaginal gel or pessaries.

A yeast infection (candidiasis) also presents with vaginal itching. This fungal infection presents with a thick, curdy white discharge but does not have an odour. It is not necessarily sexually transmitted but if it tends to be recurrent then both sexual partners should be treated.

You should also consider doing a pap smear to screen for cervical cancer since this can also present with abnormal bleeding and an abnormal vaginal discharge. A physical examination and an ultrasound scan will help to diagnose uterine fibroids or abnormal thickening of the lining of the uterus.

I do not think that you should have any problems with conception because you are still quite young, but you should get a detailed physical examination done along with the appropriate investigations to determine the underlying cause of your heavy menstrual bleeding and vaginal infection before trying for conception.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025.

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