tsj98

Dr. Seibel - thanks for your response of 8/23/07.  here is an update since August.  I have had two periods after having 4 months of none with my FSH at 146, LH 101 and estradial<15.  Now my FSH is down to 12 and my estradial at 88.  After having the CT scan showing the cyst and possible fibroid an ultrasound was done.  It showed a cyst on my ovary, a cyst to the side of it and a tumor in the uterus.  During this process over the last 6-8 months my RBC and hemoglobin have been low along with my Ferritin low also when i did not even have a period for several months of this time.  MY white blood cell count has also been low.  My PAP in June was ASCUS.  This is the first time I have ever had an abnormal PAP.  The HPV, however, came back negative.  What should I be concerned about?  Could the cysts appear simple now but change and should I be concerned about the tumor in my ovary given my blood work results over the last 6-8 months.  

[Machelle Seibel, MD]

It is not uncommon for blood levels of FSH to fluctuate between high and normal in the window around menopause. Eventually they will just remain high but for the next months they might go up and down.

Taking iron supplements will restore the low levels and together with a multivitamin, should make the blood count normal as well. It is best to take the iron and vitamins for at least 3 to 6 months because the body also needs to store extra amounts.

For cysts of the ovary, most doctors just repeat the ultrasound every 2-3 months to watch them and see if they go away. The cyst might be an abnormal ovulation that made the FSH go down and this type of cyst usually goes away in a few months. If it does not, your doctor will discuss removing it, usually by laparoscopy.

About 30% of abnormal pap smears are not due HPV. Just repeating the smear and doing local removal of abnormal areas in the office is often enough to take care of this problem. Many doctors repeat pap smears every 3 months, often combined with colposcopy which looks like binoculars mounted on a stand. This helps see the abnormal areas better.

It is likely that with careful follow up, all of this will resolve. But in the worst case, watching it carefully will allow treatment early, and that should correct the problem if it doesn't go away on its own.
Machelle M. Seibel, MD