Woman hasn't had her period since giving birth in 2007

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Woman hasn't had her period since giving birth in 2007
Only 23, but she fears this may be her last child
By Ng Wan Ching

May 16, 2009

SLEEPING CHILD: Ms Lafone Ching with her daughter Le-nel, who is now almost 2 years old. TNP PICTURE: NG XI JIE

IT has been almost two years since her child was born and she suffered heavy bleeding due to placenta and membrane tissues left behind in her womb.

But Ms Lafone Ching's medical problems are not over.

She has not had her period since giving birth and is now facing the prospect of losing her fertility at the young age of 23.

'I want to have more babies and I am scared that this means I can't anymore,' she said.

Her latest problem started last October when she returned to KK Women's and Children's Hospital (KKH) to find out why she had not started menstruating again.

She had stopped breast-feeding last June and her period should have started soon after.

The KKH doctor gave her five days worth of hormone pills to take to try to start her period. She finished the pills, but still no period.

In November, she went back to KKH to find out why the pills did not work.

Said Ms Ching, a hotel reservations officer: 'I was told by my doctor it was because the cervix opening was 'stuck' together.'

She said the doctor told her that these adhesions - called Asherman's Syndrome - were caused by the two womb evacuation procedures she underwent in July and August 2007.

The New Paper reported in August 2007 that Ms Ching suffered heavy bleeding as a result of placenta membranes left behind in her womb after birth.

She had to undergo a womb evacuation procedure in which doctors scrape the lining of the uterus to remove the placental and membrane tissues.

Second procedure

Her womb was perforated during that procedure. And there were still membranes left behind. She had to undergo a second procedure, which managed to clear everything.

During her November check-up, her doctor suggested inserting an IUCD as 'the last method for her period to come'.

An Intra-uterine Contraceptive Device (IUCD) is used for birth control and inserted into the uterus to prevent pregnancy.

But in her case, it would be to help her get her period.

The doctor explained that the T-shaped IUCD could hold the cervix walls apart to try and break through the adhesions, said Ms Ching.

After the IUCD insertion on 19 Jan, she was given one month of hormone pills to take.

On 16 Feb, the IUCD seemed fine in a scan at KKH, but she had yet to have her period, she said. Her doctor suggested another month of hormone pills.

On 6 Apr, when she still did not get her period, she went to KKH. When her doctor checked her, he told her that her IUCD had been inserted 'into the wrong cavity', Ms Ching claimed.

In a reply to The New Paper, KKH said the surgeons had to perform an additional step of opening up a passage in the womb lining cavity, as it was closed or 'stuck', in order to facilitate the subsequent insertion of the IUCD into the uterine cavity.

Associate Professor Tan Kok Hian, chairman of the Division of Obstetrics and Gynaecology at KKH, clarified that the IUCD was not inserted in the 'wrong place' but had deviated a few millimetres from the desired or ideal position because of the difficulties surrounding the procedure.

The IUCD has since been removed at KKH.

Ms Ching's mother, Madam Adelina Ong, 49, a customer service officer, is worried about her daughter's condition.

'What if after all this, Lafone cannot have any more children? She's still so young,' she said.

Possible effects

Depending on the degree of severity, Asherman's Syndrome may result in infertility, repeated miscarriages, pain from trapped blood, and high-risk pregnancies.

Ms Ching said her KKH doctor has arranged to have a private sector specialist do the second IUCD insertion at a private hospital.

'They are planning to do the operation in June or July. I believe KKH will bear the costs,' she said.

When she had her placenta tissue problem after birth, she also sought the opinion of a private sector specialist. Then, she paid for it herself.

'But things have gone wrong again. All this has left a great impact on me and caused me suffering and pain,' said Ms Ching.

 

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Condition often leads to irregular menstruation
May 16, 2009




IT'S common for many women who are breast-feeding or have breast-fed not to menstruate for an extended period.

Their high levels of prolactin, a hormone needed to produce breast milk, may suppress the hormones that trigger the menstrual cycle, said Associate Professor Tan Kok Hian, chairman of the Division of Obstetrics and Gynaecology at KK Women's and Children's Hospital.

During routine follow-up, when a doctor notices that a patient has not had her return of menses for a prolonged period after breast-feeding has stopped, further checks are carried out to exclude other causes such as Asherman's Syndrome.


The condition is characterised by the presence of adhesions within the womb cavity. Menstrual irregularities are among the common features of Asherman's Syndrome.

Ms Ching was diagnosed with it.

This condition is a complication that may affect a woman who has undergone a womb evacuation for retained products of conception such as the placenta and membrane tissues.

Ms Ching underwent two such procedures.

Not rare

According to various overseas research, Asherman's Syndrome occurs in about 25 per cent of women who needed evacuation of the womb after delivery.

Said Assoc Prof Tan: 'The true prevalence of Asherman's Syndrome is unclear as many are unaware of the symptoms or diagnosis. Increased awareness about the condition and its diagnosis is also expected to reveal a higher frequency than previously reported.'

With regard to the insertion of the Intrauterine Contraceptive Device (IUCD), he said it's not common practice to do an ultrasound scan during the procedure to see if the insertion is in the actual position.

'The scan results may be hazy and therefore do not provide the surgeons with an accurate picture. Generally, a scan is done post-procedure (if the patient presents with medical symptoms such as lack of menses),' he said.

For Ms Ching, during a reassessment at the clinic, the surgeon noted the slight deviation in the IUCD's position. As per practice standards, he removed it and advised her on the various options of re-insertion.

Patients diagnosed with Asherman's Syndrome may suffer some common complications such as menstrual irregularities or absence of menses.

'However, it would be premature and inaccurate to advise whether or not Ms Ching, at the age of 23, will menstruate again, as medical options and procedures are still available for her consideration,' said Assoc Prof Tan.