Patient: I am 28yo. I birth by c-section. I recently have been having trouble with bleeding in between periods. I had a Pap smear the end of February and it was normal, they did a ultrasound and found 2 cyst and also said I have thick lining in my uterus. The doctor put me on progesterone for 2 weeks to try and regulate my period. I completed it about 3 weeks ago and I have not had any bleeding at all. Also I recently noticed a pea size lump on my cervix. What could that be from? Should I be concerned and the lump and the not bleeding?
Doctor: Hello,Thanks for the query to ATD,As understood from the history that you have been experiencing inter-menstrual bleeding lately since some months and have your pap smear report as normal. The most likely cause of inter menstrual bleeding in reproductive age group is breakthrough bleeding or irregular shedding which occurs due to decrease in progesterone levels or luteal phase defect. It was in this regards that after finding the endometrium thickened that you were placed on progesterones for 2 weeks to compensate for progesterone deficiency and was expected that once you would stop the progesterone pills, you shall experience a normal withdrawal bleed which shall be your menses.But as you have not recieved any withdrawal bleed since 3 weeks from the last day of progestin intake then before anything, you must get a urine pregnancy test done which if turns out to be negative, then you can opt for a serum progesterone level test to look for hormonal deficiency. Post the test if your periods are still absent then within a week you should then opt for a dilatation and curettage procedure to remove the old unshed endometrium to allow a fresh cycle to start. You may be placed on progesterones from day 15-day25 of your cycle for 3-6 months to make up for the deficiency and regularise your cycle.The small lump that you have perceived over the cervical lip is probably a nabothian cyst which is a benign lesion of cervical gland and is of not much clinical importance.I hope i have answered your query in detail, you may discuss the options with your physician ,Wishing you good health,Regards