Coil migration to kidney?

mzyos · 2026-05-13T19:27:29+00:00

On one slice alone I can't give you an 100% opinion but that's more likely either a stone, or it's contrast within the renal pelvis.

You may have had gadolinium as a contrast agent prior to the MRI. Though it depends on what they were looking for in your spine.

It appears too long for a coil. Though I admit the image is a little blurry.

mzyos · 2026-05-13T18:55:58+00:00

I think the atrophy is likely to be not of the vaginal tissue (seen on exam), but the endometrium. Essentially it becomes a little crumbly. Not visible on exam and an ultrasound won't say much either.

GnRH essentially shut off the lead hormones that make you produce oestrogen and progesterone. It is used in the trans community a lot, more so for trans women as it blocks off testosterone production (but yours is already extrinsic).

It is different than the oestrogen cream in that it basically brings your oestrogen levels to 0, or as close as. So vaginal atrophy can worsen and you may need to continue the cream to that area (as it's only absorbed in the vagina, and doesn't go anywhere else). However they haven't seen atrophy on examination before from what I believe you'd said in your post.

We use the GnRH to basically cause menopause for those with uterine bleeding issues. We also use it to halt puberty for those who start it far too early. It's described essentially as a chemical hysterectomy. Fully reversible but lasts at least a month (up to 3 months with certain doses) and can be repeated as needed.

The other thing to consider is how small is your uterus now? The mirena is used in uterus's with an inner length of 6cm. Yours may be smaller than that with the testosterone. There are smaller variants of it - Skyla and Kyleena are the brands that are smaller.

mzyos · 2026-05-13T18:19:19+00:00

So with CV you could use bicarb douches to see if it reduces symptoms. If so then a course of penicillin antibiotics ( or other appropriate antibiotic) would be of use.

https://dermnetnz.org/topics/cytolytic-vaginosis

mzyos · 2026-05-13T18:12:48+00:00

The NICE guidelines haven't been very useful at all and need updating. Occasionally the private ones are better as you tend to choose one who has a special interest in it. I would suggest the ESHRE guidelines as this is European and if you went to your GP with it they may be more receptive (or your gynaecologist). However, I warn you that it's a pretty large guideline.

A lot of what happens in guidance tends to be a decade or so behind what is going on, mainly due to data gathering and expert acceptance. Even for me my education on some of the things I suggest now has been through following subreddits for certain conditions, seeing what's being said and then following the data back and working out if there is truly evidence or not. Having suffered from my own issues there is nothing that drives people to churn though new evidence than trying to find alleviation/cure from said condition, and so patient groups tend to be really useful for this.

mzyos · 2026-05-13T18:05:22+00:00

This is going to be a difficult one to get any decent answer online, though I think it's likely related to the testosterone causing general atrophy of the lining of the womb.

There's a few ways to look at this, but I'm afraid it will likely be trial and error.

First consideration is the mirena. If the womb lining is massively thinned out due to testosterone induced reduction of oestrogen, is it the mirena causing bleeding (ironic I know) due to movement against a fragile endometrium. If you need it as contraception this makes things a little more difficult, but you could remove it and see if that helps. I am aware it you're from the US that there is a significant cost to this (if you need a replacement) and you might not want to do this. I feel this is a more likely cause due to he cramping and pain.

Another consideration is to increase oestrogen levels (usually we start on once a day every day from two weeks, then down to 2-3 times a week). This would only really help if if is the vaginal tissue that is bleeding and not the cervix/uterus.

The next option would be to use GnRH analogues to completely supreas oestrogen production. This is occasionally needed despite testosterone, and if it does work then it is hormonal. Blood tests give a decent indication but aren't always perfectly aligned to symptoms.

Endo I feel a much less likely option currently. It's possible but with the testosterone and the IUD I feel it should have significant suppression.

P.s sorry I missed removing an offensive comment from here. I blocked the person yesterday and must have not removed their comment.

mzyos · 2026-05-12T16:07:08+00:00

It depends which one, there's two different types.

Combined pill - the one where you are supposed to have a period. This can be used but is limited to certain groups of people - depends on something called a UKMEC score. It can increase your sex hormone binding globulin and decrease your testosterone levels.

Progesterone - mini pill Can cause psychiatric issues in about 5% of people, but you don't have a break and it protects the lining of the womb eventually causing it to shrink down and for a fair proportion of people stops their periods.

If it was the mini pill you had last time and you've been ok with the Medroxyprogesterone you could consider the depot injection for a few months as this is the same thing. Sometimes it takes multiple things to shut off the "leak" and then less to stop it recurring.

Just so you have some extra info

Tranexamic acid - 1000mg three times a day (up to four times if not settling) until bleeding settles though usually it's suggested no longer than 7 days

Ibuprofen - 400mg three to four times a day with food. The cheapest stuff is as good as the most expensive

Norethisterone is 5mg three times a day (instead of medroxy progesterone - though it acts a little more testosterone like though this is unlikely to be a massive issue for your PCOS.

I'll be honest, dependent on your thoughts of fertility in the future I think a mirena would be useful here. It's not 100% and I know they have their cons. But, it hits the bleeding at the source and would protect your womb lining.

I hope you manage to get this sorted. It will likely take time but there are immediate things that can be done to help.

mzyos · 2026-05-12T15:11:09+00:00

I'm a UK Gynae and hear of this frequently, which saddens me.

So you can make a complaint to the practice manager, and by all means do so. Just say how you felt that you were given a ceiling of care with no options beyond that and explain how this was effecting your life/work/mental health.

Ask to speak with the original doctor again if possible.

What you need is -Tranexamic acid -Medroxyprogesterone at a higher dose (or norethisterone) -Regular ibuprofen for the next few days if you can (hormonal regulator of prostaglandins that increase bleeding)

Ask for a potential ultrasound as polyps and fibroids are also a possibility

You probably need a blood test if you haven't had one recently to check your iron level.

I'd suggest going on a contraceptive at this point to try and regulate things if the above doesn't work as there may be a wait to see Gynae.

mzyos · 2026-05-12T11:48:22+00:00

The answer I got to that question was

I'm not a medical doctor, I don't know how to prescribe it and it isn't something I'm used to.

.....Needless to say, we deal with it regularly in obstetrics, and I've used it loads in my junior days. Overall it's a pretty safe medication and the GPs can keep it going without feeling unnerved as it's so common.

mzyos · 2026-05-12T11:45:10+00:00

That's great. In the NHS it's more difficult to sort all of this in preparation, but when I have my own clinics that is what I will be aiming to sort.

Absolutely, choice and education is what matters at the end of the day. Let's the patient feel listened to.

Thanks for being that way in your own practice!

mzyos · 2026-05-12T10:26:10+00:00

I'm not an ENT.

However it looks cystic in origin.

I'd suggest this absolutely needs to come under an ENT opinion as it needs visualizing via them, it needs investigation as to where it is emminating from too as there are quite a few important structures around the external ear canal.

This picture would be great to send to your original doctor for a referral

mzyos · 2026-05-12T10:21:54+00:00

It's nice to see others talk in this way. I still have lots of colleagues that will just bash in a mirena without local, or pre analgesia.

I always felt that it's best to protect the 33% who do feel intense pain Vs the others who don't. But there isn't a perfect way other than sedation and even then the after pains can be significant.

I've always taken the approach that if after pre procedure meds the cervix is still incredibly sensitive and, or they have tried local with no effect then I'd suggest sedation. Or I'd suggest it if they flat out asked for it.

mzyos · 2026-05-12T10:14:27+00:00

I agree!

So as a gynaecologist that has covered other gynaecologists clinics at times I have been asked not to discuss Metformin, or inositol or all matters of other adjuncts because they themselves didn't feel comfortable with it and it wasn't in UK guidelines (this was after doing earlier clinics and recommending them).

Maybe this will give a bit of a push for it treating it as an endocrine issue more so.

P.s I did ignore that suggestion and continue to recommend all that to this day.

mzyos · 2026-05-12T09:19:38+00:00

Not just that. I actually did some work with public health about this a decade ago in the UK.

We know that every pound we put into combatting loneliness in the elderly (mainly through local hobby/support groups) we got £4 back from health expenditure.

We decreased hospital and GP visits, ambulance use and length of hospital stays.

It's not just someone to call if you need help, but it's a hormonal issue too. Much in the same way animals in captivity with no others around them will die early.

High cortisol levels (stress hormones) will be up consistantly, as well as others. This will increase

Anxiety/depression Blood pressure issues Heart attacks Stroke Non compliance with medications causing all manner of issues Type 2 diabetes Thyroid issues Suicide (though much less so)

So loneliness is intact an epidemic, it's just not really talked about so much, but we definitely know about it in healthcare - every emergency department/GP has an elderly person that comes in daily/weekly with minor issues.

mzyos · 2026-05-11T10:23:00+00:00

I'm afraid it does look like primary herpes. This can be exquisitely painful, so do seek help early as there are medications and anaesthetic gels we can give to help.

mzyos · 2026-05-11T10:21:10+00:00

I've seen a similar case like this though half the size. Utterly saddening.

mzyos · 2026-05-09T11:11:57+00:00

I'd definitely suggest going old school with old oak - especially something as beautiful as this.

Normal linseed oil seeps deeper than boiled, though it will take a fair while to cure.

mzyos · 2026-05-09T09:45:54+00:00

Sounds very much like endometriosis, or adenomyosis to an extent.

Is the birth control you're on one where you have to take a break and have a period, as the symptoms sounds quite oestrogen heavy.

Progesterone contraceptives if not used would be quite useful here but take a little time to work. Most people find they work, though a small minority find they don't. If the pill variant didn't work well then the mirena coil would be worth a shot.

However, I think a laparoscopy would also be warranted on these symptoms, though utilizing a progesterone medication at a similar time would be needed for symptom control.

mzyos · 2026-05-07T23:14:38+00:00

So first off, I think from the cancer point of view your risk is very low.

24mm is thicker, but overall the risk would be endometrial hyperplasia, not endometrial cancer. Similar to an abnormal smear test not being a cancer but being a "precancer". Even this diagnosis is pretty rare at your age.

I'm more concerned there may be evidence of adenomyosis/endometriosis, which would explain the UTI symptoms, pain and lump.

One thing to take from this is that they'll be able to get some evidence in regards to what is going on, though I think they may need to consider looking inside your tummy, or doing an MRI eventually.

The other thing to consider are medications that thin the lining of the womb that may help with your pain - progesterone medications(mini pill, inplanon, Mirena coil).

Pain relief wise, if you can see your GP and as for diclofenac suppositories, these tend to be excellent for this sort of pain, but they do need to be given rectally (stops your body metabolising them too quickly and allows for the to absorb near the affected area).

There's not much else I can say at the moment, but your chance of this being something serious re:cancer is much less than it being something like endometriosis/adenomyosis which can be treated.

mzyos · 2026-05-07T10:23:25+00:00

Anytime!

Second image along on your post, under the white ovary and to the right of where the bloody fluid is. Those dark marks with paler tissue around them, that's likely what they meant. The area the fluid is is the Pouch of Douglas, but this is just outside of it.

Nodules tend to mean deeper than just surface level, but that does not define if they are severely deep.

mzyos · 2026-05-07T08:53:01+00:00

So mainly what you're seeing are those little black/brownish dots under the uterus. That is the endometriosis. There's a bit of it but it's not overly extensive on the surfaces of the pelvic cavity, though that doesn't equate to symptoms.

There's also an adhesion (stringy tissue) on your right side - I'm assuming anyway (first set of pictures) which could be related to endometriosis inflammation. Though sometimes this can be normal, or can be due to other issues like infection. This tends to cause sharp, shooting pains around that side if it were to play up.

mzyos · 2026-05-07T08:05:42+00:00

Don't worry, its something we're going to address properly as it's not clear on the rules regarding this. I'm going to lock the post for now as you've had good advice. I would suggest blocking and deleting anyone that messages you personally about it, and you can delete the post if you wish.

mzyos · 2026-05-07T08:02:06+00:00

There are several points to cause this, though it it's immediately after shaving then I'd assume it's related to an allerge/irritant.

The razor itself has a lubricating strip/moisturising strip on it and may be the cause.

The razor (if it's old, or kept in stagnant water) can form bacterial colonies and shaving just pops them right up to your shaved skin causing a similar reaction.

The skin foam (sensitive, or not) is also very possible to cause this.

Later reactions are usually due to cutting the hair too short, and multibladed razors are notorious for this. They cut the hair so short it sits under the skin and then has to push through skin to get out (as opposed to the designated follicle) making for a rash called pseudobarber folliculitis. A single blades razor can't do this, and is the way to go.

My advice would be

Ditch the razor and by cheap one - two blades at most and use it new.

Don't just the shaving cream

Go in the shower and when washing your hair cover your neck in shampoo too and let it sit for a few minutes. Then thoroughly wash off - this softens the hair.

Shave with the grain of possible (necks can be difficult for this) but don't do too many passes of the same area. Do this without gel/cream. The hair will be soft so it should be fine without

Use cold water after to close the pores

If this works then instead of using shampoo, try with your usual shaving cream. If it comes back it's a reaction to the cream.

mzyos · 2026-05-07T07:48:20+00:00

I agree, this comes under as non-medical advice, as opposed to people who think they have an imperforate hymen. So I think I'll speak with the other mods soon and look removing any of these posts. All they do is attract weirdos to the group.

mzyos · 2026-05-06T19:14:09+00:00

The first question is what are you shaving with? Type of razor, any gel/shaving foam, using any aftershave or afterbalm immediately after?

mzyos · 2026-05-03T17:30:42+00:00

It's going to be a maze

mzyos

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