Refused a smear but worried about symptoms.

[LuSmithTheMyth]

Hey there, new to these forums but haven't got any answers anywhere else and I've noticed these forums are quite active so maybe here I'll have more luck.

I just had my baby ten weeks and a half ago. I had a normal vaginal delivery and no problems with bleeding during pregnancy, just severe abdominal cramping from time to time during last trimester. My bleeding was heavy for the first few weeks and tailed off after four weeks, returning as light pink spotting two weeks after which didn't go until I had a seven and a half week check in which I was given the depo provera jab. My bleeding cleared for two weeks but I still had yellowy discharge, however in the last week spotting has returned. It smells a little too and I have lower back pain, pelvic pain and tenderness and bowel problems. I asked at my seven and a half week check for a smear test and she refused saying that they wouldn't look at it. I'm 27 and had my first two years ago which came back negative (normal). I'm due one next November. My symptoms are concerning me as they seem to all point to the big C. I don't know if something as Cervical Cancer would progress so fast so soon as I've never had abnormal bleeding before but I've had a yellow odorous discharge for as long as I can remember (since I was sexually active perhaps). Around the time of my first smear I had a full STD check which all came back normal (also 2 years ago or so).

I know abnormal bleeding doesn't necesarily point to such a worrysome thing, and that maybe it's been triggered by depo provera again or a hormonal imbalance, even cervical errosion perhaps, but I would feel better knowing a smear test result, then any abnormal result could be looked into. Should I bypass and find somewhere that would give a colposcopy? I asked to be referred three times to a gyne and got the same answer - no need.

I have an ultrasound (only external) on the 2nd Jan, which I'm worried might not pick anything up. I have no other means of investigation going on.

I've considered a private smear if I'm refused again but I don't know where to go for one as I live in South Kent. (UK)

Advice?

Who did you see the dr or a nurse? I'd imagine a private gp would see you theres one in the midlands who charges £65 for a consult but obviously a smear test will be more.

If your not happy with your gp dont forget you can always change practice just by attending a new one and asking to register. I did that for dh and I years ago.

I guess so but the only two near to me merged together so it wouldn't make a difference. Unfortunately the GP I go to is a group practice so there's about nine doctors there and the majority of them I've seen and haven't seemed worried- I only asked one doctor regarding a smear and she flat out said they would throw it away! I'm seeing her tomorrow regarding a pelvic examination I think (not a smear) as I couldn't handle it at my 6 week (7 week) check. The only thing she recommended that time was having intercourse with my partner so the speculum wouldn't hurt me when she did an examination. I don't think thats the answer to pelvic pain and abnormal bleeding but there you go!

I think you have to ask why they are refusing you a smear, there must be a rationale behind it. Eg if its too soon after the baby etc then ok and you do have an ultrasound booked.

If its just professional pride then seek a bupa clinic out. Or nag, you would not believe the inappropiate refs health professionals recieve because a patient has nagged, GP's give in eventually.

Yeah I will probably try nagging tomorrow since I've got an appointment with her, but she'll probably just ignore my pleas as usual. I'll then have to make another appointment with the doctor. I don't want to have this on my mind for too long or leave it too late! I know two years is probably a very short time for something like this to occur or spread and I know I'm probably worrying too much but reassurance helps..

I think 10 weeks post birth your problems may still be delivery related did the midwife say that they whole of the placenta had come away? (especially if discharge is smelly). Has a swab be en taken of the discharge.

Cramping duriung your 3rd trimester is not unusual. Whilst it is undertsandable that you are concerned I think that the ultrasound is a good place to start.

BTW I have seen on threads about smears previously that the labs have a very strict protocol with regard to doing them if you do not fit the criteria they will not process, so it would be a waste of time them taking it and you having the ordeal. (I happy to be corrected on this tho')

Yeah I can imagine they have a quite strict protocol :( I just think that if others can have yearly checkups why can't they check out someone with symptoms of abnormal bleeding and pain? I don't really want to wait another year for it to be too late by then.

The severe cramping hasn't returned as such, I am having bowel problems, lower back pain and abdominal cramps but I get pelvic pain as well. I'm told the pelvic floor is all close together so thats fair enough but the abnormal bleeding worries me. If I didn't have this it wouldn't give me such a worrying outlook.

I've had a blind swab taken twice despite not being able to have a cervical swab and both times it came back normal. So they say its obviously not infection. I'm not sure what they checked for though - just bacteria I imagine, though they don't check for every STD I bet. I wouldn't have thought I would have one so soon after birth though, considering I haven't had sex for five months plus.

A smear is a screening test rather than an investigation for symptoms, IYSWIM.

Even if your GP did a smear the lab wont look at it if it is outside their protocol.

Has your GP discussed with your what the plan is for further investigation if the ultrasound doesnt show any cause for your symptoms?

No she hasn't mentioned what they would do should an ultrasound show no problems.. I've only got an external and if it shows nothing I'm hoping they'll think to give a transvaginal considering my symptoms but who knows! I know they don't give you an answer there and then though, which concerns me because after the ultrasound I'm not sure what options I have. I'm considering not having the next shot of depo in case it is that but I had the irregular pink bleeding before that so I figured it can't really be related.

I dont know - what else do they offer for those in my situation do you reckon?

If you have an appointment to see the GP tomorrow perhaps you could ask them what the plan is?

Do they know what your fear is? If you tell them they should be able to discuss with you whether it is a likely cause of your symptoms.

She just told me not to worry and that my fears were unconfounded but this was three weeks ago now, so obviously with it not going away on its own I'm panicking more.

I'm gonna ask what the plan is tomorrow, and what she thinks it could be.

it's quite easy to get a private smear at any local private ( such as BUPA) hospital for around £50.

However, it's highly unlikely that you have advanced cervical cancer which is causing bleeding. Much mire likely to be related to your hormones and delivery.

Post delivery bleeding can last as long as 6 weeks, and any further bleeding could be hormone related. Are you BF?

No formula feeding :( could be hormone related I guess, but maybe ultrasound will put my mind at rest.

I doubt advanced cervical cancer but my worries are getting worse- I'm not in any severe pain but dull pain and tenderness and bleeding is light.

I'm gonna convince her to check my cervix tomorrow to see if its okay anyway via pelvic exam if I can stand it (gonna have to though) and beg for something to be done to ease my mind!

Hello there, as a practice nurse I hope I can put your mind a tiny bit at rest!

To answer your question about smears, you can't really do one before 12 weeks after having a baby vaginally as there will not be enough cells at the cervix to test - they need to regrow after the trauma of birth. So any test taken now would probably come back as 'inadequate cellular material' and you'd then have to wait another 12 weeks for cellular regrowth - so it wouldn't really help to have one now.
The symptoms you describe are not unusual for 10 weeks after giving birth at all! Def go and see your GP and get your mind put at rest but post birth bleeding and discharge does drag on and everyone's different in how long it takes to go away. I hope this helps, and best wishes to you xx

HI there, sorry you are so worried. I am in a similar position myself.

In my case, I had the reminder note to come for a smear when pregnant which Wasn't advised when pregnant. I asked for a smear when I had a coil fitted 13 weeks post natally but they wouldn't do one for the reasons Naomi has said above. I have had strange bleeding but the rational part of me kind of knows this is to do with BF and the coil fitting. I also have a lots of discharge and have had a negative swab; the discharge can also be attributed to the coil. Maybe in your case it is hormonal; post natal and hormone injection?

My baby is 6 months now and I had a smear this week; I had to cancel appointments as I was bleeding previously; cycle all over the place. I haven't had the results of the smear yet.

I am a bit anxious about the result BUT I am completely paranoid about my life at the moment. I feel too lucky to have my wonderful baby and my other children, my husband, our home etc ..... I feel that I am too lucky and something must come along and spoil it; at the moment cervical cancer is the thing my mind is focussing on, my hormones are still all over the place and the rational part of me knows I am a bit crazy. Your post made me wonder if you are in that similar post natal fog where you can't think straight (even though you think you are). Apologies if I'm totally wrong and it's only me then.

I would wait until 3 months post natal at least and then demand a smear and if they still won't do one, look up well woman check online and go for a bupa or Ppp check where they will do a smear.

catsareevil is correct - a 'smear test' or cervical screening test is for women without symptoms.
It sounds like the surgery have pencilled you in for an examination which is what they are supposed to do and it should include visualisation of the cervix. If they've taken blind swabs then its possible that if you do have an infection that the (possible) infected area hasn't been sampled. If the exam tomorrow goes ok then they may have another go at taking a swab. Also some infections are quite difficult to grow in the lab.

Website links
NHS CSP
NHS Direct
Clinical practice guide for assessment of young women with bleeding

Hi OP, sorry you're not feeling well. Your symptoms sound very much like pelvic inflammatory disease to me. I've had two infections in the past, both characterised by spotting/irregular bleeding, bowel problems, pelvic pain & cervical tenderness etc. The GP mis-diagnosed on both occasions & was generally unsympathetic & useless.

If you don't feel happy with how it goes tomorrow, do go to your local STI clinic. They are far more specialised in these matters and should do a thorough screening & physical exam for you. They can also advise you on the depot & alternative contraceptive methods.

Try not to worry but do make sure you rule out PID as it can happen post-partum. It may even have caused your 3rd trimester issues. It's easily treated with antibiotics but symptoms do take a while to settle down.

Congrats on the baby & hope you feel better soon.

I had constant bleeding with the depo so the bleeding could be related to that rather than anything more sinister

Just a tiny point, catsraeevil and Bela - smear tests are done if a woman is symptomatic but the cervical screening programme is a separate entity, i.e if you go to your GP with abnormal bleeding they will do a smear regardless of when you last had one done under the screening programme.

As Naomii said above, they are most likely refusing to do a smear because a smear at less than ~ 14 weeks post natal will likely not give a sample that can be read in the lab.

Paying for one privately won't change this. They should have explained that to you, of course, but it's not just your GP being awkward. The test is pointless for at least another two weeks and probably at least four to be safe.

A lot of your symptoms could just be post-natal normality, but if you're worried, book another appointment, and open by saying that you know it could be nothing but that your really don't feel well and could they do a thorough check over to make sure.

Thanks guys, its really great of you all to be so understanding and reassuring at a time like this.

Naomii - I don't think I was aware of this, I thought that most of the time cells come back as abnormal after birth rather than inadequate because of the change in hormone levels, I wasn't aware that they couldn't read them at all! I guess the bleeding and discharge I could understand given the depo jab, hormones etc, but I was concerned about the pelvic pain etc too at the same time.

Zipitydoodaa- I'm sorry to hear you're going through this too :( I totally understand where you are coming from and my thoughts of this are consuming me more day after day, at first I was trying to put thoughts of it aside but as my symptoms aren't clearing it drives me to thinking insane things! I've got to a place also where I have a great OH, a baby, a good life, I don't want things to go wrong either. You'll have to let me know of your result, I hope you enjoy Christmas nonetheless! If you were 13 weeks and they still refused then perhaps they would refuse me too :(

Bela - thanks for the info etc. I know that they tend to not like to do smears outside of the program (I was told that the lab would just throw it away anyway) but I would have thought abnormal symptoms would throw a caution to them and they would want to do something about it. I just hope they can take more swabs today to ease my mind (though I won't know any answers until the new year I imagine..)

StripeyZ - I was actually concerned it was this too.. though I know a blind swab would probably not pick it up and it could be something only a proper examination could or a proper swab of the cervix.. how did they find yours was PID? Did they eventually get a proper sample or just give antibiotics??

Seona - I figured that the depo could be the cause of the bleeding, so I'm trying hard not to be irrational but the pelvic tenderness and pains do not help my case :( I have no idea what that is.

ginnybag - I guess it's best to wait and only have done what I can as you say, but I'm scared of getting something sorted too late and being with the thoughts of "if i'd been sorted out soonerr...." I just really hope that its nothing and my bodys just taking longer to settle :\

The thing I get scared the most about is that I did tend to have a lot of strange discharge (yellow, brown) for a long time before I fell pregnant even and after having unprotected sex with OH for the first time it only clicked that maybe I contracted the bad strain of HPV virus (I don't want to make him sound bad as he loves me and I him but hes had quite an active past sex life). I don't know...

Also Naomii - if the cells take a while to grow back does this mean its unlikely to be anything bad?? :\

Hi Lu, the answer to your question is no, not necessarily. I am sure when you see your GP he/she will be able to reassure you that your symptoms are not unusual and most likely can be sorted ever so easily. You would be surprised at how many ladies come into my surgery terribly stressed and scared about 'down below' symptoms, it's very easy to jump to the worst case scenario. So you're not alone.
It's also very common to have been exposed to HPV, remember most of us clear the virus by ourselves and it goes away altogether. Cervical cancer is rare really, especially in younger women.

The other thing that is very common is to be a bit anxious after having a baby and to have repetitive thoughts about harm coming to you, dp or your baby. If you feel it getting a bit on top of you then do mention it to your HV, as I say, it's not out of the ordinary. I'm so glad you're talking about it here, by the way - things are so much better spoken about than whirling around in your head whilst sleep deprived and hormonal! xx

Thanks Naomii.. I appreciate the advice you've given me. I can imagine I probably have been exposed to HPV at some point in my life being young and sexually active but I'm just hoping my body would do enough to fight it away. I know my symptoms are not highly unusual on contraception/just after a baby when things are settling but I went to the GP and I feel even more awful than before! She managed to tell me cervical cancer is rare and I guess deep down I know this but knowing people who've had abnormal cells scares me too. The only thing is the GP practically shouted me down for feeling the way I did because I'd mentioned a smear test to her before and made me feel like a wally for even panicking about anything - she said she would take me seriously if I was pouring blood but since I'm only bleeding lightly that there's nothing unusual and she thinks the pain is "psychological" which I don't agree with as I've never had this pain before. Makes me so mad. She told me off royally, and said she didn't want to go anywhere near to check me for anything because the last experience had been so awful (she'd tried to give me a pelvic exam at 7 weeks postpartum and I was still so horribly tender so couldn't have it done)... I feel like I'm terribly in the wrong.

So sorry you had a bad experience Lu. Charming social skills your GP has there...
Nobody's ever in the wrong for being worried so put that thought away. But what she has told you is that there isn't too much to be concerned about so I think you should try and hold on to that. Also hold onto the fact that it generally takes at least 10-15 years from infection with HPV for cancerous cells to develop.
This website is fantastic, btw - have a look www.jostrust.org.uk/
x

LuSmith Thank you for your comments, I will still enjoy Christmas, I hope you do too.

Naomii, I wish you were the practice nurse at my surgery, you sound so sensible and understanding. The thing you said about anxiety after having a baby has really hit a nerve with me.