Postpartum Bleeding: Causes, Treatments, and Hormonal Effects

Lochia postpartum

Hello Doctor, I gave birth naturally on May 26 and did not breastfeed.
About three weeks postpartum, my lochia changed from clear to red.
I went to the emergency room, and the doctor said my uterine contractions were poor.
They prescribed uterotonics and hemostatic agents.
After taking the first hemostatic pill, I felt a bit cold.
After three days of medication, the lochia gradually decreased, but on June 20, I suddenly noticed a small amount of red lochia again, which was only present when I wiped.
I continued to monitor it, and today, June 23, I returned for a check-up.
The vaginal ultrasound showed that my uterus was clean, and there were no wounds upon examination.
The doctor prescribed a hemostatic agent (I took the first pill today and felt a bit cold again—could this be a side effect, or should I just keep observing?).
They also prescribed pain relief and antibiotics, but no uterotonics since the doctor said my uterus had returned to normal size.
The doctor mentioned that after finishing the five-day course of medication, the bleeding should gradually darken until it stops.
If red bleeding occurs again, I need to return for a follow-up and possibly start birth control pills, as it may be due to hormonal changes.
I would like to ask the doctor if the purpose of taking birth control pills is to regulate hormones? The doctor also mentioned whether it could be my period.
If it is my period, will taking the current medication affect it? I apologize for so many questions and thank you for your help.

Bao, 20~29 year old female. Ask Date: 2016/06/23

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, natural delivery on May 26.
It is normal to have lochia one month postpartum, as long as the amount is not excessive.
My suggestion is to continue monitoring, and there is no need to take contraceptive pills.
Wishing you good health.

Reply Date: 2016/06/23

More Info

Postpartum bleeding, or lochia, is a common concern for many women after childbirth. It is essential to understand the causes, treatments, and hormonal effects associated with postpartum bleeding to manage it effectively and ensure a healthy recovery.

Lochia is the vaginal discharge that occurs after giving birth, consisting of blood, mucus, and uterine tissue. It typically lasts for several weeks and progresses through different stages, starting with bright red blood (lochia rubra) and gradually changing to pinkish-brown (lochia serosa) and then to yellowish-white (lochia alba). The duration and amount of lochia can vary significantly among women, influenced by factors such as the mode of delivery, whether breastfeeding, and individual health conditions.

In your case, it seems that you experienced a delay in the transition from lochia to a more normal state, which led to concerns about uterine contractions and potential complications. The fact that you were prescribed uterine contraction medications and hemostatic agents indicates that your healthcare provider was addressing the possibility of uterine atony, a condition where the uterus does not contract effectively after delivery, leading to prolonged bleeding.

The sudden reappearance of bright red blood after a period of decreasing lochia can be concerning. It may indicate that the uterus is still shedding tissue or that there is a hormonal imbalance affecting the menstrual cycle. The hormonal changes that occur postpartum can be significant, especially if you are not breastfeeding. Breastfeeding typically helps suppress ovulation and regulate hormonal levels, while formula feeding may lead to a quicker return of menstrual cycles.

Regarding the use of contraceptive pills, your doctor likely suggested them to help regulate your hormonal levels. Birth control pills can provide a steady dose of hormones, which may help stabilize your menstrual cycle and reduce the risk of irregular bleeding. If the bleeding you are experiencing is indeed related to hormonal fluctuations rather than retained products of conception or other complications, hormonal regulation through contraceptives can be beneficial.

It is also important to monitor the color and amount of bleeding. If you notice a return to bright red blood after it has darkened, or if you experience any additional symptoms such as severe pain, fever, or foul-smelling discharge, you should seek medical attention promptly. These could be signs of infection or retained placental tissue, both of which require further evaluation.

In summary, postpartum bleeding can be a complex issue influenced by various factors, including hormonal changes and uterine recovery. It is crucial to maintain open communication with your healthcare provider, follow their recommendations regarding medications, and report any concerning symptoms. Your health and well-being are paramount, and understanding the underlying causes of your symptoms will help you navigate this recovery period more effectively.

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