Post-Miscarriage Bleeding: What to Expect and When to Seek Help

Post-abortion hemorrhage that does not stop?

At 5 to 6 weeks of pregnancy, on April 14, the doctor informed me of a miscarriage and prescribed three days' worth of uterotonics.
During a follow-up appointment on April 28, the doctor noted that some retained products of conception had not been expelled and prescribed another three days of uterotonics.
The nurse advised that if the bleeding continued for another week, I should return for another check-up.
I started bleeding on April 12 and continued until May 6.
On May 7, I had intercourse, and on May 8, I experienced what seemed like the onset of menstruation, as I felt some dull pain in my lower abdomen similar to menstrual cramps.
From May 10 to May 11, the bleeding increased significantly (more than double the amount I experienced during my pre-pregnancy periods).

1.
Can you tell me if this means that the miscarriage has been completely managed?
2.
Since the bleeding increased starting May 8, is this considered menstruation or retained products of conception?
3.
Is the increased bleeding from May 10 to May 11 considered normal?
4.
How long should I rest before trying to conceive again for the best outcome for my uterus?

Judy, 30~39 year old female. Ask Date: 2017/05/11

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description of the menstrual situation, it seems that these are not normal menstrual phenomena, and therefore it is difficult to determine whether you are truly experiencing menstruation.
I recommend that you consult a gynecologist to arrange for urine tests, ultrasound, or blood tests to determine whether a miscarriage has been completed or if irregular bleeding is caused by hormonal imbalances.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2017/05/11

More Info

Post-miscarriage bleeding can be a concerning experience for many women, especially when it is accompanied by pain or unusual changes in bleeding patterns. Understanding what to expect and when to seek medical help is crucial for both physical and emotional recovery.

1. Is the bleeding considered to be "cleaned out"?
After a miscarriage, it is common for women to experience bleeding known as lochia, which can last for several weeks. The fact that you were prescribed medication to help with uterine contractions suggests that your healthcare provider was concerned about the possibility of retained tissue, which can lead to complications. If you are still experiencing bleeding weeks after the miscarriage, it may indicate that not all tissue has been expelled. A follow-up ultrasound may be necessary to determine if there is any retained tissue in the uterus.

2. Is the increased bleeding after May 8th a normal part of recovery or a new menstrual cycle?
The increase in bleeding you experienced starting May 8th could be due to several factors. It might be a continuation of lochia, especially if it is still within the timeframe of typical post-miscarriage bleeding. However, if the bleeding is heavier than your normal menstrual flow, it could also indicate the onset of your first menstrual period post-miscarriage. It is important to monitor the characteristics of the bleeding—if it is bright red, accompanied by clots, or if you experience significant pain, you should contact your healthcare provider.

3. Is the heavy bleeding on May 10-11 normal?
Heavy bleeding that is significantly more than your usual menstrual flow, especially if it occurs after a miscarriage, should be evaluated by a healthcare professional. While some women may experience heavier bleeding as their body adjusts post-miscarriage, it is essential to rule out any complications such as retained products of conception or an infection. If you are soaking through pads in an hour or less, or if you experience severe pain or fever, seek medical attention promptly.

4. How long should you wait before trying to conceive again?
The timing for trying to conceive after a miscarriage can vary based on individual circumstances. Generally, healthcare providers recommend waiting for at least one normal menstrual cycle before attempting to conceive again. This allows your body to recover and ensures that your menstrual cycle has returned to its regular rhythm, which can help with dating a future pregnancy. However, some studies suggest that conceiving soon after a miscarriage may not increase the risk of complications. It is best to have a discussion with your healthcare provider about your specific situation, including any physical or emotional factors that may influence your decision.

In summary, while some bleeding after a miscarriage is normal, it is essential to monitor the amount and characteristics of the bleeding. If you have concerns about retained tissue, heavy bleeding, or if you experience significant pain, it is crucial to seek medical advice. Additionally, discussing your plans for future pregnancies with your healthcare provider can help ensure a healthy and supportive approach to your reproductive health.

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