Post-Myomectomy Complications: Prolonged Menstrual Issues Explained

Less than three months after uterine fibroid surgery, there is a recurrence of prolonged menstrual periods and occasional heavy bleeding?

1.
Is it normal to experience signs of uterine atony after undergoing surgery for uterine fibroids (surgery in January of this year)? It has been less than three months, and I have had heavy bleeding since early April.
Besides taking uterotonics and hormonal medications, how can I restore normal uterine contractions? My menstrual period has lasted for 30 days (still ongoing) since the surgery, with intermittent blood clots and heavy bleeding.
After a follow-up visit, I took uterotonics for 7 days, but it was ineffective.
After another follow-up, I switched to hormonal therapy, which reduced the bleeding but it still continues.
After stopping the medication for about a day, fresh bleeding appeared again the next afternoon and has persisted.
I am now considering resuming hormonal therapy.
How long might it take to see a return to normal menstrual cycles? Do you have clinical experience with similar patients? Should I consult another specialty—perhaps for stress management? (I occasionally wake up at night with my head drenched in sweat.)
2.
The uterine fibroids were not large, and I underwent an open abdominal surgery.
Is it normal to feel various sensations of numbness and fullness in the lower abdomen?
3.
The tissue removed during the surgery was sent for pathological examination, and everything was normal.
Thank you for clarifying these concerns.

GI, 40~49 year old female. Ask Date: 2018/05/07

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
Is it normal to experience signs of uterine atony after undergoing surgery for uterine fibroids (surgery in January of this year)? It has been less than three months, and I have had heavy bleeding since early April.
Besides taking uterotonics and hormonal medications, how can I restore normal uterine contractions? My menstrual period has lasted for 30 days (still ongoing) since the surgery, with intermittent blood clots and heavy bleeding.
After a follow-up visit, I took uterotonics for 7 days with no effect.
Upon returning for another follow-up, I switched to hormonal therapy, which reduced the bleeding but it still continues.
After stopping the medication for about a day, fresh bleeding appeared again the next afternoon and has continued.
I am now considering resuming hormonal therapy.
How long might it take to see a return to normal menstrual cycles? Do you have clinical experience with similar patients? Should I consult another specialty—perhaps for stress management? (Occasionally, I wake up at night drenched in sweat.) Answer: The surgical outcome has not been satisfactory, and due to various unclear explanations, I am unsure how to respond.
I recommend seeking a second opinion from another physician.
2.
Is it normal to feel various sensations of numbness and fullness in the lower abdomen after an open surgery for a relatively small uterine fibroid?
3.
The tissue that was removed during the surgery was sent for pathological examination, and everything was normal.

Reply Date: 2018/05/07

More Info

Post-myomectomy complications can be quite complex, and it is not uncommon for patients to experience prolonged menstrual issues following surgery. In your case, it seems that you are dealing with several symptoms that can be attributed to uterine atony or inadequate uterine contraction after the myomectomy.
1. Prolonged Menstrual Issues: After a myomectomy, it is possible for the uterus to take some time to return to its normal function. The fact that you are experiencing prolonged bleeding (30 days and counting) with blood clots is concerning and should not be overlooked. It is not unusual for some women to experience irregularities in their menstrual cycle after such a procedure, but persistent heavy bleeding is a sign that further evaluation is necessary. The use of uterotonics (medications that promote uterine contractions) and hormonal treatments is common in these situations, but if these are not effective, it may indicate that there is an underlying issue that needs to be addressed.

In terms of how long it may take to see improvement, this can vary widely among individuals. Some women may notice a return to normalcy within a few cycles, while others may take longer. It is essential to maintain open communication with your healthcare provider about your symptoms. If the hormonal treatments are not yielding the desired results, it may be time to consider additional diagnostic evaluations, such as an ultrasound, to check for retained products of conception or other complications.

2. Abdominal Sensations: The sensations of tingling or fullness in the lower abdomen after an abdominal myomectomy can be attributed to several factors, including postoperative healing, scar tissue formation, or even nerve irritation. It is not uncommon for patients to feel some degree of discomfort or unusual sensations as the body heals. However, if these sensations are accompanied by significant pain, changes in bowel or bladder habits, or other concerning symptoms, it would be prudent to follow up with your healthcare provider.

3. Psychological Factors: Stress and anxiety can significantly impact menstrual cycles and overall health. If you are experiencing night sweats and other symptoms of anxiety, it may be beneficial to discuss these with your doctor. Sometimes, a referral to a mental health professional can help address the psychological aspects of recovery, which can, in turn, improve physical symptoms.

In conclusion, while some degree of menstrual irregularity can be expected after a myomectomy, persistent heavy bleeding and other concerning symptoms warrant further investigation. It is crucial to work closely with your healthcare provider to monitor your condition and adjust treatment as necessary. If you feel that your current treatment plan is not effective, do not hesitate to seek a second opinion or ask for a referral to a specialist, such as a reproductive endocrinologist or a gynecologist specializing in menstrual disorders. Your health and well-being are paramount, and addressing these issues comprehensively will help you achieve a better quality of life post-surgery.

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