Post-Myomectomy Concerns: Prolonged Bleeding and Clots Explained - Obstetrics and Gynecology

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After undergoing a myomectomy, it is not uncommon for patients to experience various menstrual irregularities, including prolonged bleeding and the passage of blood clots. Your concerns regarding the re-emergence of heavy menstrual bleeding and clots within three months post-surgery are valid and warrant a thorough discussion.

1. Is it normal to have prolonged bleeding and clots after a myomectomy?
It is not unusual for patients to experience changes in their menstrual cycle following a myomectomy. The surgery itself can disrupt the normal hormonal balance and the uterine lining, leading to irregular bleeding patterns. However, continuous bleeding for 30 days, especially if it is heavy and accompanied by clots, is not typical and should be evaluated by your healthcare provider. While some spotting or light bleeding can occur as the body heals, significant or prolonged bleeding may indicate complications such as retained tissue, infection, or hormonal imbalances.

2. Possible causes of prolonged bleeding and clots:
- Retained Uterine Tissue: If any fibroid tissue or endometrial lining remains after the surgery, it can lead to ongoing bleeding.

- Hormonal Imbalances: The removal of fibroids can affect hormone levels, leading to irregularities in the menstrual cycle.

- Infection: Post-surgical infections can cause abnormal bleeding and should be ruled out.

- Uterine Scarring (Asherman’s Syndrome): In some cases, scar tissue can form in the uterus, leading to abnormal bleeding patterns.

- Other Gynecological Conditions: Conditions such as adenomyosis or endometriosis can also cause prolonged bleeding and should be considered.

3. Recommendations for treatment:
- Consult Your Gynecologist: It is crucial to follow up with your healthcare provider to discuss your symptoms. They may perform a pelvic exam, ultrasound, or other diagnostic tests to determine the cause of your prolonged bleeding.

- Monitor Symptoms: Keep a detailed record of your bleeding patterns, including the amount, duration, and any associated symptoms (such as pain or fever). This information can be helpful for your doctor.

- Medications: Depending on the underlying cause, your doctor may recommend medications such as hormonal treatments to help regulate your menstrual cycle or medications to manage bleeding.

- Surgical Intervention: In some cases, further surgical intervention may be necessary to remove any retained tissue or address other complications.

In summary, while some irregularities can be expected after a myomectomy, prolonged bleeding and the presence of clots should not be overlooked. It is essential to seek medical advice to ensure that any underlying issues are addressed promptly. Your health and well-being are paramount, and timely intervention can help prevent further complications.