Prolonged Bleeding After Endometriosis Treatment with Birth Control

Prolonged bleeding after using contraceptive pills to treat endometriosis?

Hello Doctor, I was recently diagnosed with mild endometriosis and started taking Microgynon 30 (Levonorgestrel 150 micrograms, Ethinylestradiol 30 micrograms) for a total treatment duration of 63 days.
During the treatment, I did not experience any unusual symptoms or discomfort.
However, starting on the fifty-fifth day of the treatment, I began to experience menstrual bleeding.
Initially, it was light spotting, but the amount gradually increased (dark in color) until days sixty-two and sixty-three, when the bleeding became quite heavy, comparable to the third or fourth day of my menstrual cycle before starting the contraceptive pill, accompanied by typical menstrual cramps.
Now, it has been five days since the end of the treatment, which is the thirteenth day of the bleeding, and I am still experiencing a moderate amount of bright red menstrual blood.
I have read other articles on Taiwan's e-hospital website stating that if the bleeding is not excessive and does not last more than three months continuously, it is considered normal.
However, I would like to ask the doctor how to determine if the current duration and amount of bleeding are normal, especially since the bleeding has lasted longer than expected without signs of stopping.
The articles mention continuous bleeding for three months; does this refer to normal bleeding amounts or just spotting? Should I schedule a follow-up appointment for further evaluation? Thank you for your response.
Since I am currently seeking medical advice abroad, I appreciate your professional consultation.
(P.S.
I would like to mention that I have hypothyroidism and take Levothyroxine 100 micrograms daily.
I have checked and it should not affect my condition, but I wanted to mention it just in case.)

Xiao Ming, 30~39 year old female. Ask Date: 2018/12/20

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Mild endometriosis, started taking Microgynon 30 (Levonorgestrel 150 micrograms, Ethinylestradiol 30 micrograms), total treatment duration of 63 days.
During the process, there were no special sensations or discomfort, but on the fifty-fifth day of treatment, I started experiencing menstrual bleeding.
Initially, it was light spotting, but the amount gradually increased (dark in color) until days sixty-two and sixty-three, when the bleeding became quite heavy, comparable to the third or fourth day of my period before starting the contraceptive pill, accompanied by typical menstrual cramps.
Now, it is the fifth day after completing the treatment, which is the thirteenth day of the menstrual bleeding, and there is still a significant amount of blood (moderate, bright red in color).
I have read other articles on the Taiwan e-Hospital website, which state that if the bleeding is not excessive or does not last continuously for more than three months, it is considered normal.
However, I would like to ask the doctor how to determine if the current duration and amount of bleeding are normal, given that the bleeding has lasted longer than usual and shows no signs of stopping.

Answer: Based solely on the description, it is difficult to determine whether the amount and duration of bleeding are normal.
In the past, I have seen definitions stating that continuous bleeding for three months is considered normal; is this normal bleeding or just spotting?
Answer: The articles from Taiwan e-Hospital can be used as a reference, but the clinical physician's diagnosis should be prioritized.
Should I return for a follow-up examination?
Answer: Yes, you should return for a follow-up.
Thank you for the doctor's response.
Since it is difficult to seek medical care abroad, I specifically sought professional consultation.
(P.S.
I would like to mention a bit about my personal condition: I have hypothyroidism and take Levothyroxine 100 micrograms daily.
I have checked and it should not affect this, but I wanted to mention it just in case.)

Reply Date: 2018/12/20

More Info

Prolonged bleeding after treatment for endometriosis, particularly when using hormonal contraceptives like Microgynon 30, can be concerning and warrants careful evaluation. Your experience of experiencing bleeding that began on the 55th day of treatment and has persisted even after completing the regimen is not uncommon, but it does raise questions about the underlying causes and whether further medical intervention is necessary.

Firstly, it is important to understand that hormonal treatments, including birth control pills, can lead to changes in menstrual patterns. Some women may experience breakthrough bleeding or spotting, especially during the initial months of treatment. This is often due to the body adjusting to the hormonal changes. However, if the bleeding becomes heavy or prolonged, it may indicate that the body is not responding as expected to the medication.

In your case, the bleeding started as light spotting and progressed to a heavier flow, resembling your typical menstrual cycle. The fact that you are experiencing significant bleeding (described as medium flow and bright red) 13 days after the end of your treatment raises a few considerations:
1. Breakthrough Bleeding vs. Menstrual Cycle: Breakthrough bleeding can occur with hormonal contraceptives, but it typically resolves within a few days. If you are experiencing a flow similar to your regular menstrual cycle, it may indicate that your body is transitioning back to its natural cycle after stopping the medication. However, if this bleeding continues or worsens, it is essential to consult with your healthcare provider.

2. Duration and Volume of Bleeding: The definition of "normal" bleeding can vary. While some sources may state that bleeding lasting longer than three months is concerning, it is crucial to consider the volume and the pattern of bleeding. If you are soaking through pads or tampons every hour or passing large clots, this could indicate a more significant issue that requires medical attention.

3. Underlying Conditions: Given your history of endometriosis and hypothyroidism, it is essential to rule out any complications. Conditions such as uterine fibroids, polyps, or even a resurgence of endometriosis can contribute to abnormal bleeding. Your thyroid condition, while generally stable on Levothyroxine, can also influence menstrual patterns, so it is wise to keep your healthcare provider informed about any changes.

4. When to Seek Medical Advice: If the bleeding persists beyond a few days, becomes heavier, or is accompanied by severe pain, dizziness, or other concerning symptoms, you should seek medical attention promptly. It may be necessary to perform an ultrasound or other diagnostic tests to evaluate the cause of the prolonged bleeding.

5. Follow-Up Care: Since you mentioned that you are currently abroad and finding it challenging to seek care, consider scheduling a follow-up appointment with a healthcare provider as soon as possible. It is essential to have a professional assess your situation, especially since you have ongoing symptoms.

In summary, while some degree of bleeding can be expected after stopping hormonal treatment, the persistence and volume of your bleeding warrant further evaluation. It is crucial to monitor your symptoms closely and seek medical advice to ensure that any underlying issues are addressed promptly. Your health and well-being are paramount, and proactive management is key to navigating these challenges effectively.

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