Post-Surgery Concerns: Heavy Menstrual Flow After Chocolate Cyst Removal

Postoperative Issues After Chocolate Cyst Surgery

Hello, doctor.
I underwent surgery for a chocolate cyst on December 5, 2018 (8 cm on the left ovary and 4 cm on the right ovary).
After the surgery, I started taking Danazol, one pill daily, and I have just completed one month of treatment.
My first menstrual period began on January 8, 2019, and it has continued until now, January 18, 2019, lasting for 10 days with no signs of decreasing flow.
The amount of bleeding each day is greater than the first day of my menstrual cycle before the surgery.
Is this normal? During my follow-up appointment on January 17, 2019, the doctor mentioned that the ultrasound showed no fluid accumulation or blood, and the ovaries have returned to normal.
It was suggested that the heavy menstrual flow might be due to slow uterine contractions.
The doctor then prescribed me two medications: one to stop the bleeding and another to enhance uterine contractions, which I am to take three times a day.
I have taken two doses so far, but it seems that the menstrual flow has not decreased.

1.
Is it normal for the first menstrual period after surgery to be heavy and last more than 10 days?
2.
How long should it take for the medications to stop the bleeding and enhance uterine contractions to take effect?
3.
How many days of continuous bleeding should prompt me to return for a medical consultation? (If the hemostatic medication is ineffective)
4.
How should I calculate the timing of my next menstrual period?
5.
Currently, I am experiencing heavy bleeding and often feel as if the menstrual flow is coming from the urethra.
I am unsure if it is actually coming from the urethra or if the heavy flow is affecting the urinary area.
6.
How long after surgery can I resume sexual activity?

nina, 20~29 year old female. Ask Date: 2019/01/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On December 5, 2018, a chocolate cyst surgery was performed (left ovary 8cm, right ovary 4cm).
After the surgery, I started taking Danazol, one pill daily, and have been on it for a month.
My first menstrual period began on January 8, 2019, and as of now, January 18, 2019, it is still ongoing.
The menstruation has lasted for 10 days and the flow has not decreased; in fact, the daily flow is greater than the first day of my menstrual cycle before the surgery.
Is this normal? Answer: It is not normal.

The follow-up appointment on January 17, 2019, showed no signs of abdominal fluid or blood in the ultrasound, and the ovaries have returned to normal.
The doctor suggested that the heavy menstrual flow might be due to slow uterine contractions.
The doctor then prescribed two medications: one to stop the bleeding and another to enhance uterine contractions, which I am to take three times a day.
I have taken two doses so far, but it seems there is no sign of reduced menstrual flow.

1.
Is it normal for the first menstrual period after surgery to be heavy and last more than 10 days? Answer: It is not normal.

2.
When can I expect the bleeding and uterine contraction medications to take effect? Answer: It varies from person to person.

3.
How many days of continuous bleeding should prompt me to return for a check-up? (If the bleeding medication is ineffective) Answer: If bleeding continues after finishing the medication, you need to return for a check-up.

4.
How should I calculate the timing of my next menstrual period? Answer: First, stop the bleeding.

5.
Currently, I have a heavy flow and often feel like the menstrual blood is coming from the urethra.
I am unsure if it is actually coming from the urethra or if the heavy flow is affecting the urinary area.
Answer: Menstrual blood does not affect the urethra.

6.
How long after the surgery can I engage in sexual intercourse? Answer: After the menstrual bleeding has stopped.

Reply Date: 2019/01/18

More Info

After undergoing surgery for a chocolate cyst, it is not uncommon to experience changes in menstrual flow, especially during the first few cycles post-operation. In your case, having a prolonged and heavy menstrual period lasting over ten days can be concerning, but it is essential to understand the context of your surgery and the medications you are taking.

1. Is it normal to have a prolonged and heavy menstrual flow after surgery?
It is not unusual for women to experience heavier and longer menstrual periods following surgery for a chocolate cyst, particularly if hormonal medications like Danazol (the drug you referred to as "異位寧") are being used. These medications can take some time to stabilize your hormonal levels, and the body may react with heavier bleeding as it adjusts. However, if the bleeding is significantly heavier than what you experienced before surgery, it is important to monitor the situation closely.

2. When will the medications take effect?
The medications prescribed to you, including the hemostatic agent and the uterine contraction enhancer, typically take a few days to show their effects. It is essential to follow the prescribed dosage and timing. If you do not notice any improvement in your menstrual flow after a few days of taking these medications, you should contact your healthcare provider for further evaluation.

3. When should you seek medical attention for prolonged bleeding?
If your menstrual bleeding continues beyond 14 days or if you experience symptoms such as severe pain, dizziness, or signs of anemia (like extreme fatigue or paleness), you should seek medical attention immediately. Continuous heavy bleeding may indicate complications such as retained tissue or other issues that may require further intervention.

4. How to calculate the next menstrual cycle?
After a prolonged period, it can be challenging to predict your next cycle accurately. Generally, menstrual cycles are counted from the first day of one period to the first day of the next. If your bleeding stops, you can start counting from that day. However, given the irregularities post-surgery, it may take a few cycles for your body to return to a more predictable pattern.

5. Is the sensation of blood coming from the urethra normal?
The feeling of blood coming from the urethra can be alarming. It may be due to the heavy menstrual flow overwhelming the vaginal canal, causing blood to mix with urine. However, if you notice blood in your urine or if the sensation persists, it is crucial to consult your doctor to rule out any urinary tract issues or complications from the surgery.

6. When can you resume sexual activity?
Typically, it is advised to wait at least 4 to 6 weeks after surgery before resuming sexual activity. This allows time for healing and reduces the risk of infection. However, if you are experiencing heavy bleeding or other complications, it may be wise to wait longer and consult your healthcare provider for personalized advice.

In summary, while some changes in menstrual flow can be expected after surgery for a chocolate cyst, it is crucial to monitor your symptoms closely. If you experience any concerning signs or if your symptoms do not improve with medication, do not hesitate to reach out to your healthcare provider for further evaluation and management. Your health and well-being are paramount, and timely intervention can help prevent complications.

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