Post-Hysteroscopy Concerns: Brown Discharge and Menstrual Irregularities Explained

Post-hysteroscopic polypectomy, the patient may experience menstrual bleeding accompanied by brownish discharge?

Hello, Dr.
Huang.
I underwent a cervical polypectomy on May 27th, and the doctor mentioned that there were quite a few polyps, but they were removed cleanly.
I experienced light bleeding for about 10 days post-surgery.
After a few days without bleeding, I suddenly noticed brownish blood with small clots.
After that, I had no menstrual period until July 2nd, which is over a month post-surgery.
During a follow-up appointment, the doctor said my endometrium was too thin, measuring about 0.6 cm, and advised me to wait until the end of July for my menstrual period to return.
However, I already felt like my period was about to start.
The doctor was concerned that adhesions from the surgery might cause menstrual blood to get trapped inside, as I had experienced this after a previous miscarriage.
Therefore, the doctor performed a cervical examination, which was quite uncomfortable.
Although my period was expected at the end of July, on July 5th, it seemed like my period started with symptoms of bloating and pain, dark blood, and some clots, but the flow was not heavy.
This morning, I also noticed some strange brownish discharge.
Dr.
Huang, could you please explain what might be happening? Does this indicate any problems? This is my second cervical surgery; the first time everything was normal, but this time feels unusual.
I would greatly appreciate your clarification as I am quite worried.

Emily, 40~49 year old female. Ask Date: 2019/07/06

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On May 27, I underwent a cervical polypectomy, and the doctor mentioned that there were quite a few polyps, but they were removed cleanly.
After the surgery, I experienced light bleeding for about 10 days.
A few days after the bleeding stopped, I suddenly noticed brown blood with small clots, and then there was no bleeding until July 2.
More than a month after the surgery, I still hadn't had my period.
During a follow-up appointment, the doctor said my endometrium was too thin, measuring about 0.6 cm, and advised me to wait until the end of July for my period to return.
However, I already felt like my period was about to come.
The doctor was concerned that adhesions from the surgery might cause menstrual blood to get trapped inside the uterus (which I had experienced after a previous abortion), so during the internal examination, the doctor dilated my cervix, which was quite uncomfortable and painful.
Although my period was expected at the end of July, on July 5, it seemed like my period started, with symptoms of bloating and pain, dark blood, and some clots, but the flow was not heavy.
This morning, I also noticed some strange brown discharge.
Dr.
Huang, could you please explain what this might mean? Is there any issue? This is my second cervical surgery; the first one went normally, but this time feels unusual.

Answer: It should be okay; just continue to observe.

Reply Date: 2019/07/06

More Info

After undergoing a hysteroscopy for polyp removal, it's understandable to have concerns about post-operative symptoms such as brown discharge and menstrual irregularities. Let's break down your situation based on the information provided.

Post-Operative Symptoms
1. Brown Discharge: The presence of brown discharge, especially after a procedure like hysteroscopy, is often due to old blood being expelled from the uterus. This can happen as the uterine lining heals and may not necessarily indicate a problem. It's common for patients to experience some irregular bleeding or spotting after such procedures, which can last for several days to weeks.

2. Menstrual Irregularities: Following a hysteroscopy, it is not unusual for menstrual cycles to be disrupted. The procedure can affect the endometrial lining, and since you mentioned that your endometrial thickness was measured at 0.6 cm (which is considered thin), this could contribute to delayed menstruation. The body may take some time to readjust, and hormonal fluctuations can lead to irregular cycles.

3. Pain and Cramps: The discomfort you are experiencing, including dull pain and cramping, can be attributed to the healing process of the uterus. After a surgical procedure, it is common to experience some level of discomfort as the body recovers.

Concerns About Adhesions
You mentioned a previous experience with retained products of conception after a dilation and curettage (D&C), which raises valid concerns about intrauterine adhesions (Asherman's syndrome). The doctor’s decision to check the cervix for patency is a precautionary measure to ensure that menstrual flow can occur without obstruction. If there were adhesions, they could potentially lead to complications such as retained menstrual blood, which could cause pain and abnormal discharge.

Next Steps
1. Monitoring Symptoms: It is essential to keep track of your symptoms. If the brown discharge persists or if you experience heavy bleeding, severe pain, or any signs of infection (such as fever or foul-smelling discharge), you should contact your healthcare provider immediately.

2. Follow-Up Appointments: Since your doctor has advised waiting until the end of July for your next menstrual cycle, it’s crucial to adhere to this timeline. If your period does not return or if you have ongoing concerns, a follow-up appointment may be necessary to reassess your condition.

3. Further Evaluation: If menstrual irregularities continue beyond the expected timeframe, or if you experience significant discomfort, further evaluation may be warranted. This could include an ultrasound to assess the uterine lining and check for any potential complications such as adhesions or retained tissue.

Conclusion
In summary, while brown discharge and menstrual irregularities can be concerning, they are often part of the healing process following a hysteroscopy. It is essential to monitor your symptoms and maintain open communication with your healthcare provider. If you have any doubts or if your symptoms worsen, do not hesitate to seek medical advice. Your health and peace of mind are paramount, and your doctor is there to help you navigate these post-operative changes.

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