When Will My Period Return After Induction Abortion?

When does menstruation return after induction of labor?

Hello Dr.
Wu, I experienced premature rupture of membranes at 14 weeks of pregnancy, which led to an induction procedure on October 15, 2002 (the doctor mentioned that it was caused by adenomyosis leading to bleeding and subsequent infection).
After the procedure, I had persistent lower abdominal pain for a month, and lochia lasted for three weeks.
On November 12, the abdominal pain intensified, accompanied by some deep red bleeding (with some discharge-like material), but it only lasted for one day and the abdominal pain subsided.
However, on November 16, I experienced severe abdominal pain again, similar to what I had on November 12.
I consulted with an obstetrician-gynecologist, who stated that neither of these episodes could be considered menstruation.
I received an injection and medication, but as of today, November 20, my period has not arrived, and the abdominal pain continues.

I have a few questions:
1.
My menstrual cramps have become increasingly severe over time; could this be related to adenomyosis?
2.
Is the prolonged abdominal pain indicative of poor uterine contraction function?
3.
Is a hysterectomy necessary for adenomyosis, or can laparoscopic surgery be performed to remove it before attempting to conceive? I have been experiencing bleeding since I first discovered I was pregnant, and the doctor indicated that it was due to adenomyosis affecting embryo implantation.
4.
I experience lower abdominal pain after each bowel movement (is this pain from hemorrhoids or caused by adenomyosis? My hemorrhoids are approaching stage three), and I also experience pain during intercourse.
Thank you for taking the time to address all these questions.

judy, 20~29 year old female. Ask Date: 2002/11/20

Dr. Wu Zongcheng reply Obstetrics and Gynecology

1.
The causes of dysmenorrhea can be divided into two main categories: (1) organ tumors and (2) functional pain.
Uterine fibroids can certainly cause dysmenorrhea.

2.
The prolonged abdominal pain is likely due to inflammation.
If a bacterial infection has not completely healed, it can lead to chronic infection, which may impair uterine contraction function, resulting in prolonged menstrual periods or spotting, but this is not the cause of the abdominal pain.

3.
Adenomyosis can lead to miscarriage, and after a thorough examination, if necessary, a tumor resection may be required.
A hysterectomy is not needed, especially since you still wish to conceive, correct?
4.
Pain during defecation or intercourse raises the primary consideration of endometriosis.
Please undergo an ultrasound examination and a CA-125 blood test to gain further insights.

Reply Date: 2002/11/20

More Info

After an induction abortion, the timeline for the return of your menstrual period can vary significantly from person to person. Generally, it is expected that your menstrual cycle will resume within four to six weeks after the procedure, but this can depend on several factors, including your individual health, hormonal balance, and the specifics of your abortion experience.

In your case, since you experienced complications such as abdominal pain and prolonged bleeding, it is essential to monitor your recovery closely. The fact that you had a history of adenomyosis (as indicated by your mention of uterine adenomyosis) could also influence your menstrual cycle and pain levels. Adenomyosis can lead to heavier and more painful periods, and it may also complicate the recovery process after an abortion.

Regarding your specific questions:
1. Menstrual Pain and Adenomyosis: It is indeed possible that your increasing menstrual pain is related to adenomyosis. This condition occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus, leading to painful and heavy periods. If your pain has been worsening, it would be wise to discuss this with your healthcare provider, as they may recommend imaging studies or other evaluations to assess the extent of the adenomyosis.

2. Abdominal Pain and Uterine Contraction: Prolonged abdominal pain after an abortion can be concerning. It may indicate that your uterus is having difficulty contracting back to its normal size or that there are retained products of conception. If the pain persists, it is crucial to follow up with your healthcare provider to rule out any complications such as infection or retained tissue.

3. Management of Adenomyosis: Surgical options for adenomyosis can vary. While a hysterectomy (removal of the uterus) is a definitive treatment, many women may consider less invasive options such as laparoscopic surgery to remove adenomyosis tissue. Discussing your desire to conceive in the future with your healthcare provider is essential, as they can help you weigh the risks and benefits of different treatment options.

4. Pain During Bowel Movements: Pain during bowel movements can be caused by various factors, including hemorrhoids or pelvic pain related to adenomyosis. If you are experiencing significant discomfort, it may be beneficial to consult with a gastroenterologist or a colorectal specialist to address any potential issues related to your bowel health.

In summary, while it is common for menstrual cycles to resume within a few weeks after an abortion, individual experiences can vary widely, especially in the context of underlying conditions like adenomyosis. It is crucial to maintain open communication with your healthcare provider, who can guide you through your recovery, manage your symptoms, and help you plan for future pregnancies if that is your goal. If your symptoms persist or worsen, do not hesitate to seek further medical evaluation. Your health and well-being are paramount, and addressing these concerns early can lead to better outcomes.

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