Post-Hysteroscopic Polypectomy: Abnormal Bleeding Concerns

Post-operative bleeding after hysteroscopic polypectomy?

Hello Doctor, I originally had infiltrative endometriosis, adenomyosis, and endometrial polyps.
On December 30, 2019, I underwent a hysteroscopic surgery to remove the endometrial polyp.
For the first week after the surgery, I experienced only light bleeding, which stopped around seven days post-operation.
However, on January 11, I suddenly noticed pink discharge, and by today, January 13, the bleeding has become increasingly bright red.
My last menstrual period started on December 25, and my menstrual cycle has always been regular, so I expect my next period to start around January 25.
Due to the adenomyosis, I usually experience significant bloating and pain during my periods, but the bleeding over the past few days has only been accompanied by slight discomfort in my lower abdomen on January 11, with no severe pain or heavy bleeding.
It feels like this bleeding is not typical of my menstrual cycle, and I am concerned about the sudden onset of bleeding after having stopped for three to four days post-surgery.
Could this be a normal symptom following hysteroscopic surgery?

Nsi321, 20~29 year old female. Ask Date: 2020/01/13

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it could be ovulatory bleeding, or it may be related to the recent hysteroscopy.
Please monitor it for another 2-3 days, and if it continues to be heavy, I recommend returning to your original hospital for evaluation.
Wishing you good health.

Reply Date: 2020/01/13

More Info

After undergoing a hysteroscopic polypectomy, it is not uncommon for patients to experience some abnormal bleeding. In your case, the initial post-operative bleeding was minimal and ceased after about a week, which is generally expected. However, the subsequent appearance of pinkish discharge followed by bright red bleeding can be concerning, especially since it occurred outside of your regular menstrual cycle.

Firstly, it is important to understand that after any surgical procedure involving the uterus, such as a hysteroscopic polypectomy, the endometrial lining can be sensitive and may take some time to heal. The presence of bright red bleeding could indicate several possibilities:
1. Healing Process: The uterus may still be healing from the surgery, and the bright red bleeding could be a sign of this process. The tissue may be more vascular and prone to bleeding during the healing phase.

2. Hormonal Fluctuations: Given that you have a history of endometriosis and adenomyosis, hormonal fluctuations can lead to irregular bleeding patterns. The surgery may have temporarily altered your hormonal balance, which could explain the unexpected bleeding.

3. Residual Polyp or Other Lesions: Although the polyp was removed, there is a possibility that residual tissue or another polyp could be causing the bleeding. This is something that should be evaluated by your healthcare provider.

4. Infection: Post-operative infections can also lead to abnormal bleeding. If you experience additional symptoms such as fever, foul-smelling discharge, or increased pain, it is crucial to seek medical attention.

5. Menstrual Cycle Variability: Sometimes, the timing of your menstrual cycle can be affected by stress, changes in routine, or even the surgery itself. It is possible that the bleeding you are experiencing is an early onset of your menstrual cycle, although it feels different from your usual pattern.

Given these possibilities, it is essential to monitor your symptoms closely. If the bleeding continues, increases in volume, or is accompanied by significant pain or other concerning symptoms, it is advisable to contact your healthcare provider. They may recommend a follow-up examination, which could include an ultrasound or hysteroscopy to ensure that there are no complications such as retained tissue or infection.

In summary, while some post-operative bleeding can be normal, especially after a procedure like a hysteroscopic polypectomy, any significant changes in bleeding patterns should be evaluated by a medical professional. It is always better to err on the side of caution and seek advice if you have concerns about your recovery.

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