Abnormal Menstrual Cycles After Induction: Key Insights

Menstrual irregularities

Hello Dr.
Wu, I previously wrote to inquire about issues following my induction, and I appreciate you taking the time to respond.
I have some additional questions to ask you.
After my induction on October 15 (at 14 weeks of pregnancy), my period started on November 12 but only lasted for one day.
It returned on November 16 for two days, and then again on November 21 for three days, after which I experienced intermittent light dark brown discharge every 2 to 3 days, lasting for 2 to 3 days each time, which has continued until today, December 9.
On December 1, I experienced severe lower abdominal pain, and the discharge increased in volume and became darker.
After examination, the doctor diagnosed me with uterine inflammation and prescribed a week’s worth of medication.

I would like to ask:
1.
Is the dark brown discharge considered menstrual bleeding or just spotting? It resembles the discharge I had during my pregnancy.
2.
Will the medication for uterine inflammation resolve the issue in one week? What could have caused the inflammation? (I have not had sexual intercourse since the induction.)
3.
I previously consulted a doctor who mentioned that the bleeding on November 12 and November 16 was not my actual period and prescribed medication, stating that my period would officially start after finishing the medication.
Given that I had discharge for three days on November 21, which day should be considered the first day of my period? Should I return to the hospital where I had the induction for further evaluation?

judy, 20~29 year old female. Ask Date: 2002/12/09

Dr. Wu Zongcheng reply Obstetrics and Gynecology

Director Wu Zongcheng of the Department of Obstetrics and Gynecology at Tainan Hospital, Ministry of Health and Welfare, responded: (1) After induction of labor or delivery, ovarian function (female hormones) has not yet returned to normal, which can result in light bleeding and irregular menstrual cycles.
Your issue is likely caused by this abnormal bleeding.
(2) Uterine inflammation should heal with one week of medication; if there is still pain, you should continue with outpatient care.
(3) Your menstruation is characterized by an irregular cycle.
Generally, ovarian function returns within 1-2 months after induction of labor, and the cycle will normalize as long as you pay attention to contraception (irregular cycles make it difficult to calculate safe periods).

Reply Date: 2002/12/09

More Info

Understanding abnormal menstrual cycles after an induction can be quite complex, especially following a pregnancy termination. It is essential to consider the physiological changes that occur in the body after such a procedure, as well as any potential complications that may arise.

1. Understanding the Brown Discharge: The brown discharge you are experiencing could be a result of old blood being expelled from the uterus. This is not uncommon after an induction or miscarriage, as the body takes time to return to its normal menstrual cycle. The discharge may not necessarily indicate a new menstrual cycle but could be remnants of the previous pregnancy or a sign of irregular bleeding. It is important to differentiate between menstrual bleeding and abnormal discharge. Menstrual blood typically appears bright red, while brown discharge often indicates older blood. Given your history and the timing of your symptoms, it would be prudent to monitor the situation closely.

2. Uterine Inflammation and Treatment: Uterine inflammation, or endometritis, can occur after an induction due to retained products of conception, infection, or other factors. The antibiotic treatment prescribed for one week is generally aimed at addressing any potential infection. While many women respond well to such treatment, it is crucial to follow up with your healthcare provider if symptoms persist or worsen. Factors contributing to inflammation can include hormonal changes, incomplete evacuation of the uterus, or even stress on the body from the induction process. Since you mentioned that you have not engaged in sexual intercourse since the induction, it is less likely that the inflammation is due to a sexually transmitted infection.

3. Determining the First Day of Menstruation: The confusion regarding which day counts as the first day of your menstrual cycle is understandable. The first day of menstruation is typically defined as the first day of bright red bleeding. If the bleeding on November 21 was bright red and lasted for three days, that could be considered your first menstrual cycle post-induction. However, if it was light or brownish, it may not be classified as a full menstrual period. Your healthcare provider's advice to wait until after completing the medication to see if a proper menstrual cycle resumes is sound. It is essential to give your body time to adjust and respond to the treatment.

4. Follow-Up Care: Given the ongoing symptoms and the complexity of your situation, it may be beneficial to return to the hospital where the induction was performed for further evaluation. They can assess whether there are any retained products of conception or other issues that need to be addressed. Additionally, if the brown discharge continues or if you experience significant pain, it is crucial to seek medical attention promptly.

In summary, your symptoms following the induction are not uncommon, but they warrant careful monitoring and possibly further evaluation. It is essential to maintain open communication with your healthcare provider, who can provide personalized guidance based on your specific situation. If you have any further questions or concerns, do not hesitate to reach out for additional support.

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