Heavy Menstrual Flow After Myomectomy: What to Expect?

Heavy menstrual bleeding after traditional open surgery for uterine fibroids?

On November 23, 2020, I underwent an open surgery to remove fibroids.
Two weeks later, I started doing some simple stretching exercises and gradually added simplified bodyweight training movements (e.g., squats, but not going all the way down).
As of December 23, it has been one month post-surgery.
On December 19 and 20, I experienced some light bleeding and felt a slight swelling in my abdomen, which I thought might be my period.
On December 21, I confirmed it was my menstrual period, and on the night of December 22, the flow suddenly became very heavy, soaking a 41.5 cm pad and staining my sheets.
I haven't experienced this level of bleeding in the past 10 years.
My doctor mentioned that irregular menstrual cycles could occur after surgery, and is heavy menstrual bleeding considered a form of irregularity? Is it normal to have a heavy first period after surgery? Should I return to the original hospital/doctor for a follow-up, or should I observe for another day or two?

zillah, 30~39 year old female. Ask Date: 2020/12/23

Dr. Cai Yonglong reply Obstetrics and Gynecology

In cases of significant bleeding, it is important to promptly return to the obstetrics and gynecology clinic for examination.

Reply Date: 2020/12/23

More Info

After undergoing a myomectomy, it is not uncommon for patients to experience changes in their menstrual cycle, including heavy menstrual flow. The surgical removal of fibroids can lead to various hormonal and physical changes in the body, which may affect menstrual patterns.
In your case, it appears that you are experiencing a significant increase in menstrual flow, which is concerning, especially since you mentioned that you have not experienced such heavy bleeding in the past ten years. It is important to understand that after a myomectomy, the uterus may take some time to heal, and during this healing process, irregularities in menstrual cycles can occur. This can include heavier bleeding, longer periods, or even missed cycles.
The heavy bleeding you described, where you filled a pad in a short amount of time and even stained your sheets, could be a result of several factors. One possibility is that the uterus is shedding more lining than usual as it adjusts post-surgery. Additionally, if there was any residual fibroid tissue or if the uterus is still healing, this could contribute to abnormal bleeding.
While some degree of irregularity is expected, particularly after surgery, it is crucial to monitor the situation closely. If the heavy bleeding continues or worsens, or if you experience symptoms such as severe pain, dizziness, or fainting, it is essential to seek medical attention promptly. These could be signs of complications such as retained products of conception, infection, or other issues that may require intervention.

Regarding your question about whether to return to your original surgeon or to observe for a day or two, it is generally advisable to err on the side of caution. Since you are experiencing a significant change in your menstrual flow, it would be prudent to contact your healthcare provider as soon as possible. They may want to perform an examination or imaging studies to ensure that everything is healing properly and that there are no complications.

In summary, while some irregularity in menstrual flow can be expected after a myomectomy, heavy bleeding that is significantly different from your previous experiences should be evaluated by a healthcare professional. It is always better to be proactive about your health, especially after undergoing surgery. Make sure to keep track of your symptoms and communicate openly with your doctor about any concerns you may have.

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