Menstrual Changes After Miscarriage: What to Expect

The menstrual blood flow after a miscarriage?

Hello, I would like to ask the doctor about menstrual issues following a miscarriage surgery.
I had a miscarriage at 17 weeks and underwent the procedure (the lochia lasted intermittently for about a month).
My menstrual period returned a little over a month after the surgery.
During the first three days of my period, the bleeding was very heavy, averaging enough to soak a large overnight pad every 1-2 hours.
On the fourth day, the bleeding suddenly stopped.
My menstrual cycles have typically lasted about four days over the past few years, so I didn't think much of it.
However, on the 8th and 9th days, I experienced fresh bleeding again, prompting me to visit a gynecologist.
The doctor diagnosed it as irregular menstruation and prescribed hormonal treatment to regulate my cycle.
After completing one cycle of the medication, my period returned on time, but the bleeding was still heavy, similar to the previous cycle.
It slowed down on the fourth day, but I continued to have a small amount of brown discharge throughout the entire period, which lasted 11 days.

I would like to ask the doctor if this menstrual pattern is abnormal.
Could it be related to the absence of egg white cervical mucus during these two cycles, possibly indicating anovulation? (During the second cycle, I used ovulation test strips, but there was no strong positive result.) Should I seek medical attention again to continue using the hormonal medication? Given my advanced age, I feel like I'm racing against time and really want to conceive, but I cannot get pregnant while on the hormonal treatment, which is quite a dilemma...

Wei, 30~39 year old female. Ask Date: 2021/01/26

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, after a miscarriage, menstruation may be irregular for a while.
If there are no discomforting symptoms, it is okay to monitor the situation for now.
Wishing you good health.

Reply Date: 2021/01/26

More Info

After experiencing a miscarriage, it is common for women to encounter various menstrual changes, which can be concerning and confusing. Your situation, involving heavy bleeding and irregular cycles following a dilation and curettage (D&C) procedure, raises several important points that warrant discussion.

Firstly, it is not unusual for menstrual cycles to be irregular after a miscarriage. The body undergoes significant hormonal changes during pregnancy, and it can take time for hormone levels to stabilize after a loss. The heavy bleeding you experienced during the first few days of your period could be attributed to the body adjusting to these hormonal fluctuations. It is also worth noting that the first few menstrual cycles after a miscarriage may not reflect your typical cycle patterns.

The sudden onset of fresh bleeding on days 8 and 9 after your initial heavy flow could indicate a few possibilities. It might be a sign of an anovulatory cycle, where ovulation does not occur, leading to irregular shedding of the uterine lining. The absence of egg white cervical mucus, which is typically associated with ovulation, supports this idea. Additionally, the presence of brown discharge could suggest old blood, which may be a remnant from your previous cycle or a sign of hormonal imbalance.

The hormonal treatment prescribed by your gynecologist is a common approach to help regulate menstrual cycles and promote ovulation. However, it is essential to monitor how your body responds to these medications. If you find that your cycles remain irregular or if you continue to experience heavy bleeding, it is crucial to follow up with your healthcare provider. They may consider further evaluation, including blood tests to check hormone levels, an ultrasound to assess the uterine lining, or other diagnostic measures to rule out any underlying issues.

Regarding your concerns about fertility, it is understandable to feel anxious, especially if you are in your advanced reproductive years. While hormonal treatments can temporarily inhibit ovulation, they are often necessary to restore regular cycles and improve the chances of conception in the long run. It is essential to have open communication with your healthcare provider about your desire to conceive and the potential impact of any treatments on your fertility.

In conclusion, while the changes you are experiencing post-miscarriage can be distressing, they are not uncommon. It is vital to continue working closely with your gynecologist to monitor your menstrual cycles and adjust treatment as necessary. If you have further concerns about your menstrual patterns or fertility, do not hesitate to seek additional medical advice. Remember, your health and well-being are paramount, and addressing these issues with your healthcare provider can help you navigate this challenging time more effectively.

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