Prolonged Bleeding After D&C: Causes and Concerns - Obstetrics and Gynecology

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Persistent bleeding after abortion?


Hello Doctor, I am currently abroad and it's not very convenient for me to see a doctor, so I would like to consult you about some issues.
I was previously pregnant for over 7 weeks and underwent a D&C on August 13.
After the procedure, the doctor did not prescribe any medication; I only took antibiotics on the day of the surgery.
Due to continuous work without rest, my lochia did not stop until August 29.
However, on September 1, I started experiencing brown spotting, which has continued until now, September 26.
The amount is similar to what I would have on the fourth day of my regular menstrual cycle.
On September 10, I had a blood test for HCG, which was 64, and a vaginal ultrasound showed that my uterus appeared normal with no retained products.
On September 22, I took a home pregnancy test, which indicated that I might be pregnant for 1-2 weeks.
I have not experienced any pain or discomfort in my uterus, and there is no unusual odor from my vagina.
I have not had sexual intercourse since the surgery.
I have a history of polycystic ovary syndrome (PCOS) and have always had irregular menstrual cycles.
Could this be affecting my situation? Or is this just irregular bleeding? Do I need any specific treatment, or should I let my body recover on its own? Thank you for your response, Doctor.

Jinjin, 20~29 year old female. Ask Date: 2021/09/26

Dr. Wu Xianghui reply Obstetrics and Gynecology


1.
If HCG levels are elevated but there are no symptoms such as abdominal pain or bleeding, continue to monitor for 1 to 2 weeks.
2.
Due to the prolonged bleeding, it is important to be aware of the possibility of developing pelvic inflammatory disease.

Reply Date: 2021/09/26

More Info


After undergoing a dilation and curettage (D&C) procedure, it is not uncommon for women to experience prolonged bleeding or irregularities in their menstrual cycle. In your case, you had a D&C on August 13, and while you experienced lochia (postpartum bleeding) until August 29, you began to notice brown discharge starting September 1, which has continued until now, September 26. You also mentioned that you have a history of polycystic ovary syndrome (PCOS), which can contribute to irregular menstrual cycles.


Understanding Prolonged Bleeding After D&C
1. Normal Recovery Process: After a D&C, it is typical for the body to take some time to return to its normal menstrual cycle. The procedure itself can disrupt the hormonal balance, leading to irregular bleeding patterns. The presence of brown discharge often indicates older blood that is taking longer to exit the body, which can be a normal part of the healing process.

2. Hormonal Imbalance: Given your history of PCOS, your menstrual cycles may already be irregular. PCOS can lead to hormonal imbalances that affect ovulation and menstruation. After a D&C, these imbalances may be exacerbated, leading to prolonged or irregular bleeding.
3. HCG Levels: Your HCG level of 64 on September 10 suggests that there may still be some residual hormonal activity from the pregnancy. Since you tested positive for pregnancy again on September 22, it is essential to monitor your HCG levels to ensure they are decreasing appropriately. Persistent elevated HCG levels could indicate retained products of conception or a new pregnancy.

4. Absence of Pain or Infection: The absence of pain and foul-smelling discharge is a positive sign, as these could indicate complications such as infection or retained tissue. However, it is still crucial to keep an eye on your symptoms.


Recommendations
- Monitoring: Continue to monitor your symptoms closely. If the bleeding persists or worsens, or if you develop any new symptoms such as fever, severe pain, or unusual discharge, it is essential to seek medical attention.

- Follow-Up Care: Since you are currently abroad and may have limited access to healthcare, consider scheduling a follow-up appointment with a healthcare provider when possible. They may recommend an ultrasound to ensure that there are no retained products of conception and to assess the state of your uterus.

- Self-Care: Allow your body time to heal. Stress and lack of rest can impact your recovery. If possible, try to take breaks and manage stress levels, as these factors can also influence hormonal balance.

- Consultation for PCOS: Given your history of PCOS, it may be beneficial to consult with a healthcare provider about managing your condition, especially if you continue to experience irregular cycles. Lifestyle changes, such as diet and exercise, can help manage symptoms associated with PCOS.

In conclusion, while prolonged bleeding after a D&C can be concerning, it is often a part of the recovery process, especially in women with underlying conditions like PCOS. Monitoring your symptoms and seeking medical advice when necessary will help ensure a safe and healthy recovery.

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