Prolonged Bleeding After Miscarriage: When to Seek Help

Miscarriage - prolonged bleeding duration..?

Dear Dr.
Tsao,
I usually have irregular menstrual cycles, approximately every 35 to 42 days, and I am already over the advanced maternal age threshold.
I had planned to visit the infertility clinic, but due to the COVID-19 outbreak in May, I postponed my plans.
However, since my menstrual period was significantly delayed, I took a home pregnancy test at the end of August and, surprisingly, I was pregnant! (My last menstrual period was on June 28).
I subsequently had two prenatal check-ups, but unfortunately, I experienced a natural miscarriage on September 29 at 13 weeks.
The emergency physician managed the situation, and after performing a hysteroscopy, they said everything was clear and scheduled a follow-up appointment for me on October 7, where the ultrasound results were normal.
From October 18 to 20, I experienced dark brown discharge, and I thought the miscarriage bleeding had ended.
However, on October 21, I suddenly had bright red blood clots.
The next day, I sought medical attention again, and the ultrasound showed that both my uterus and ovaries were normal.
The doctor suggested it might be ovulation bleeding and that it would likely resolve in a few days, advising me not to worry.
However, the bleeding has continued until now, though it is not heavy—about one panty liner per day is not fully saturated.
I would like to ask Dr.
Tsao:
1.
Given the prolonged bleeding, should I return for a follow-up appointment?
2.
Since I am older and actively trying to conceive, if the bleeding situation warrants a consultation, should I directly consult a fertility specialist, or would you recommend seeing a general obstetrician-gynecologist first?
Thank you for your patience in reading my questions.
Thank you! 🙏

SPC, 30~39 year old female. Ask Date: 2021/11/12

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you can take a pregnancy test to check if it is negative.
If it is still positive, it indicates that the pregnancy has not completely resolved.
If there is still bleeding, it is advisable to visit a general obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2021/11/12

More Info

Prolonged bleeding after a miscarriage can be concerning, especially for women who are older and actively trying to conceive. In your case, it seems that you experienced a natural miscarriage at 13 weeks and have been dealing with ongoing bleeding since then. Let’s address your questions and provide some additional context regarding the situation.

1. Should you return for a follow-up visit due to prolonged bleeding?
Yes, it is advisable to return for a follow-up visit if you are experiencing prolonged bleeding, especially if it has lasted for several weeks. While some bleeding can be normal after a miscarriage, persistent bleeding can indicate retained tissue, hormonal imbalances, or other complications. Since you mentioned that the bleeding has changed in color and consistency, it is important to have a healthcare provider evaluate your condition. They may perform an ultrasound to check for any retained products of conception or other abnormalities.

2. Should you consult a fertility specialist or a general obstetrician/gynecologist?
Given your age and the fact that you are actively trying to conceive, it may be beneficial to consult a fertility specialist, especially if you have concerns about your menstrual cycle irregularities and prolonged bleeding. A fertility specialist can provide a more comprehensive evaluation of your reproductive health and may offer targeted treatments or interventions to assist with conception. However, if you are experiencing significant symptoms or complications, starting with a general obstetrician/gynecologist is also a good option. They can assess your immediate concerns and refer you to a specialist if necessary.

Additional Considerations
- Understanding Prolonged Bleeding: After a miscarriage, it is common for women to experience some bleeding as the body expels the pregnancy tissue. However, if the bleeding continues beyond a few weeks or if it becomes heavy, it is essential to seek medical advice. Prolonged bleeding can sometimes be due to retained tissue, which may require medical intervention, such as medication or a surgical procedure (D&C) to ensure that the uterus is clear.

- Hormonal Factors: Hormonal fluctuations can also contribute to irregular bleeding patterns. After a miscarriage, it may take some time for your hormones to stabilize, which can affect your menstrual cycle. In some cases, hormonal treatments may be necessary to regulate your cycle and promote ovulation.

- Emotional and Physical Well-being: It’s important to consider both your physical and emotional health during this time. Miscarriage can be a traumatic experience, and ongoing bleeding can add to the emotional burden. Seeking support from healthcare providers, counselors, or support groups can be beneficial.

- Monitoring Symptoms: Keep track of your bleeding patterns, including the amount, color, and any associated symptoms (such as pain or fever). If you experience heavy bleeding (soaking through a pad in an hour), severe pain, or signs of infection (fever, chills), seek immediate medical attention.

In summary, given your situation, it is prudent to seek further evaluation from a healthcare provider regarding your prolonged bleeding. Whether you choose to see a general obstetrician/gynecologist or a fertility specialist, addressing your concerns promptly can help ensure your reproductive health is managed effectively. Remember to take care of your emotional well-being during this challenging time, and don’t hesitate to reach out for support.

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