Post-Hysteroscopic Surgery: Ovulation Phase Bleeding

Ovulatory bleeding after hysteroscopic surgery?

Hello Doctor: I underwent a hysteroscopic myomectomy at the end of November.
Since the surgery, I have been experiencing bleeding during my ovulation period (I had some bleeding before the surgery, but the amount has increased postoperatively).
The bleeding occurs only when I go to the bathroom, along with clear discharge.
Now, I have had my second menstrual cycle since the surgery, and the bleeding is still heavier than before, even more so than during my first menstrual cycle after the surgery.
Is this normal? Do I need to return to the hospital for further examination? Thank you.

Xiao Mei, 40~49 year old female. Ask Date: 2022/01/22

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, it is recommended that if the bleeding persists, you should consult a physician for further evaluation.
Thank you! Wishing you safety and good health.
Dr.
Chang

Reply Date: 2022/01/22

More Info

Post-hysteroscopic surgery, particularly for conditions like uterine fibroids, can lead to various changes in menstrual patterns and bleeding. It is not uncommon for patients to experience changes in their menstrual cycle and bleeding patterns after such procedures. The bleeding you are experiencing during your ovulation phase could be attributed to several factors related to the surgery and the healing process.

Firstly, after a hysteroscopic procedure, the uterine lining may take some time to heal completely. The surgery itself can cause some trauma to the endometrium (the inner lining of the uterus), which may lead to increased sensitivity and bleeding during ovulation. This is often referred to as ovulation spotting, which can occur when the follicle ruptures and releases an egg, sometimes accompanied by a small amount of blood.

The fact that you are noticing a change in the volume of bleeding compared to your pre-surgery cycles is also significant. Post-operative bleeding can be influenced by hormonal fluctuations, especially if your menstrual cycle has been disrupted by the surgery. The increase in bleeding volume during your ovulation phase may indicate that your body is still adjusting to the changes brought about by the procedure.

It is essential to monitor the characteristics of the bleeding. If the bleeding is light and only occurs with clear discharge, it may be within the range of normal post-operative changes. However, if you experience heavier bleeding, clots, or any other concerning symptoms such as severe pain or fever, it is crucial to seek medical attention promptly.

Regarding your question about whether further evaluation is necessary, it is advisable to consult your healthcare provider if the bleeding persists or worsens. They may recommend an ultrasound or other imaging studies to assess the uterine lining and ensure that there are no complications such as retained products of conception or other abnormalities. Additionally, they may check your hormone levels to rule out any hormonal imbalances that could be contributing to the increased bleeding.

In summary, while some post-operative bleeding can be normal, especially during the ovulation phase, it is essential to remain vigilant and communicate any concerns with your healthcare provider. They can provide personalized advice based on your specific situation and medical history. If the bleeding continues to be a concern, do not hesitate to return to your doctor for further evaluation and peace of mind.

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