Postpartum Menstrual Issues: Pain and Irregularities

Postpartum menstrual issues

Hello Doctor: I gave birth to my second child on December 30, 2021.
I breastfed for nearly 20 days postpartum.
My first postpartum menstruation started on February 5, 2022.
On the first day, there was only a small amount of blood, and on the second and third days, there were only brownish secretions.
On the fourth day, the bleeding increased significantly, which I considered to be a normal amount, but I experienced abnormal pain this time, whereas I did not have menstrual cramps before giving birth.
On the fifth day of my period (February 7, 2022), I visited a gynecologist, who said my uterus was normal and prescribed me medication to help with contractions.
On that day, I also started taking the oral contraceptive pill, *Yasmin*.
The contraction medication alleviated the pain, but the bleeding did not stop.
On February 18, 2022, I visited another gynecologist, who administered an injection of progesterone and prescribed progesterone pills to take twice daily.
As of today, February 23, 2022, the bleeding has not improved.
Could you please advise what might be happening with my body?

Xie, 20~29 year old female. Ask Date: 2022/02/23

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
"Abnormal vaginal bleeding" has numerous causes, including lifestyle habits and stress, age, vaginal infections, benign gynecological conditions, and malignant tumors, among others.
Therefore, it is recommended that you visit a professional obstetrician-gynecologist for examination and evaluation.

2.
Since this is your first menstrual period after childbirth, it may be more irregular.
It is advisable to monitor it for 2-3 months or seek medical attention if you experience other symptoms.

Reply Date: 2022/02/23

More Info

Postpartum menstrual issues can be quite complex and vary significantly from one individual to another. In your case, it appears that you are experiencing irregularities and pain associated with your menstrual cycle following the birth of your second child. Given the timeline and the treatments you've undergone, let's break down the potential causes and considerations for your situation.

Firstly, it's important to understand that postpartum hormonal changes can lead to irregular menstrual cycles. After childbirth, especially if breastfeeding, your body undergoes significant hormonal fluctuations. Prolactin, the hormone responsible for milk production, can suppress ovulation, leading to irregular periods or even amenorrhea (absence of menstruation) in some women. However, once you resume your menstrual cycle, as you have, it can take some time for your body to regulate itself.

In your case, the initial light bleeding followed by a heavier flow and significant pain is noteworthy. The pain you are experiencing, which is a new symptom for you, could be attributed to several factors:
1. Uterine Contractions: After childbirth, the uterus contracts to return to its pre-pregnancy size. These contractions can sometimes be painful, particularly if you are experiencing them more intensely than before.

2. Endometrial Changes: The lining of the uterus (endometrium) undergoes changes postpartum. If there are remnants of placental tissue or other abnormalities, it could lead to prolonged bleeding and discomfort.

3. Hormonal Imbalances: The introduction of hormonal contraceptives, such as the birth control pill you mentioned, can also affect your menstrual cycle. While these medications are designed to regulate cycles and alleviate pain, they can sometimes lead to breakthrough bleeding or changes in flow.

4. Infection or Complications: Although your initial check-up indicated that your uterus was normal, persistent bleeding and pain could suggest an underlying issue, such as an infection or retained products of conception.
Given that you have already consulted with two different gynecologists and received treatments including uterine contraction medication and progesterone injections, it may be prudent to seek further evaluation if your symptoms do not improve. Here are some steps you might consider:
- Follow-Up Ultrasound: An ultrasound can help assess the uterus for any retained tissue or abnormalities that may not have been evident during your initial examinations.

- Blood Tests: Checking hormone levels (such as estrogen, progesterone, and hCG) can provide insight into whether your body is responding appropriately postpartum.

- Consider a Specialist: If your symptoms persist, you may want to consult a reproductive endocrinologist or a specialist in maternal-fetal medicine who can provide a more in-depth evaluation of your hormonal and reproductive health.

- Monitor Symptoms: Keep a detailed record of your menstrual cycle, including the duration, flow, and any associated symptoms like pain, to provide your healthcare provider with comprehensive information.

In summary, while postpartum menstrual irregularities can be common, the persistence of pain and abnormal bleeding warrants further investigation. It is essential to communicate openly with your healthcare providers about your symptoms and concerns, and do not hesitate to seek a second opinion if you feel it is necessary. Your health and comfort are paramount, and addressing these issues proactively can help you achieve a better quality of life postpartum.

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