Severe Menstrual Pain and Heavy Bleeding After Childbirth: What to Do?

Severe menstrual pain and heavy menstrual bleeding both during and after pregnancy?

Hello Doctor, I usually experience significant pain and blood clots during my menstrual periods.
I've heard that menstrual pain may improve after childbirth, but I gave birth to my fourth child last year, and my periods are still very painful with blood clots.
After the fourth child, my husband had a vasectomy, and we decided not to have any more children, so I have been paying special attention to my postpartum menstrual situation.
I gave birth in November last year and breastfed, with my first postpartum period occurring at the end of August this year.
It was still very painful, with heavy bleeding and blood clots, requiring me to take painkillers for relief.
I researched my symptoms and found they resemble those of fibroids.
Currently, I am experiencing menstrual pain.
Would it be more helpful to seek medical attention now to identify the cause, or should I wait until after my period ends? If I should wait, how many days after my period ends would be appropriate to see a doctor? Additionally, during the time from November last year until my first period in August this year, I experienced 3 or 4 instances of unexplained bleeding.
At the time, I thought it might be the onset of my period, but the bleeding only lasted for one day and did not recur.
There was no sexual intercourse before the bleeding, and it was a sudden discovery of blood on my underwear, prompting me to use a pad.
The bleeding was minimal but persisted in small amounts, and then it stopped the next day.
Since there was no significant pain, I did not seek medical attention.
I wonder if these situations are related to my menstrual pain and blood clots!

Miss Hsu, 30~39 year old female. Ask Date: 2023/11/09

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is recommended to see an obstetrician-gynecologist for an ultrasound examination.
Wishing you good health.

Reply Date: 2023/11/09

More Info

Severe menstrual pain and heavy bleeding after childbirth can be concerning and may indicate underlying issues that need to be addressed. It is not uncommon for women to experience changes in their menstrual cycles after giving birth, but persistent pain and heavy bleeding warrant further investigation.

Firstly, it is essential to understand that after childbirth, hormonal changes can significantly impact menstrual cycles. For some women, menstrual pain (dysmenorrhea) may improve after childbirth, while for others, it can remain the same or even worsen. The presence of blood clots and heavy bleeding can be indicative of several conditions, including uterine fibroids, endometriosis, or adenomyosis. Fibroids are non-cancerous growths in the uterus that can cause heavy bleeding and pain, while endometriosis involves the growth of uterine tissue outside the uterus, leading to significant pain and irregular bleeding.

Given your history of heavy menstrual pain and the presence of blood clots, it is advisable to seek medical attention sooner rather than later. While some women may prefer to wait until their menstrual cycle ends to consult a doctor, it is often beneficial to seek help during your period, especially if the pain is severe. This allows the healthcare provider to assess your symptoms in real-time and may facilitate a more accurate diagnosis.

When you visit your healthcare provider, be prepared to discuss your symptoms in detail. This includes the severity of your pain, the duration of your menstrual bleeding, the size and frequency of blood clots, and any other unusual symptoms you may have experienced, such as the unexplained bleeding you mentioned. Your doctor may perform a physical examination, order blood tests, and possibly conduct imaging studies like an ultrasound to evaluate the condition of your uterus and ovaries.

As for the timing of your visit, if you are experiencing severe pain and heavy bleeding, it is appropriate to seek medical care immediately, regardless of whether your period has ended. If you experience any of the following symptoms, you should seek emergency medical attention:
1. Severe pain that is not relieved by over-the-counter pain medications.
2. Heavy bleeding that soaks through one or more pads or tampons every hour for several hours.
3. Dizziness or fainting, which may indicate significant blood loss.
4. Fever or chills, which could suggest an infection.
In the meantime, managing your pain with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may help alleviate some discomfort. However, it is crucial to consult with your healthcare provider before starting any new medication, especially if you are experiencing heavy bleeding.

In summary, while some women may experience changes in their menstrual cycles after childbirth, persistent severe pain and heavy bleeding should not be ignored. Seeking medical attention promptly can help identify any underlying conditions and provide appropriate treatment to improve your quality of life. Your health and well-being are paramount, and addressing these symptoms with a healthcare professional is the best course of action.

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