Post-Miscarriage Bleeding and Recovery Concerns

What are the issues related to lochia after a miscarriage?

Hello Doctor: I experienced a tightening sensation in my uterus and lower abdominal pain at 14 weeks of pregnancy, and I went to the emergency room on July 8.
Upon arrival at the hospital, I had just experienced a rupture of membranes, which led to a miscarriage.
After being discharged, I took six doses of herbal medicine, but as of now (August 17), the bleeding has not completely stopped since the miscarriage.
During a follow-up visit on August 9, a transvaginal ultrasound was performed, and the doctor confirmed that the placenta was cleared.
However, from July 8 to August 8, the bleeding did not completely stop, and on August 8, I noticed an increase in bleeding.
The doctor suggested that this might be the remaining lochia being expelled, followed by the onset of my menstrual period.
In the days following August 8, the bleeding was somewhat heavier, but it was not as heavy as my usual menstrual flow.
During this period after the miscarriage, I sometimes noticed bright red blood when wiping after a bowel movement (not due to constipation), but I did not experience abdominal pain.
A few days after returning home to rest, I felt soreness in my inner thighs and weakness in my legs.
I would like to ask the doctor: 1.
Can menstruation occur if the lochia has not completely cleared? 2.
Why is my menstrual period lasting so long (my usual cycle is about seven days, but it doesn't seem to be ending soon)? When can I expect my menstrual cycle to return to normal? 3.
Could the bleeding be due to other reasons? What tests should I undergo? 4.
Is there a connection between the soreness in my inner thighs, weakness in my legs, and the miscarriage? These issues have been deeply troubling me since the miscarriage, and I am worried that they may lead to future infertility.
I kindly ask for your guidance, thank you very much!

Lilian, 30~39 year old female. Ask Date: 2008/08/17

Dr. Chen Changfu reply Obstetrics and Gynecology

The duration of lochia after a miscarriage at a later gestational age can be longer, potentially lasting 4-5 weeks.
After a miscarriage on July 8, the heavier bleeding on August 8 is likely due to the healing process of the placental implantation site in the uterine lining, rather than menstrual flow, which is highly unlikely.
This may have led you to mistakenly believe that the lochia duration was prolonged.
The increased amount of bleeding after the miscarriage may have caused you to feel weak and experience leg weakness.
With a bit more patience, the lochia should clear up in the coming days.
There will also be no impact on future fertility.

Reply Date: 2008/08/17

More Info

After experiencing a miscarriage, it's common for women to have concerns regarding prolonged bleeding and recovery. Your situation, where you experienced bleeding for an extended period following a miscarriage at 14 weeks, raises several important questions that need to be addressed.

1. Understanding Lochia and Menstrual Cycles Post-Miscarriage: Lochia is the vaginal discharge that occurs after childbirth or miscarriage, consisting of blood, mucus, and uterine tissue. It can last several weeks and may vary in color and amount. If the lochia has not completely cleared, it can affect the timing of your next menstrual cycle. Typically, menstruation can resume anywhere from 4 to 6 weeks post-miscarriage, but this can vary based on individual hormonal levels and how quickly the body returns to its pre-pregnancy state. If you are still experiencing lochia, it is possible that your menstrual cycle may be delayed until the lochia has fully resolved.

2. Duration of Menstrual Bleeding: The duration of your bleeding may be influenced by several factors, including hormonal fluctuations, the completeness of the miscarriage, and your overall health. If you usually have a seven-day cycle, but this time it feels prolonged, it could be due to the body adjusting after the miscarriage. It’s important to monitor the bleeding; if it becomes excessively heavy or is accompanied by severe pain, you should seek medical attention.

3. Other Causes of Prolonged Bleeding: While lochia is a common cause of post-miscarriage bleeding, other factors could contribute to prolonged bleeding. These may include retained products of conception, hormonal imbalances, or even the onset of a new menstrual cycle. If you notice bright red blood, especially after physical exertion like straining during bowel movements, it could indicate that your uterus is still expelling tissue. It’s advisable to consult your healthcare provider for further evaluation, which may include a pelvic ultrasound or blood tests to check hormone levels.

4. Muscle Weakness and Discomfort: The symptoms of inner thigh soreness and leg weakness you are experiencing could be related to several factors. After a miscarriage, hormonal changes can lead to fatigue and muscle weakness. Additionally, if you have been less active during your recovery, this could contribute to muscle discomfort. It’s essential to engage in gentle physical activity as tolerated, which can help improve circulation and muscle strength. However, if these symptoms persist or worsen, it would be prudent to discuss them with your healthcare provider to rule out any underlying issues.

5. Emotional and Psychological Impact: It’s also important to acknowledge the emotional toll that a miscarriage can take. Feelings of anxiety about future fertility and recovery are common. If you find that these feelings are overwhelming, consider speaking with a mental health professional who specializes in reproductive health. They can provide support and coping strategies during this challenging time.

In summary, while some bleeding and discomfort can be normal after a miscarriage, it’s crucial to stay vigilant about your symptoms. If you experience heavy bleeding, severe pain, or any other concerning symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. Your health and well-being are paramount, and addressing these concerns early can help ensure a smoother recovery and future pregnancies.

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