Post-Myomectomy Menstrual Pain: What to Expect and When to Worry

Postoperative menstrual pain after uterine fibroid surgery?

I used to have regular menstrual cycles, and before my period, I would experience breast tenderness and lower abdominal discomfort.
However, I rarely had menstrual cramps unless I consumed too many cold foods.
I discovered a large uterine fibroid measuring 17 cm, and upon reflection, I realized that during my last couple of menstrual cycles, I had heavier bleeding and experienced cramps.
It has been three months since my surgery (only the tumor was removed), and my menstrual cycle is gradually returning to normal, starting from light bleeding and extending to a normal duration.
However, in the second month post-surgery, I still experience cramps a day or two before my period, along with some blood clots.
Is this considered normal? Before the surgery, I rarely had menstrual cramps, and now, two months post-surgery, I have started experiencing significant hair loss.
During my last follow-up appointment, I informed my attending physician about these symptoms, but the doctor said the hair loss is unrelated to the surgery and mentioned that there is no need to arrange for an abdominal ultrasound.
Is it acceptable to proceed without an ultrasound? Does not having an ultrasound mean that I am being adequately monitored?

Pei, 10~19 year old female. Ask Date: 2009/11/15

Dr. Li Guanghan reply Obstetrics and Gynecology

Dear Sir/Madam,
There are many potential causes of menstrual pain, including tension, stress, and anxiety.
I recommend that you take more rest and try to relax.
Please observe your menstrual cycles a few more times.
If you continue to feel discomfort, you may consult your physician again.
Wishing you peace and joy,
Dr.
Li Guang-Han, Department of Obstetrics and Gynecology, Hsinchu Hospital, Ministry of Health and Welfare.

Reply Date: 2009/11/15

More Info

After undergoing a myomectomy, it is common to experience changes in menstrual patterns and associated symptoms. Your situation, where you had a significant uterine fibroid (17 cm) removed, can lead to various post-operative experiences, including menstrual pain and changes in bleeding patterns. Here’s a comprehensive overview of what you might expect and when to be concerned.

Post-Myomectomy Menstrual Pain
1. Menstrual Changes: After a myomectomy, many women notice changes in their menstrual cycle. Initially, you may experience irregularities, such as changes in flow, duration, and pain levels. It’s not unusual for periods to become heavier or more painful for a few cycles post-surgery as your body adjusts to the absence of the fibroid.

2. Pain Levels: The pain you’re experiencing a couple of days before your period could be due to several factors. It may be related to the healing process, hormonal changes, or even the body’s response to the surgical procedure. While some discomfort can be expected, if the pain is severe or significantly different from what you experienced before surgery, it’s worth discussing further with your healthcare provider.

3. Blood Clots: The presence of blood clots during menstruation can be normal, especially after surgery. However, if you notice an increase in the size or frequency of these clots, or if they are accompanied by severe pain or heavy bleeding, it’s essential to seek medical advice.

When to Worry
1. Severe Pain: If you experience severe menstrual pain that is debilitating or significantly impacts your daily activities, this warrants further investigation. It could indicate complications such as adhesions, endometriosis, or other issues that may require treatment.

2. Heavy Bleeding: If you find that your menstrual bleeding is excessively heavy (soaking through a pad or tampon every hour for several hours), or if you are passing large clots consistently, you should consult your doctor.

3. Hair Loss: The hair loss you mentioned is concerning, especially if it began after your surgery. While your doctor may feel it is unrelated, it’s essential to consider that hormonal changes post-surgery can sometimes lead to hair loss. If this continues or worsens, it may be beneficial to seek a second opinion or consult a dermatologist or endocrinologist to explore potential underlying causes.

4. Follow-Up Care: Regular follow-up appointments are crucial after surgery. While your doctor may not feel an ultrasound is necessary at this time, if you have ongoing concerns about your symptoms, you should advocate for further evaluation. An ultrasound can help assess the uterus and surrounding tissues for any abnormalities that may be contributing to your symptoms.

Conclusion
In summary, while some menstrual pain and changes in bleeding patterns can be expected after a myomectomy, it’s essential to monitor your symptoms closely. If you experience severe pain, heavy bleeding, or other concerning symptoms, don’t hesitate to reach out to your healthcare provider for further evaluation. Your health and well-being are paramount, and it’s important to ensure that any post-operative complications are addressed promptly. If you feel your concerns are not being adequately addressed, seeking a second opinion can provide additional reassurance and clarity regarding your recovery process.

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