Post-Miscarriage Bleeding: Causes and When to Seek Help

Bleeding again after a complete miscarriage?

Hello, Doctor.
I took medication for a medical abortion and uterine contraction medication on October 30 and 31.
I had three follow-up appointments over the next two weeks to confirm that my uterus was clear (the last visit showed a faint second line on the pregnancy test).
The bleeding completely stopped by November 17.
However, starting this past Monday, November 23, I noticed brown spotting, which has increased today (November 25) to a more noticeable amount that is brown with a hint of red, similar to the bleeding I experience on days 5 to 6 of my menstrual period.
Could this be retained products from my previous miscarriage, or is it possible that this is a normal menstrual period? Could it also be ovulation bleeding? (I used to have occasional ovulation bleeding, but it was very minimal.) Should I return for a check-up, or should I wait to see if it resolves on its own? (Although I'm unsure when the bleeding will stop.) Thank you for taking the time to answer my questions.

Miss Jian, 20~29 year old female. Ask Date: 2015/11/25

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
It usually doesn't take that long to form a new menstrual cycle.
2.
Ovulation bleeding typically doesn't last that long.
3.
It should just be residual blood and should clear up soon.
If the amount increases or if there is abdominal pain, a follow-up visit is necessary.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/11/25

More Info

After a miscarriage, it is common for women to experience various types of bleeding as their bodies adjust to the hormonal changes and physical recovery. In your case, it seems you have undergone a medical abortion and have had follow-up appointments confirming that your uterus is clear. However, the recent onset of brownish-red discharge and increased bleeding can understandably cause concern.

Bleeding after a miscarriage can be attributed to several factors. First, it is important to note that the body goes through a significant hormonal shift after a pregnancy ends, whether through miscarriage or abortion. The levels of hormones such as estrogen and progesterone drop, which can lead to irregular bleeding patterns. This can manifest as spotting or bleeding that may not be consistent with your normal menstrual cycle.

The brownish color of the blood you are experiencing typically indicates older blood that has taken longer to exit the body. This can be a normal part of the healing process. However, the increase in bleeding you mentioned, which resembles the flow of a typical menstrual period, raises some questions. It is possible that this bleeding could be your first menstrual period following the miscarriage. Many women experience changes in their menstrual cycle after a miscarriage, including variations in flow and color.

Another possibility is that you could be experiencing ovulation bleeding. Ovulation bleeding can occur around the time of ovulation, which typically happens about two weeks after the start of your last menstrual period. If you have a history of experiencing ovulation bleeding, this could explain the brownish discharge followed by a heavier flow.

However, it is also essential to consider the possibility of retained products of conception, which can occur if the uterus does not completely expel all tissue after a miscarriage. This can lead to continued bleeding and may require medical intervention. Since you have already had follow-up appointments confirming that your uterus is clear, this is less likely, but it is still a possibility worth monitoring.

Given your situation, it is advisable to keep track of your bleeding patterns. If the bleeding continues to increase, becomes excessively heavy, or is accompanied by severe pain, fever, or any other concerning symptoms, you should seek medical attention promptly. It is always better to err on the side of caution, especially after a miscarriage.

In terms of when to seek help, if the bleeding persists beyond a few days or if you have any doubts about its nature, it would be prudent to return to your healthcare provider for further evaluation. They may perform an ultrasound or other tests to ensure that everything is progressing normally and that there are no complications.

In summary, while some irregular bleeding can be normal after a miscarriage, it is crucial to monitor your symptoms closely. If you have any concerns or if the bleeding does not resolve, do not hesitate to reach out to your healthcare provider for guidance and reassurance. Your health and peace of mind are paramount during this recovery period.

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