QuestionDear Brenda
I am 38 yrs old and have just fallen pregnant for the first time but unfortunately I had to have a D&C on the 1/11/08 I was 10 wks pregnant, but the US showed no heart beat and that the baby had passed away at 7 weeks, so the Doc suggested a D&C as I was very distraught and just could not think of waiting for the baby to miscarry naturally it would have been to much for me. However, since the D&C I have been bleeding - It did stop on the Tuesday after the D&C then started up again on Thursday and has not stopped since. I saw the Doctor this last Friday 1/25 and he ordered HCG (preg hormone) tests and told me some woman can take longer to heal, while I was talking to him I had period like cramps which he was not too worried about, once I got home I passed a golf ball sized blood clot, followed by some red blood, the bleeding tapered off a little then today I passed another clot, not so big accompanied again by the red bleeding, is this normal? Is this my period kicking in? Is my age against me? Do you think the Doctor may have missed some tissue? I just want my body to go back to normal so we can start trying again for another baby, my Husband is so worried about me, and I am not sure wether I should be worrying and asking my Doctor to do more tests etc, or if I should just wait this out and hope it all starts healing soon, please let me know what you think, I feel like I am a little paranoid, but I have never experienced anything like this. Hope to hear from you soon and thank you Cathy
AnswerDear Cathy,
Well, first, I am sorry to hear of your difficulties and pregnancy loss. Please don't feel awkward about having the D&C rather than miscarrying naturally. The waiting is why most doctors recommend a D&C. It is just so difficult for most women to have to wait that out. Plus, often when you naturally miscarry the uterus does not completely empty and a D&C is necessary eventually anyway.
Most often after a miscarriage or D&C your bleeding will taper off to spotting within 7-10 days, and maybe random spotting will continue for another week. Your hCG will drop steadily, usually hitting zero during the end of the spotting, or about 10 days after the miscarriage or D&C. Some women find they have mild pregnancy symptoms, or little ovulation cramps. Many many women think they could be pregnant, because strange things are happening and their period is "late" (although almost every post-miscarriage period is late.) These symptoms are due to the body's attempts to regulate its hormones again. It may kick into gear right away, and you will get a new period in 4-5 weeks, or it may struggle a bit, and the period will not come for up to 8 weeks.
Less often, your bleeding tapers off quickly, but with some spotting. You think it is over. Perhaps a week or even two will pass, and you begin to wait for your period. Then suddenly, it begins again. Strong cramping, heavy bleeding, and pain. You hope it is just your period, but it is not. (You must not bleed at all for about 20 days for it to be a real period, otherwise you have not gone through the hormone chain properly.) Usually within a few days, it does stop, and you are just spotting again. Here is what usually has happened - some tissue was missed during your D&C or natural miscarriage. A bit of placenta clung to the wall of the uterus. It continued to draw a little blood, and the body continued to create very small amounts of pregnancy hormone. Eventually the body realized no baby was there and turned loose this last bit of tissue. The miscarriage process begins again. Only now will your levels drop to zero and a new cycle begin. You cannot expect a normal period any sooner than 4 weeks from this, and up to 7 weeks could still be normal. Your total wait time from original miscarriage to first period can creep up to 9-10 weeks and still be normal.
You should continue to have your hCG levels monitored to make sure they are dropping steadily and coming back down to zero. If your level is still over 100 a few weeks after the D&C, you likely will pass heavier blood and tissue with this last episode and then it will be done. If not, if you do continue spotting afterwards, a medication may be ordered by your doctor to help the body in cramping to push out any remaining tissue.
If your levels are zero or not very high, and you still just keep spotting and spotting, your doctor might order a shot of Provera or some other form of progesterone. This big dose will put your body into thinking it is nearing the end of a cycle. When the dose is done, the sudden drop in progesterone should trick your body into thinking it is time for a period, and you will bleed. This period can be terribly heavy or light, but it counts. If this has happened, it is still a good idea to wait through at least two normal menstrual cycles before trying to conceive again. This allows the body to heal completely and also lets hormones stabilize and get back into a regular cyclic pattern again.
I hope this information has helped you and answered your question. Try to give it another week or so. Hopefully the heavier bleeding will taper off and your body will begin to go into a normal cycle. Again, if you continue to have the heavy bleeding with clots and/or continual spotting for longer than the next 7-10 days, go ahead and call your doctor to report the symptoms and request an hCG level (if one was not done at your follow-up visit). I wish you well.
Brenda
