From the Guidelines
Vaginal bleeding after stopping breastfeeding should be evaluated for underlying gynecological problems, and if none are found, treatment options such as NSAIDs or hormonal treatment can be considered. The causes of vaginal bleeding after stopping breastfeeding can be attributed to the return of normal menstrual cycles as prolactin levels decrease, allowing estrogen and progesterone to resume their regular patterns 1. This hormonal shift often leads to the shedding of the uterine lining that built up during the amenorrhea period of breastfeeding. For most women, this bleeding is normal and requires no treatment as the body adjusts to its pre-pregnancy hormonal state. However, if bleeding is extremely heavy, persists longer than 7 days, or is accompanied by severe pain or fever, medical attention should be sought immediately.
Some key points to consider in the evaluation and treatment of vaginal bleeding after stopping breastfeeding include:
- Evaluating for underlying gynecological problems such as interactions with other medications, STDs, pregnancy, or new pathologic uterine conditions (such as fibroids or polyps) 1
- Considering treatment options such as NSAIDs for short-term treatment (5–7 days) or hormonal treatment (if medically eligible) with low-dose COCs or estrogen for short-term treatment (10–20 days) 1
- Counseling on alternative contraceptive methods if heavy or prolonged bleeding persists and the woman finds it unacceptable 1
- Offering another contraceptive method if desired 1
It's essential to track bleeding patterns and symptoms to help healthcare providers determine if the bleeding is within normal limits or requires intervention. The body typically regulates itself within 2-3 cycles, but persistent irregular bleeding may indicate other conditions that require further evaluation.
From the Research
Causes of Vaginal Bleeding After Stopping Breastfeeding
- Vaginal bleeding after stopping breastfeeding can be caused by various factors, including hormonal changes, ovulation, and the return of menstruation 2, 3.
- The duration and character of postpartum bleeding among breast-feeding women can vary, with some women experiencing bleeding episodes separated from the original lochial flow by at least 4 bleeding-free days 2.
- Hormonal contraception, such as combination oral contraceptive pills, progestin-only pills, and medroxyprogesterone acetate injections, can also cause abnormal uterine bleeding, which may be a concern for women who have stopped breastfeeding and are using hormonal contraception 4.
Treatment of Vaginal Bleeding After Stopping Breastfeeding
- Treatment for vaginal bleeding after stopping breastfeeding depends on the underlying cause, but may include hormonal therapies, such as combination oral contraceptives or progestins, to regulate menstrual cycles 5.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and supplemental estrogen may also be used to treat abnormal uterine bleeding in women who have stopped breastfeeding 4, 5.
- In some cases, further evaluation and management may be necessary to rule out underlying conditions, such as polycystic ovary syndrome, thyroid dysfunction, or endometrial cancer 5.
Evaluation and Management
- Evaluation of vaginal bleeding after stopping breastfeeding should include a thorough history and physical examination, as well as targeted laboratory tests to rule out underlying conditions 5.
- Women who experience vaginal bleeding after stopping breastfeeding should be evaluated for signs of ovulation and menstruation, as well as for any underlying conditions that may be contributing to the bleeding 2, 3.
- Management strategies may include counseling and reassurance, as well as medical therapies to regulate menstrual cycles and treat abnormal uterine bleeding 4, 5.