Ovulation bleeding postpartum - is it normal?

[Fifii]

I am almost 10 months postpartum, my cycle returned in august despite me breastfeeding regularly every day (and night!).

since my period returned I’ve experienced cramping and bleeding around ovulation (at least I assume it’s ovulation.. it’s mid cycle so maybe?). I didn’t experience this prior to getting pregnant, so it’s a very inconvenient addition 😅

has anyone else experienced this? Did it last long? Did it eventually stop?

for reference I already know I have endometriosis, and recently got told I’m anaemic too

I recommend going to your GP ask for a pelvic ultrasound, and a transvaginal one to see what they find. You may have a cyst or something or an endometrioma which can be quite common with endo.

You could look into trying the mirena which will make the uterus lining thinner, less bleeding and less cramps). So definitely try that, sometimes the progesterone only pill (mini-pill) can be better for some.

Also ask your GP for mefenamic acid and/or naproxen (NSAIDs which help a lot as they are anti-inflammatories and give pain relief). and tranexamic acid (helps reduce heavy bleeding) - you need to start taking it days before your period starts so that it can work at best capacity. Also do you take any other meds? Opiods can be amazing for the pain and you can take them as needed.

Do you have any other symptoms?

@TheLivelyViper thank you so much for your reply!

I will definitely do that. I did contact my gp last month but they were a bit vague - organised blood tests and basically said to monitor how my next few cycles go. I had laparoscopic surgery in spring 2024 and they removed all the endo they could see (excision), including an endometrioma. I was taking mefenamic acid and tranexamic acid prior to the surgery - I didn’t enjoy taking them but they did help a bit!

Probably an impossible question but I was really hoping that the endo couldn’t have come back already? Especially since I got pregnant so soon after the surgery and I’ve only had three periods since having my baby. My process from diagnosis to surgery to pregnancy was really quick (which I’m very grateful for) but I do feel a bit uninformed around the condition.

im taking iron and folic acid supplements for the anaemia and deficiency but nothing else. I really hadn’t wanted to do any hormonal contraception ever again but the bleeding really does affect me so I may have to consider it.

i get quite a bit of cramping and bloating whenever I get bleeding - both mid cycle and during my period. Huuuuge bloating before my period too - someone last month thought i was pregnant again!! I also just feel generally unwell and exhausted but that could be the anaemia.

thank you for your really detailed reply, lots to think about!

This depends on where all your endo tissue was, but it may be that not all of it was removed, I mean it depends sometimes if there's some where they may need to remove an organ sometimes they don't etc.

Also, it is a whole body inflammatory condition and so the tissue is always growing and can sustain its self sometimes, also adhesions etc can grow, so 10 months postpartum is sort of enough time and some would have likely grown during your pegenancy as well. It doesn't grow because of your period at all and doesn't have anything to do with that tsther things like estrogen, and prostaglandins help it to be painful.

The main symptom of endometriosis is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition so your pain is felt throughout the month not just when on your period.

It will likely be less tissue but that doesn't necessarily correlate with symtpoms.

In terms of pain an NSAID like naproxen or mefenamic acid can really help, and I'd consider going back on them from now. Also for the bleeding tranexamic acid until you can use something more long-term like the mirena coil. Is the pain quite bad? As you could look into trying some opiods as well, maybe as needed at first? It really depends on the person.

You might need to increase your iron dose if your still really struggling with symtpoms of it. Maybe ask for a prescription dose which can be higher.

Also there are different types of pills you can try so ones which increase and decrease doses across the cycle etc. Ask your GP not just about different types but ones on different mechanisms compared to any you have tried and didn't like.

So during a menstrual cycle, progesterone is released later on (luteal phase) - it basically tells the hypothalamus and pituitary glands, stop now you've done your job (which is thickening the uterus lining - estrogen's job), let's not go overboard and progesterone maintains the uterus lining (whereas after your period, estrogen stimulates it to grow more). Essentially, the hypothalamus, or pituitary glands, at that point stop producing FSH, LH - that means that less estrogen is produced. The mirena uses synthetic progesterone to thin the uterus lining and help to shrink things like fibroids.
It also suppresses estrogen secretion to hopefully stop more growth of the uterus lining (helpful for periods it leads to less bleeding and cramps). That's the pathway for both the pill and the mirena but the mirena is more localised which often means less side effects for most people.