When a scheduled surgery coincides with a menstrual period, patients often worry if the procedure must be postponed. This concern is understandable, as bleeding near a surgical event can seem problematic. For surgical teams, however, this is a common occurrence and a frequent part of pre-operative planning.
The General Consensus
For the majority of non-pelvic and non-gynecological procedures, active menstruation does not pose a medical safety risk or require rescheduling. This includes common operations like orthopedic, cardiac, or general surgeries. The body’s coagulation system is not significantly impaired by a normal menstrual cycle. Studies have found no significant difference in intraoperative blood loss between menstruating and non-menstruating patients.
The volume of blood lost during a typical menstrual period is relatively small, averaging 30 to 80 milliliters over the full cycle. This amount is negligible compared to a patient’s total blood volume and does not meaningfully impact blood loss during the surgery itself. Therefore, for surgeries not directly involving the reproductive organs, menstrual flow is considered a logistical issue, not a medical contraindication.
Specific Procedures Requiring Disclosure
The timing of the menstrual cycle becomes relevant, and disclosure is necessary, when the procedure involves the pelvic region or hormonally sensitive tissues. Surgeries requiring direct access to the uterus or cervix, such as a hysteroscopy or laparoscopy for endometriosis, can be affected by the presence of blood. The flow can obstruct the surgeon’s view, making it difficult to visualize the surgical field or perform delicate manipulations.
Hormonal and Bleeding Considerations
Procedures involving hormonally dependent tissues, such as breast reduction or some cosmetic surgeries, may have higher perimenstrual bleeding or bruising. Patients with a pre-existing bleeding disorder, such as von Willebrand disease, or a history of heavy menstrual bleeding must also disclose this to the surgical team. This information allows the team to prepare for a potentially higher risk of hematoma or other bleeding complications during or after the operation.
Managing Logistics and Communication
Regardless of the type of surgery, informing the surgical team, especially the pre-operative nurses and anesthesiologist, is the first step if your period arrives. This allows the staff to make appropriate accommodations for comfort and hygiene during the procedure and immediate recovery. Hospital protocol requires the removal of all internal menstrual products, including tampons and menstrual cups, before the patient enters the operating room.
Leaving a tampon or cup in place poses a risk of toxic shock syndrome if left for an extended period. It also prevents the team from accurately monitoring blood loss during surgery. The hospital staff will provide highly absorbent pads or special absorbent under-pads for use during the operation and recovery until the patient is fully awake and mobile.