Bleeding after a hysterectomy—the surgical removal of the uterus—is alarming because the primary organ responsible for menstrual flow is gone. The source of any subsequent bleeding is not a return of the period, but indicates an issue with the remaining surgical site, surrounding tissues, or structures near the vagina. The specific origin of the blood depends heavily on what was removed and how long after the surgery the bleeding is noticed.
Understanding What Was Removed and What Remains
A hysterectomy is not a single procedure, and the type performed dictates the anatomical structures that remain and can potentially bleed. A Total Hysterectomy involves the removal of both the uterus and the cervix. When the cervix is removed, the surgeon must close the top of the vagina, creating a scar known as the vaginal cuff.
Conversely, a Supracervical or Partial Hysterectomy removes only the main body of the uterus, leaving the cervix intact. This remaining structure is often called the cervical stump or retained cervical tissue. Understanding which tissues were retained is the first step in identifying the potential source of bleeding.
Bleeding Causes in the Early Recovery Period
During the initial recovery phase, typically the first six to eight weeks after the operation, light vaginal discharge or spotting is expected as part of the normal healing process. This discharge may vary in color, appearing as red, pink, or brown, and should consistently become lighter over time. Spotting often involves small amounts of bright red blood as the internal, dissolvable sutures used to close the vaginal cuff begin to break down and are shed.
A more specific source of bleeding during this time is the formation of a pelvic hematoma, which is a collection of blood near the surgical site. While small hematomas often resolve on their own, a larger accumulation can cause discomfort and result in blood or discharge from the vagina.
Another common complication is the development of granulation tissue at the vaginal cuff. This is an overgrowth of fragile, highly vascular scar tissue that forms as the internal incision heals. Granulation tissue can bleed easily, sometimes only becoming noticeable after the resumption of sexual activity. This tissue can often be treated with a chemical cauterization agent, such as silver nitrate.
Bleeding Causes Months or Years After Surgery
When bleeding appears months or years after the surgical recovery is complete, the causes are often distinct from those related to initial wound healing.
If a supracervical hysterectomy was performed, retaining the cervix, the most frequent cause of later bleeding is the cervical stump. This retained tissue may still contain a small amount of endometrial lining, which can respond to hormonal fluctuations, resulting in light, cyclical bleeding that resembles a mini-period. This phenomenon is a known possibility following a partial hysterectomy.
Another common long-term cause is vaginal atrophy, which is a thinning and drying of the vaginal walls due to a lack of estrogen. This condition is particularly common if the ovaries were removed during the hysterectomy, causing an abrupt drop in hormone levels. The atrophic tissue becomes fragile, inflamed, and prone to bleeding upon minor friction, such as during intercourse or a pelvic exam. This issue is typically addressed with localized treatments like vaginal estrogen creams.
Less commonly, bleeding may not originate from the remaining reproductive structures at all, but from adjacent organs. Blood may be coming from the urinary tract (hematuria) due to a bladder or kidney issue, or from the gastrointestinal system, such as from hemorrhoids or diverticulitis. In rare instances, late-onset bleeding may signal a more serious condition, such as a new or recurrent cancer of the vagina or the retained cervical tissue.
When to Contact Your Healthcare Provider Immediately
While light spotting can be a normal part of the healing process, certain signs indicate a serious complication that requires immediate medical attention, regardless of how long ago the hysterectomy occurred. You should contact your healthcare provider at once if you experience any of the following symptoms:
- Heavy vaginal bleeding, defined as soaking through more than one sanitary pad per hour for two consecutive hours.
- The passage of large blood clots is also a reason for urgent evaluation.
- Signs of potential infection, including a fever above 100.4°F, chills, or foul-smelling vaginal discharge.
- Sudden, severe abdominal or pelvic pain that does not resolve with rest.
- Symptoms of significant blood loss, such as feeling dizzy, lightheaded, or fainting.