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Dr. Norm S.
Dr. Norm S., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 11287
Experience:  Over 30 years of experience in OB/GYN practice, including teaching students. Fellow of American Board of Obstetrics and Gynecology.
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About 5 months ago I had an endometrial abalation done which

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About 5 months ago I had an endometrial abalation done which seemed to go well and all seemed to heal well. At the time of the the surgery I was on micgrogynon 30 but because of my age (49) it was suggested that I change to cerezette, which I have now been on for 2 months. I had some spotting after about 3 weeks but for the past 6 weeks have not had any further spotting- although I have noticed that every few days I will see what looks like a tiny tiny speck of what looks a bit like brown/red dried blood coming away in amongst the ordinary clear discharge. They are only as big as a pin head and look dried as they dont reactivate or spread when water is added to them as I've tried it. Is this even possible as it's occured to me I'm looking too closely as might be imagining this...or that these specks are coming from elesewhere- like around my anus.
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It's possible to have some bleeding after endometrial ablation, so I presume that's what you're seeing. Usually it's possible to tell whether blood is coming from the vagina or anus. There is no promise after endometrial ablation that there will be no further bleeding, only that there will be less bleeding than before.
Customer: replied 3 years ago.

Obviously I realise that but the it looks like dried tiny specks....that are in amongst normal clear discharge- it is possible for it to be dried and why would that be?

Blood that comes out very slowly will turn brown and dry up. It probably dries up before it gets into the clear discharge which washes it out.
Customer: replied 3 years ago.

So what do you think is causing it as it has only started happening since I changed to cerezette- do you think it's a change in hormones or do you think it could be a sign of infection or irritation?

Usually bleeding after endometrial ablation just means that the uterine lining (endometrium) hasn't been completely destroyed. We try to get rid of all the uterine lining, but often there will be some endometrium remaining, and that can bleeding. It doesn't mean there is any infection or irritation.

Women on Cerazette will often have some spotting, bleeding or periods. I suspect that you'd be having some spotting even if you weren't on Cerazette, but the progesterone is preventing buildup of the endometrium, as well as preventing pregnancy.

The bleeding probably didn't happen before because it took a while for the endometrium to build up enough to bleed, since there's not much endometrium there.
Customer: replied 3 years ago.

No that's not the case I as I was on Micrognon 30 for 3 months following the abalation and I was only spotting on weeks that I was on my pill free break. These specks every few days have only started happening since the cerezette.

Women on Microgynon usually bleed during the pill free week. Women on Cerazette can bleed anytime, which is what you're doing. The bleeding means there is endometrium present to bleed.

If you stop the Cerazette, I predict you will have spotting, although it may not happen for a while. The fact that you have endometrium to bleed means that you're better off taking some progesterone, because progesterone protects endometrium from endometrial cancer.
Customer: replied 3 years ago.

Now I'm confused because I thought Cerezette WAS progesterone only based. If I continue to take cerezette and don't bleed will the lining contunue to increase, as I understand many women on cerezette don't get proper periods?

You are correct that Cerazette is progesterone only. If you continue to take Cerazette, it will prevent the lining from increasing. You may or may not continue to bleed, which depends more on whether there is estrogen present or not. The estrogen comes from your ovaries. As long as your ovaries continue to make estrogen, you may continue to spot or bleed. Once there is no estrogen present, all bleeding will stop.
Customer: replied 3 years ago.

So you don't think these tiny specks are of any great concern? I have only been on cerezette for 9 weeks so it's still early days.I guess there is a chance that it will resolve as my body gets more used to it?


I just want to clarify that the lining won't continue to just get thicker and thicker without a proper bleed?

I don't think these specks are of concern. They may well disappear after a while, but perhaps not.

As long as you keep taking the Cerazette, that will prevent the lining from getting thicker. That's what progesterone does, whether it's from the birth control pill, Cerazette, depo provera.
Customer: replied 3 years ago.

So why do some women continue to have periods on Cerezette and some don't?

Nobody knows. Most women continue to have periods on Cerazette, although they may be irregular or may also have spotting. Different women react differently to hormones, whether it's the pill, HRT, or other hormones.
Customer: replied 3 years ago.

Ok, so just to clarify you think these tiny specks are very small bits of lining coming away and are so small they are drying up....... that maybe partly aggrevated by the fact that I haven't bleed properly for about 6 weeks?

The specks could be small bits of lining or small bits of blood, either so small that they are drying up because it takes a while for them to come out.

It may be partly aggravated by the fact that you haven't bled properly for about 6 weeks. I assume that by bleed properly, you mean to have a regular period, and that probably won't happen again.
Customer: replied 3 years ago.

Do you think it wont happen again because of the abalation or the cerezette- or both?

I think that you won't have a normal period because of the ablation.

If you had normal hormonal changes that normally would lead to a period, that would cause whatever lining was present to clean off. It wouldn't seem like a normal period, because you don't have very much lining.
Customer: replied 3 years ago.

Thank you for your help.

You're welcome.
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