With the epidemic of cesarean section that is approaching 40%, we are seeing more often young patients with post-menstrual bleeding. Could you walk us through your diagnostic approach for the woman with a history of cesarean section, who complains of postmenstrual bleeding?
A thorough history will be the most important indication for abnormal uterine bleeding (AUB) associated with a cesarean scar defect (CSD). Along with the history of one or more cesarean sections is a menstrual history indicating a typical bleeding pattern. These women will admit to dark blood, usually old, emanating often several days after a regular menstrual cycle has ceased. Often, the blood is expelled with activity such as exercise or intercourse. These women will report that overall bleeding days associated with their cycle are many, owing to the number of additional days in which there is expulsion of blood from the CSD. In general, this post-menstrual bleeding tends to be also lighter than the regular menstrual flow.
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