Dear Mrs, I totally understand how much frustrating is your personal obstetrical and gynecological history. Based on the history you presented we can list the following points : 1- You had already three cycles after your cesarean section, which means that the bleeding, even if it started during the first cycle you had post cesarean, is not directly correlated to the cesarean itself. Of course there are some rare entities that can be present with excessive bleeding or intermenstrual spoting due to repeat cesareans such as what we call the niche , but these enteties are benign and you should not be worried about them. 2- Your age is very important in order to decide weither to do or not to do an endometrial biopsy. if you are above the age of 45, it is highly recommended to do so in order to rule out premalignant and malignant etiologies 3-Regarding the management plan in your case, the following should be done a- a CBC (complete blood count) must be done in order to see if you are anemic due to this excessive bleeding. iron supplementation might be warranted b- an ultrasound to determine the endometrial thickness is also important and to detect any possible organic uterine pathology such as a polyp or a fibroid that is causing the bleeding c- Regarding the pain, and the excessive bleeding during menses and in addition to the fact that you already had 3 previous cesareans then a method of contraception that can solve all these problems is the excellent treatment and prevention. I highly recommend Mirena IUD placement that will treat the excessive bleeding, the cramps during cycle and is a very effective as a method of contraception and is not contraindicated in case of migraine. Best Regards, Ali Mourad, MD