Concerns After Medical Abortion: No Bleeding or Pain One Week Later

One week after using medication for abortion, the gestational sac has not been expelled, and there is no further bleeding or abdominal pain?

Hello, Doctor.
I would like to ask you some questions.
My cycle is about 5-6 weeks long.
On August 18, I took RU486, and on August 20, I took two doses of Misoprostol (Mifepristone) but vomited some liquid about 20 minutes after taking it.
On August 21, I took another dose of Misoprostol.
During this time, I experienced bleeding similar to the third or fourth day of my menstrual period, along with mild abdominal pain.
On August 26, I returned for a follow-up, and the doctor said the gestational sac was located very low in the uterus.
No medication was prescribed, and I was advised to wait a week to see if it would pass naturally.
However, three days later, I suddenly stopped bleeding and have no abdominal pain.
I do not wish to undergo surgery and hope for a natural expulsion.
May I ask: 1.
Should I return for an earlier follow-up? 2.
What is the maximum time I can wait for a natural expulsion? 3.
Besides surgery, are there any other methods to expedite the expulsion? Thank you for your response, Doctor.

Yuan Yuan, 30~39 year old female. Ask Date: 2016/08/29

Dr. Lü Lizheng reply Obstetrics and Gynecology

If there is a significant amount of bleeding or if the abdominal pain worsens, you should return for a follow-up visit.
In addition to surgery, medication can also be used to expedite the expulsion.
Please discuss this with your physician.
Sincerely, Dr.
Lu Li-Cheng, Taoyuan Hospital.

Reply Date: 2016/08/29

More Info

It sounds like you are experiencing a complex situation following a medical abortion, and I understand your concerns regarding the lack of bleeding or pain one week after the procedure. Let's address your questions and provide some additional context regarding medical abortions and the expected recovery process.

1. Do you need to return for an earlier check-up?
Given that you have not experienced any bleeding or abdominal pain since the initial post-abortion symptoms, it is reasonable to consider returning for an earlier check-up, especially if you have concerns about whether the abortion was complete. While some women may not experience significant bleeding after a medical abortion, the absence of bleeding for an extended period can sometimes indicate that the process has not fully completed. It's essential to communicate your concerns to your healthcare provider, as they may want to perform an ultrasound to ensure that the pregnancy tissue has been expelled completely.

2. What is the maximum time to wait for natural expulsion?
After a medical abortion, it is generally expected that the majority of women will experience bleeding and cramping as the body expels the pregnancy tissue. If you have not experienced any bleeding or cramping for more than a week, it is advisable to consult your healthcare provider. Typically, if there is no bleeding or cramping within 1-2 weeks after taking the medication, a follow-up appointment is recommended. However, the timeline can vary from person to person, and some may take longer to expel the tissue naturally. Your healthcare provider will be able to give you specific guidance based on your individual situation.

3. Are there other methods to expedite the expulsion besides surgery?
If you are hoping to avoid surgical intervention, there are a few options that may help facilitate the natural expulsion of pregnancy tissue. These can include:
- Medications: In some cases, healthcare providers may prescribe additional medications, such as misoprostol, to help stimulate uterine contractions and promote the expulsion of tissue.

- Natural methods: Some women find that certain natural methods, such as gentle exercise, staying hydrated, and using heat pads on the abdomen, can help encourage cramping and bleeding. However, these methods are not scientifically proven and should be approached with caution.

- Monitoring: It is crucial to monitor your symptoms closely. If you begin to experience severe pain, heavy bleeding, or any signs of infection (such as fever or foul-smelling discharge), you should seek medical attention immediately.

In conclusion, while it is not uncommon for some women to experience a delay in bleeding after a medical abortion, it is essential to stay in communication with your healthcare provider. They can provide personalized advice and determine whether further evaluation or intervention is necessary. Remember, your health and well-being are the top priority, and seeking guidance from a medical professional is always the best course of action when you have concerns.

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