Prolonged Bleeding After Medical Abortion: When to Seek Follow-Up Care?

After a medical abortion, experiencing bleeding for more than two months led to a hysteroscopy procedure?

Hello, I underwent a medical abortion (RU486) at BPAS in the UK at 8 weeks and 2 days.
After taking the medication, I used a suppository that same day, and the doctor prescribed an antibiotic to take before bed.
I should have expelled the embryonic tissue, but I have been experiencing continuous bleeding, varying in intensity, and I have also passed multiple blood clots.
This bleeding has persisted for over two months.
Upon returning to Taiwan for a check-up, the doctor recommended a hysteroscopy, which I just completed.
Now, I am experiencing pain during urination, lower abdominal pressure, and difficulty exerting myself.
My question is whether I need to return to the original hospital where the procedure was performed for follow-up, or if I can go to another clinic/hospital for further examination.
Additionally, if there are no significant issues afterward, is a follow-up visit still necessary? Thank you for your guidance.

Niming, 20~29 year old female. Ask Date: 2016/12/21

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, I apologize for not being able to provide a diagnosis based on your description.
If you are still experiencing discomfort, I recommend returning to the hospital where you had the surgery for a follow-up.
If there is still no improvement, you may consider visiting a hospital for a detailed examination by a gynecologist.

Reply Date: 2016/12/21

More Info

After a medical abortion, particularly one involving the use of RU486, it is not uncommon for patients to experience prolonged bleeding. This bleeding can vary in intensity and may include the passage of blood clots. In your case, the bleeding has persisted for over two months, which is longer than typically expected. It is crucial to understand the implications of prolonged bleeding and when to seek follow-up care.

Prolonged bleeding after a medical abortion can be caused by several factors. It may indicate that not all of the pregnancy tissue has been expelled from the uterus, which can lead to complications such as infection or heavy bleeding. The presence of blood clots, especially if they are large or accompanied by severe pain, can also be a sign that further medical evaluation is necessary.
Given that you have already undergone a hysteroscopy (a procedure that allows a doctor to look inside the uterus), it is essential to monitor your symptoms closely. The pain during urination and lower abdominal discomfort you are experiencing post-procedure could be related to the hysteroscopy itself or may indicate an underlying issue that needs to be addressed.
In terms of follow-up care, it is advisable to return to the facility where you initially had the abortion, especially if they have your medical history and can provide continuity of care. They will be familiar with your case and can offer the most appropriate guidance based on their knowledge of your situation. However, if you feel uncomfortable returning to the original facility or if it is logistically challenging, you can seek care at another clinic or hospital. Just ensure that the new provider is informed of your medical history, including the abortion and the subsequent hysteroscopy.

It is important to seek immediate medical attention if you experience any of the following symptoms:
1. Heavy bleeding (soaking through two or more pads in an hour for two consecutive hours).

2. Severe abdominal pain that is not relieved by over-the-counter pain medications.

3. Fever or chills, which could indicate an infection.

4. Foul-smelling vaginal discharge.

In conclusion, while it is possible to seek care elsewhere, returning to the original facility is often the best course of action for follow-up care after a medical abortion. They can provide the most accurate assessment of your condition and determine if any further treatment is necessary. If your symptoms persist or worsen, do not hesitate to seek medical attention promptly. Your health and well-being are paramount, and addressing any complications early can help prevent more serious issues down the line.

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