Abnormal Bleeding After RU486: When to Seek Medical Help

Heavy abnormal bleeding after taking RU486?

Hello Dr.
Huang, I took RU486 at the hospital on February 10 and experienced bleeding for 9 days.
On February 25, I had a second episode of bleeding that lasted a total of 35 days.
During this second bleeding, it was mostly a large amount of liquid bright red blood, accompanied by numerous large and small blood clots.
I had to change sanitary pads every hour, and the bleeding was intermittent with sudden heavy flows.
I went through a whole pack of tissue paper in three days.
During this period, I had five follow-up visits, and each time I was prescribed uterotonics, and sometimes hemostatic agents.
On March 10, during the second follow-up, an ultrasound showed blood clots in the lower part of the uterus, but even after they were removed, the bleeding continued with bright red blood and clots.
On March 28, during the fifth follow-up, the doctor prescribed a 21-day course of hormones, but since the bleeding had decreased, I decided not to take them.
The bleeding stopped on March 31.
From April 19 to 22, when I used the restroom, I noticed small amounts of brownish stringy clots and faint brown blood on the tissue.
On April 23, I suddenly experienced heavy bleeding with bright red liquid blood; straining during urination caused blood clots to be expelled, and the toilet was filled with bright red blood.
Besides the clots, there were also tissue pieces that looked like endometrial tissue, resembling chunks of meat.
On April 24, the bleeding lessened slightly, and the blood on the sanitary pad was closer to the color of a menstrual period, but after urination, the toilet still had bright red blood and clots.
Is this considered the first menstrual period after RU486? Do I need to return for another follow-up?

K, 30~39 year old female. Ask Date: 2017/04/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Hello, Dr.
Huang.
I took RU486 at the hospital on February 10 and experienced bleeding for 9 days.
On February 25, I had a second episode of bleeding that lasted a full 35 days.
During the second bleeding episode, I experienced a significant amount of bright red liquid blood, accompanied by numerous large and small blood clots.
I had to change my sanitary pads every hour, and the bleeding was intermittent, with sudden heavy flows.
I went through a whole pack of tissue paper in three days.
During this time, I had five follow-up visits, and each time I was prescribed uterotonics, and sometimes hemostatic agents.
On March 10, during the second follow-up, an ultrasound showed blood clots in the lower part of the uterus, but even after they were removed, the bleeding continued with bright red blood and clots.
On March 28, during the fifth follow-up, the doctor prescribed a 21-day course of hormones, but since the bleeding had decreased, I decided not to take them.
The bleeding stopped on March 31.
From April 19 to 22, when I used the restroom, I noticed small amounts of brownish stringy clots and faint brown blood on the tissue.
On April 23, I suddenly experienced heavy bleeding with bright red liquid blood.
When I strained during urination, blood clots were expelled, and the toilet was filled with bright red blood.
In addition to the clots, there were also tissue fragments that looked like endometrial tissue, resembling fleshy lumps.
On April 24, the bleeding decreased slightly, and the blood on the sanitary pad was closer to the color of menstrual blood, but after urination, the toilet still contained bright red blood and clots.

1.
Can this be considered the first menstrual period after RU486?
Answer: Yes, it can be considered the first menstrual period after RU486.

2.
Do I need to return for a follow-up?
Answer: If the bleeding continues to decrease, then a follow-up may not be necessary.

Reply Date: 2017/04/24

More Info

Understanding abnormal bleeding after taking RU486 (mifepristone) is crucial for ensuring the safety and health of individuals undergoing medical abortion. RU486 is commonly used in combination with misoprostol to terminate early pregnancies, and while it can be effective, it can also lead to various side effects, including abnormal bleeding.

In your case, the timeline and symptoms you described indicate a complex situation. After taking RU486 on February 10, you experienced prolonged bleeding for 9 days, followed by a significant second episode of bleeding that lasted 35 days. This is indeed concerning, especially given the volume of blood loss you reported, which included large blood clots and a need to frequently change sanitary products. The fact that you experienced sudden heavy bleeding on April 23, accompanied by the passage of what appeared to be tissue, raises additional concerns.

Typically, after a medical abortion, it is expected that bleeding may occur for a few days to a couple of weeks as the body expels the pregnancy tissue. However, heavy bleeding that requires changing sanitary products every hour, or the presence of large clots, is not considered normal and warrants medical attention. The bleeding you experienced, especially with the accompanying symptoms of abdominal pain and the passage of tissue, suggests that there may be retained products of conception or other complications such as infection or uterine atony.

Regarding your question about whether this bleeding could be considered your first menstrual period after the RU486 treatment, it is important to note that the return of menstruation can vary significantly among individuals. Generally, it can take several weeks to a few months for menstrual cycles to normalize after a medical abortion. However, the nature of your bleeding—especially the heavy flow and the presence of tissue—indicates that this may not be a typical menstrual period but rather a continuation of the post-abortion bleeding.

As for whether you need to return for further evaluation, the answer is yes. Given the severity and duration of your bleeding, along with the symptoms you described, it is advisable to seek medical attention. A healthcare provider can perform a thorough evaluation, which may include a pelvic examination and an ultrasound, to assess for any retained tissue or other complications. They may also consider additional treatment options, such as medications to help control the bleeding or, in some cases, surgical intervention if necessary.

In summary, while some bleeding is expected after taking RU486, the extent and nature of your bleeding suggest that it is not within the normal range. It is crucial to consult with a healthcare provider for a comprehensive evaluation to ensure your health and safety. Do not hesitate to seek help, as timely intervention can prevent further complications and provide peace of mind.

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