Post-Medication Abortion Concerns: Bleeding and Treatment Options

Issues After Medical Abortion

Hello, Doctor: About a month and a half after a medical abortion, I started experiencing bleeding similar to a menstrual period, which lasted for three weeks.
I visited the doctor three times during this period.
During the first visit, the doctor performed an ultrasound but did not clarify whether everything had been completely expelled.
He prescribed a three-day course of hemostatic medication.
After three days, I returned for a follow-up, and he prescribed another week of hemostatic medication because I was concerned.
The next day, I consulted another obstetrician-gynecologist.
This time, a urine test showed a faint positive pregnancy result, but no ultrasound was performed.
This doctor prescribed uterotonics, anti-inflammatory pain relief, and medications to alleviate gastrointestinal discomfort, as well as treatments for Gram-positive and Gram-negative bacterial infections and viral infections.
I have completed the course of these medications, but the bleeding continues, although the amount is not significant.
The last doctor mentioned that it would eventually resolve on its own.
I would like to know if it is safe to continue taking the medications prescribed by the last doctor until the bleeding stops, or if a surgical procedure is necessary due to the possibility of incomplete abortion.
Since the abortion, I have had no sexual intercourse.

Cai Xiaohua, 30~39 year old female. Ask Date: 2017/07/17

Dr. Huang Jianzhong reply Obstetrics and Gynecology

About a month and a half after a medical abortion, I started experiencing bleeding similar to a menstrual period, which lasted for three weeks.
I visited the doctor three times during this period.
During the first visit, the doctor performed an ultrasound but did not clearly indicate whether everything had been completely expelled.
He prescribed a three-day course of hemostatic medication.
After three days, I returned for a follow-up appointment and was given another week of hemostatic medication because I was concerned.
The next day, I consulted another obstetrician-gynecologist.
This time, a urine test showed a faint positive pregnancy result, but no ultrasound was performed.
This doctor prescribed uterotonics, anti-inflammatory pain relief, and medications to alleviate gastrointestinal discomfort, as well as treatments for Gram-positive and Gram-negative bacterial infections and viral infections.
I completed the course of these medications, but the bleeding continued, although it was not heavy.
The last doctor mentioned that the bleeding would eventually resolve on its own.
I am not experiencing abdominal pain, but there is still a small amount of ongoing bleeding.
If the abortion was incomplete, can I continue taking the medications prescribed by the last doctor until the bleeding stops, or is a surgical procedure necessary? Since the abortion, I have had no sexual intercourse.

Answer: You can continue taking the medications prescribed by the last doctor until the bleeding stops; otherwise, a surgical procedure for dilation and curettage (D&C) may be necessary.

Reply Date: 2017/07/17

More Info

Post-medication abortion can lead to various concerns, particularly regarding bleeding and the completeness of the abortion process. It is not uncommon for women to experience bleeding that resembles a menstrual period for several weeks following a medical abortion. This bleeding can vary in intensity and duration, and it is essential to monitor it closely.

In your case, experiencing bleeding for three weeks after a medical abortion is within the range of normal, but it is crucial to ensure that the abortion was complete. The fact that you have had multiple follow-up appointments and received different medications indicates that your healthcare providers are taking your concerns seriously. The use of uterotonics (such as oxytocin or misoprostol) is common to help the uterus contract and expel any remaining tissue, while anti-inflammatory and pain relief medications can help manage discomfort.

The presence of a faint positive pregnancy test after a medical abortion can be concerning, as it may indicate retained products of conception. However, it is also possible for the hormone hCG (human chorionic gonadotropin) to remain in the body for some time after a miscarriage or abortion, which can lead to a positive test even if the abortion was complete.
If you are experiencing ongoing bleeding but no significant pain, it may suggest that the body is still in the process of expelling any remaining tissue. However, if the bleeding becomes heavy, or if you experience severe pain, fever, or foul-smelling discharge, these could be signs of complications such as infection or retained tissue, which would require immediate medical attention.

Regarding your question about whether you can continue taking the medications prescribed by your last doctor until the bleeding stops, it is essential to follow your healthcare provider's recommendations. If the medications are intended to help with uterine contractions and manage any potential infections, they may be beneficial. However, if the bleeding persists beyond a reasonable timeframe or if you have concerns about the effectiveness of the treatment, it is crucial to communicate this with your healthcare provider.

In some cases, if there is suspicion of incomplete abortion or if the bleeding does not resolve with medical management, a surgical procedure such as dilation and curettage (D&C) may be necessary to ensure that the uterus is clear of any remaining tissue. This decision should be made in consultation with your healthcare provider, who can assess your specific situation based on clinical findings and your overall health.

In summary, while it is common to experience prolonged bleeding after a medical abortion, it is vital to monitor the situation closely. If you have ongoing concerns, especially with the faint positive pregnancy test and persistent bleeding, do not hesitate to seek further evaluation from your healthcare provider. They can provide the most appropriate guidance based on your individual circumstances and ensure that any potential complications are addressed promptly.

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