RU486: Duration of Bleeding After Medical Abortion

Regarding the bleeding duration after using RU486 for abortion?

Hello Dr.
Huang, I would like to ask about the duration of bleeding after taking RU486 for a medical abortion.
In the past, when I was 16, I underwent a surgical abortion at three months gestation.
Then, at 19, I became pregnant again, but it did not implant safely and resulted in a spontaneous abortion.
This past May and June, I developed a cyst about 5 cm in size, but the doctor said it would not go away.
Surprisingly, it disappeared on its own a month later.
Last month, on September 22, I took the medication, and on September 24, I started experiencing heavy bleeding, which I believe was when the placenta expelled.
I felt a lot of pain and discomfort, and I wondered if it was related to my previous abortion or the cyst.
I had difficulty with urination and bowel movements.
On September 25, I returned to the clinic and was prescribed three days of uterotonics (the doctor did not provide much explanation).
The bleeding gradually decreased, but the discomfort persisted.
However, starting from September 29 and 30, the bleeding increased again, requiring me to use extra-long pads every 30-40 minutes, which would overflow.
I urgently returned to the clinic, and the doctor performed an ultrasound, noting that I still had blood clots.
I was instructed to take a bath and gently clean the vaginal area, and I was given another three days of uterotonics (this time I asked what it was for).
The doctor advised that by October 12, I should not have any bleeding at all; if I did, I needed to return for a follow-up, as it could potentially lead to infertility.
After returning home, I thought about it and questioned whether the blood clots were not in the uterus but related to the vagina.
However, I found online that some people experience bleeding for up to a month after a medical abortion.
I have not reached a month yet, but I noticed that in the last two days, the blood clots have increased in size, approximately 0.5 to 1 cm, which I wonder if it is normal.
I plan to visit another large hospital on the 12th, and I wanted to ask you about this beforehand.
Thank you, Dr.
Huang, for your hard work.

Yú ér, 20~29 year old female. Ask Date: 2017/10/09

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last month, on September 22, I took medication, and on September 24, I started experiencing heavy bleeding.
The placenta likely detached that day.
I felt intense pain and soreness, and I wondered if it was related to my miscarriage two years ago or to the hydatidiform mole.
I had difficulty with urination and bowel movements.
On September 25, I returned to the clinic and took "uterotonics" for three days (I assumed that was what it was because the doctor didn’t provide much explanation).
The bleeding gradually decreased, but the soreness persisted.
However, starting from September 29 and 30, the bleeding was manageable with just a panty liner.
But on October 2 and 3, I experienced heavy bleeding again, needing to change a long sanitary pad every 30-40 minutes, which was leaking heavily.
I rushed back to the clinic, and the doctor performed an ultrasound, noting that I still had blood clots.
I was instructed to take a shower and gently clean my vagina with my hand.
The doctor prescribed another three days of uterotonics (this time I asked what it was for) and told me that by October 12, I should not have any bleeding at all, even a little, and if I did, I needed to return to the clinic, as it could lead to infertility later on.
After returning home, I thought about it and questioned whether the blood clots were not in the uterus but related to the vagina.
However, I found online that some people experienced bleeding for up to a month after a medical abortion.
I haven’t reached a month yet, but I noticed that in the last two days, the blood clots have increased in size, approximately 0.5 to 1 cm.
Is this normal?
1.
Is this related to my miscarriage two years ago or the hydatidiform mole?
Answer: It is not related to the miscarriage two years ago or the hydatidiform mole.

2.
I took medication on September 22, started heavy bleeding on September 24, took uterotonics for three days starting September 25, had manageable bleeding on September 29 and 30, but then experienced heavy blood clots again on October 2 and 3, and now the blood clots have increased in size to about 0.5 to 1 cm.
Is this normal?
Answer: The placenta likely detached that day.
The three days of uterotonics were to help expel the blood clots.
The increase in blood clots to about 0.5 to 1 cm in size over the last two days is likely normal.

Reply Date: 2017/10/09

More Info

RU486, also known as mifepristone, is a medication used for medical abortion. It is often followed by another medication, misoprostol, to help expel the pregnancy tissue. One of the common concerns after taking RU486 is the duration and nature of bleeding, which can vary significantly among individuals.

In general, after taking RU486, it is normal to experience bleeding that can last from a few days to several weeks. The initial bleeding often starts within a few days after taking the medication and can be heavier than a typical menstrual period. This bleeding is usually accompanied by cramping, which can be quite painful. The duration of bleeding can be influenced by various factors, including how far along the pregnancy was at the time of the abortion, individual health conditions, and whether any complications arise.

In your case, it seems that you experienced significant bleeding starting from September 24, which is consistent with the expected timeline after taking RU486. The presence of blood clots, especially in the size range of 0.5 to 1 cm, can also be normal as the body expels the pregnancy tissue. However, if the bleeding is excessively heavy (soaking through pads in less than an hour), or if you experience severe pain, fever, or foul-smelling discharge, these could be signs of complications such as retained tissue or infection, which would require immediate medical attention.

The use of uterotonics (medications that stimulate uterine contractions) like Ergonovine can help in expelling any remaining tissue and reducing bleeding. However, it is crucial to follow your healthcare provider's instructions regarding their use. If you are still experiencing significant bleeding after several weeks, or if the bleeding suddenly increases, it is advisable to seek further evaluation. An ultrasound may be necessary to check for any retained products of conception, which could explain prolonged bleeding.

Regarding your concerns about the relationship between your past medical history (such as previous abortions or the presence of a cyst) and your current situation, it is important to note that while past pregnancies can influence your current reproductive health, each situation is unique. The body can react differently to medical procedures based on various factors, including hormonal levels, uterine health, and overall physical condition.

If you are considering seeking a second opinion at a larger hospital, that is a reasonable step, especially if you feel uncertain about your current care. It is essential to advocate for your health and ensure that you receive the appropriate follow-up care.
In summary, while some bleeding and clotting can be normal after taking RU486, it is crucial to monitor the situation closely. If you have any doubts or if your symptoms worsen, do not hesitate to seek medical advice. Your health and well-being are paramount, and it is important to ensure that any potential complications are addressed promptly.

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