Post-Abortion Bleeding: What to Expect and When to Worry

Bleeding after abortion?

Hello doctor, I would like to ask about my situation.
I had a medical abortion on November 6, and a week later I only had a little spotting.
When I returned for a follow-up, the doctor mentioned that there were still some small blood clots that hadn't been expelled completely.
After that, I stopped bleeding around late November, but on December 1, I started bleeding again.
I thought it was my period, but I experienced light bleeding throughout December until early January when it finally stopped.
Is this my menstrual cycle, or is there something else going on?

Xiao Xiao Fan, 20~29 year old female. Ask Date: 2018/01/03

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On November 6, I underwent a medical abortion.
A week later, there was only a small amount of bleeding left.
During the follow-up appointment, the doctor mentioned that there were still some small blood clots that had not been completely expelled.
It wasn't until late November that the bleeding stopped, but on December 1, I started bleeding again.
I thought it was my period, but I experienced light bleeding throughout December until early January when the bleeding finally stopped.
Could you tell me if this is my menstrual cycle or something else?
Answer: It is likely that there are still some small blood clots that have not been completely expelled, which is why you experienced light bleeding throughout December until early January when the bleeding finally stopped.

Reply Date: 2018/01/03

More Info

Post-abortion bleeding can be a confusing and concerning experience for many women, particularly when it comes to distinguishing between normal post-abortion bleeding and the onset of a new menstrual cycle. Based on your description, it seems you have experienced a series of bleeding episodes following a medical abortion on November 6, which raises several important considerations.

Firstly, after a medical abortion, it is common for women to experience bleeding that can last for several weeks. This bleeding is often referred to as "lochia," which is the vaginal discharge that occurs after childbirth or abortion. It typically starts as a heavier flow, similar to a menstrual period, and gradually decreases in volume over time. It can also contain small blood clots, which are usually not a cause for concern unless they are large or accompanied by severe pain.

In your case, you mentioned that after the initial abortion, you had a small amount of bleeding that persisted until late November, followed by a return of bleeding in December. It is important to note that the timing of your bleeding could indicate a few different scenarios:
1. Incomplete Abortion: If there are retained products of conception (such as blood clots or tissue) in the uterus, this can lead to continued or intermittent bleeding. Your doctor mentioned that there were still some small blood clots present after your initial follow-up, which could explain the ongoing bleeding. It is crucial to have a follow-up ultrasound if you suspect that tissue has not been fully expelled.

2. Menstrual Cycle Resumption: After an abortion, it may take some time for your menstrual cycle to normalize. The first period after an abortion can be irregular and may not follow the typical pattern you are used to. The bleeding you experienced in December could potentially be your first menstrual period, especially if it was lighter than your usual flow. However, since it lasted throughout December, it is advisable to monitor the pattern and volume of bleeding.

3. Hormonal Changes: The hormonal fluctuations that occur after an abortion can also lead to irregular bleeding. Your body is adjusting to the changes in hormone levels, which can affect the timing and nature of your menstrual cycle.

Given your situation, here are some recommendations on what to do next:
- Monitor Your Symptoms: Keep track of the amount of bleeding, the presence of any clots, and any accompanying symptoms such as pain or fever. If you experience heavy bleeding (soaking through a pad in an hour), severe pain, or signs of infection (fever, chills, foul-smelling discharge), seek medical attention immediately.

- Follow-Up Appointment: It is essential to have a follow-up appointment with your healthcare provider. They may recommend an ultrasound to ensure that there are no retained products of conception and to assess the health of your uterus.

- Discuss Your Concerns: During your follow-up, discuss your concerns about the bleeding and ask about what to expect regarding your menstrual cycle. Your healthcare provider can provide guidance on what is normal and what may require further investigation.

- Be Patient: It can take time for your body to return to its normal state after an abortion. While it is important to be vigilant about any concerning symptoms, some irregularity in bleeding can be expected.

In conclusion, while some bleeding after an abortion is normal, persistent or unusual bleeding warrants further evaluation. It is always best to err on the side of caution and consult with your healthcare provider to ensure that everything is progressing as it should. Your health and peace of mind are paramount, and your provider can help you navigate this challenging time.

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