RU486: Normal Bleeding Duration and Concerns After Use

RU486, also known as mifepristone,

Hello, Dr.
Huang.
I have the following symptoms that I would like you to address:
1.
I took RU486 on June 22 at Chang Gung Memorial Hospital in Kaohsiung, when I was 7 weeks and 3 days pregnant.
2.
On July 3, during an afternoon ultrasound examination, Dr.
Yang was unable to determine whether it was the placenta or the endometrium, so she prescribed a five-day course of hemostatic medication (Tranexamic Acid), instructing me to take four tablets a day and to monitor for any abnormal bleeding.
3.
It has now been 12 days since the bleeding started.
I used panty liners from days 6 to 10, but from days 10 to 13, the bleeding suddenly increased, accompanied by blood clots (similar to the second day of my menstrual period).
Is this normal?
4.
I started taking Chinese herbal medicine on the third day after taking RU486, which includes ingredients like Shenhua Decoction and other herbs that promote blood circulation and remove blood stasis, and I have been taking it for a week.
5.
On the ninth day after taking RU486, I switched to a warming menstrual regulation decoction, which my Chinese medicine doctor said does not have blood-moving effects.
I am currently taking this alongside the hemostatic medication prescribed by Chang Gung, spaced one hour apart.
6.
Given the timeline, the recent increase in bleeding seems abnormal.
Is there any aspect that I might not be managing well, or is there something in my diet that I should be cautious about (I have not consumed ice or sesame oil)? Additionally, what is the average duration of bleeding after taking RU486 that is considered normal?
7.
After taking the hemostatic medication, I experience bleeding whenever I move, and occasionally I have abdominal cramping (I am unsure if this is psychological).
I feel overwhelmed by the situation.

Nancy, 20~29 year old female. Ask Date: 2019/07/04

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
On June 22nd (Saturday) at Kaohsiung Chang Gung Memorial Hospital, I took RU486, and at that time, I was 7 weeks and 3 days pregnant.

2.
On July 3rd (Wednesday) in the afternoon, during a transvaginal ultrasound, Dr.
Yang was unable to determine whether it was the placenta or the endometrium, so she prescribed a five-day course of hemostatic medication (Tranexamic Acid) and instructed me to take four tablets a day, then monitor for any abnormal bleeding.

3.
To date, I have been bleeding for 12 days.
I used panty liners from days 6 to 10, but from days 10 to 13, the bleeding suddenly increased, accompanied by blood clots (similar to the second day of my menstrual period).
Is this normal?
4.
I started taking traditional Chinese medicine on the third day after taking RU486, which included ingredients like Shenhua Decoction and other herbs that promote blood circulation and remove stasis, and I took the Chinese medicine for one week.

5.
On the 9th day after taking RU486, I switched to Warming the Meridian Decoction, and the Chinese medicine practitioner said it does not have blood-activating effects.
Currently, I am taking it in conjunction with the hemostatic medication prescribed by Chang Gung, spaced one hour apart.

6.
Given the duration, the recent increase in bleeding volume seems abnormal.
Is there any aspect that I may not have managed well, or are there any dietary considerations (I have avoided ice and sesame oil)? Additionally, what is the average duration of bleeding after taking RU486 that is considered normal?
7.
After taking the hemostatic medication, I experience bleeding whenever I move, and occasionally I have abdominal cramps (I am unsure if this is psychological).
It feels overwhelming...

Answer: Please clarify your concerns thoroughly with Dr.
Yang at Kaohsiung Chang Gung Memorial Hospital.

Reply Date: 2019/07/04

More Info

RU486, also known as mifepristone, is a medication commonly used for medical abortion, particularly in the early stages of pregnancy (up to 10 weeks). After taking RU486, it is normal for patients to experience a range of symptoms, including bleeding and cramping. Understanding the expected duration and nature of bleeding, as well as when to seek medical attention, is crucial for those who have undergone this treatment.

Normal Bleeding Duration and Characteristics
After taking RU486, bleeding typically begins within a few days and can last anywhere from a few days to several weeks. The initial bleeding may start as light spotting and can progress to heavier bleeding, often resembling a menstrual period. It is not uncommon for patients to experience blood clots during this time, especially in the first week or two.
In your case, you mentioned that you have been bleeding for 12 days, with an increase in bleeding and the presence of blood clots around days 10 to 13. This can be considered within the normal range, as some women may experience heavier bleeding as the body expels the pregnancy tissue. However, if the bleeding becomes excessively heavy (soaking through a pad in an hour or less), or if you experience severe pain, it is essential to seek medical attention promptly.

Factors Influencing Bleeding
Several factors can influence the amount and duration of bleeding after taking RU486. These include:
1. Gestational Age: The further along you are in your pregnancy, the more tissue your body needs to expel, which can lead to heavier bleeding.

2. Individual Variation: Each person's body responds differently to the medication, and factors such as hormonal levels and overall health can affect bleeding patterns.

3. Concurrent Medications: You mentioned taking Tranexamic acid (a medication used to reduce bleeding) and traditional Chinese medicine. While Tranexamic acid is intended to help manage bleeding, the interaction with other medications or herbal treatments can vary. It's important to discuss any additional medications with your healthcare provider to ensure they are safe and appropriate.

When to Seek Medical Attention
Given your symptoms, it is advisable to monitor your bleeding closely. If you experience any of the following, you should contact your healthcare provider:
- Heavy Bleeding: Soaking through two or more pads in an hour for two consecutive hours.

- Severe Pain: Intense abdominal pain that does not improve with over-the-counter pain relief.

- Fever or Chills: Signs of infection, such as fever over 100.4°F (38°C).

- Foul-Smelling Discharge: This could indicate an infection.

Psychological Factors
You also mentioned experiencing occasional abdominal pain and feeling overwhelmed. It's important to recognize that psychological factors can play a significant role in how one perceives physical symptoms. Anxiety and stress can heighten the perception of pain and discomfort. If you find that your emotional state is affecting your recovery, consider discussing this with a healthcare professional who can provide support or refer you to a counselor.

Conclusion
In summary, while some bleeding and cramping after taking RU486 is normal, it is essential to remain vigilant about the nature of your symptoms. If you have concerns about the amount of bleeding or any accompanying symptoms, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. They can provide personalized advice based on your specific situation and ensure that you are recovering safely.

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