Medication Abortion: What to Expect and When to Seek Help

Medication abortion

Hello, I would like to ask about my situation.
Yesterday, on July 2nd, I took my first dose at the hospital and only felt discomfort in my stomach, having difficulty burping.
On the morning of July 4th, I took my second dose at home.
I first took pain medication and anti-nausea pills, and after 10 minutes, I took Cytotec (the nurse instructed me to take three tablets sublingually on an empty stomach for 30 minutes).
However, they dissolved within 5 minutes, and about 5-10 minutes later, I started vomiting, expelling yellow bile and other contents.
I experienced severe abdominal pain for about 5-10 minutes, and after 2-3 hours, I began to notice a small amount of blood, which gradually increased.
The blood was dark red, and I passed a tiny piece of tissue, which I believe is not an embryo (the doctor mentioned the embryo was about 1 cm in size).
By the morning of July 5th until the evening, I only felt a heavy, dull sensation in my abdomen without significant pain or bleeding; a sanitary pad was about 70% full after 3-4 hours.
However, around 1 or 2 AM, I started experiencing severe uterine contractions, feeling like something heavy was dropping, accompanied by cramping.
The blood was bright red.
I took pain medication, but I still felt slight discomfort in my abdomen.
The blood flow was not excessive; a sanitary pad was about 40% full after 1 hour.
Is this normal? Should I go to the emergency room or schedule a follow-up appointment?

Lucy, 20~29 year old female. Ask Date: 2019/07/06

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On July 2nd, I took the first dose at the hospital and felt discomfort in my stomach, struggling to burp.
On the morning of July 4th, I took the second dose at home.
I first took pain medication and anti-nausea pills, and after 10 minutes, I took Cytotec (the nurse instructed me to take three tablets sublingually on an empty stomach for 30 minutes).
However, they dissolved completely in about 5 minutes.
After approximately 5-10 minutes, I started vomiting, expelling yellow bile and experiencing severe abdominal pain for another 5-10 minutes.
A few hours later, I began to notice a small amount of blood, which gradually increased.
The blood was dark red, and I passed a tiny piece of tissue, which I don't think was an embryo (the doctor mentioned the embryo was about 1 cm in size).
By the morning of July 5th, I felt heaviness in my abdomen without significant pain or bleeding; my pad was about 70% full after 3-4 hours.
However, around 1 or 2 AM, I experienced intense uterine contractions that felt like heavy cramps, with bright red blood.
I took pain medication, but I still felt slight discomfort.
The bleeding was not excessive, with my pad being about 40% full after an hour.
Is this normal? Should I go to the emergency room or schedule a follow-up appointment? Answer: It is advisable to go to the emergency room or schedule a follow-up appointment for an ultrasound to confirm.

Reply Date: 2019/07/06

More Info

Medication abortion, also known as medical abortion, involves the use of medications to terminate a pregnancy. It typically consists of two main medications: mifepristone and misoprostol (often referred to by its brand name, Cytotec). Understanding what to expect during this process and knowing when to seek medical help is crucial for ensuring safety and effectiveness.

Based on your description, it seems you have followed the protocol for a medication abortion, which usually involves taking mifepristone first, followed by misoprostol. The symptoms you are experiencing, such as nausea, vomiting, abdominal pain, and bleeding, are common side effects of this procedure. Here’s a breakdown of what you might expect and when to seek help:
1. Initial Symptoms: After taking mifepristone, some individuals may experience nausea, vomiting, or gastrointestinal discomfort. Taking an anti-nausea medication beforehand, as you did, is a good strategy to mitigate these effects.

2. Misoprostol Administration: After taking misoprostol, it is normal to experience cramping and bleeding as the uterus contracts to expel its contents. The cramping can be quite intense, similar to menstrual cramps or labor pains, and the bleeding can vary from light spotting to heavier flow, often with the passage of clots or tissue.

3. Bleeding Patterns: The bleeding you described, starting with a small amount and then increasing, is typical. The color of the blood can vary, with darker blood often indicating older blood and brighter red blood indicating fresh bleeding. The presence of small clots or tissue is also common, especially in the early stages of the abortion process.

4. Pain Management: It’s important to manage pain effectively. Over-the-counter pain relievers like ibuprofen or acetaminophen can help, but if the pain becomes severe and unmanageable, it’s advisable to seek medical attention.

5. When to Seek Help: You should contact your healthcare provider or go to the emergency room if you experience any of the following:
- Heavy bleeding (soaking through two or more pads in an hour for two consecutive hours).

- Severe abdominal pain that is not relieved by pain medication.

- Fever over 100.4°F (38°C) that lasts more than four hours.

- Foul-smelling vaginal discharge.

- Symptoms of shock, such as lightheadedness, fainting, or rapid heartbeat.

In your case, while some cramping and bleeding are expected, the severity of your symptoms, particularly the intense cramping and the amount of blood you are experiencing, warrants caution. If you feel that your symptoms are beyond what you consider normal or if you are feeling very uncomfortable, it is advisable to seek medical attention. It’s always better to err on the side of caution, especially when it comes to your health.

In summary, while some discomfort and bleeding are normal during a medication abortion, you should monitor your symptoms closely. If you have any concerns or if your symptoms escalate, do not hesitate to reach out to your healthcare provider or visit an emergency room for further evaluation. Your health and safety are the top priority.

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