Post-Medication Abortion Bleeding Patterns: What to Expect

The amount of bleeding decreased significantly the day after the medical abortion?

Hello, doctor.
On March 4th, I took the first pill at the clinic, and two days later, I took three pills, but I was ten minutes late.
Shortly after, I started experiencing abdominal pain and nausea.
Around 6 PM, I began to bleed, and the amount was similar to my usual menstrual flow.
Around midnight, I suddenly had a large amount of bleeding, but when I woke up the next morning, the bleeding had returned to a level similar to normal.
Two hours later, I changed my tampon, and it was still very clean.
The doctor initially told me that the bleeding would be heavier and last longer than usual.
I just found out that women who are taking psychiatric medications may not be suitable for medical abortion.
Is this normal, doctor? Thank you.

En, 20~29 year old female. Ask Date: 2020/03/07

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you should still follow your doctor's instructions and return to the hospital for a follow-up to see if the miscarriage has been completed.
Wishing you good health.

Reply Date: 2020/03/07

More Info

After undergoing a medical abortion, it is common to experience a variety of bleeding patterns, which can be concerning for many women. Understanding what to expect in terms of bleeding after taking medications like mifepristone and misoprostol is crucial for managing your health and alleviating anxiety.

Bleeding Patterns After Medical Abortion
1. Initial Bleeding: Following the administration of mifepristone, many women will experience light bleeding or spotting within a few days. This is often similar to a regular menstrual period. The bleeding may start off light but can increase in intensity.

2. Heavy Bleeding: It is typical for women to experience heavier bleeding after taking misoprostol, which is usually administered 24 to 48 hours after mifepristone. This bleeding can be more substantial than a normal period and may include the passage of blood clots. The heavy bleeding often occurs within the first few hours after taking misoprostol.

3. Duration of Bleeding: The duration of bleeding can vary significantly from person to person. While some may experience heavy bleeding for a few hours followed by lighter bleeding for several days, others may have prolonged bleeding that lasts up to two weeks or more. It is essential to monitor the bleeding and note any significant changes.

4. Clots and Pain: Passing blood clots is common, especially in the first few days after taking misoprostol. Abdominal cramping and pain are also expected as the uterus contracts to expel its contents. The intensity of pain can vary, and over-the-counter pain relief may be necessary.

Concerns with Concurrent Medications
You mentioned being on psychiatric medications, which can sometimes complicate the abortion process. While many women on psychiatric medications can safely undergo a medical abortion, certain medications may affect bleeding patterns or the overall experience. It is crucial to communicate with both your psychiatrist and the healthcare provider performing the abortion about any medications you are taking.

When to Seek Medical Attention
While some bleeding and cramping are normal, there are specific signs that warrant immediate medical attention:
- Excessive Bleeding: If you soak through two or more pads in an hour for two consecutive hours, this is considered excessive bleeding and requires urgent evaluation.

- Severe Pain: If you experience severe abdominal pain that is not relieved by over-the-counter medications, you should seek medical help.

- Foul Smell or Fever: Any signs of infection, such as a foul-smelling discharge or fever, should be addressed promptly.

Conclusion
In summary, after a medical abortion, it is normal to experience a range of bleeding patterns, including heavier bleeding and the passage of clots. The duration and intensity can vary widely among individuals. If you have concerns about your bleeding or the interaction of your psychiatric medications with the abortion process, it is essential to consult with your healthcare provider. They can provide tailored advice and reassurance based on your specific situation. Remember, your health and well-being are paramount, and seeking help when needed is always the best course of action.

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