Post-Abortion Bleeding: What to Expect After Medication Abortion

Medication abortion issues

I would like to inquire about the post-abortion bleeding situation.
On June 7, I took the first dose of medication, followed by the second dose on June 9.
I had a follow-up appointment on June 10, where an ultrasound confirmed the expulsion of the gestational sac.
From June 10 to June 17, I experienced normal bleeding, blood clots, and tissue.
During my follow-up on June 17, a pregnancy test showed no signs of pregnancy, and the doctor mentioned that the expulsion was quite clean, but there might still be some small remnants that would be expelled later.
On June 17 and 18, the flow was very light, with only occasional spotting when using the restroom.
On June 19, I noticed a small amount of brown discharge, and on June 20, the bleeding increased, appearing bright red.
On June 21, the bleeding was heavier (similar to days three or four of a menstrual period), and I continued to expel some tissue.
There has been no abdominal pain, and I took uterotonics for ten days from June 10 to 20.
Is this bleeding pattern normal? I thought it was almost finished, but it has increased again in the past two days.
Thank you.

Qoo, 40~49 year old female. Ask Date: 2021/06/21

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, taking abortion pills can sometimes lead to abnormal bleeding.
It is recommended to follow up with your original obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2021/06/21

More Info

After a medication abortion, it is common to experience a range of bleeding patterns, and understanding what to expect can help alleviate anxiety during this time. Based on your description, it seems you have undergone a medication abortion with the administration of two doses of medication, followed by follow-up ultrasounds and blood tests to confirm the expulsion of the pregnancy tissue.

Understanding Post-Abortion Bleeding
1. Initial Bleeding: After taking the first dose of medication (often mifepristone), you may not notice significant bleeding immediately. However, after taking the second dose (usually misoprostol), many women experience heavier bleeding as the body expels the pregnancy tissue. This bleeding can be similar to a heavy menstrual period and may include blood clots and tissue.

2. Duration and Variation: The bleeding typically lasts for several days to weeks. It is normal for the bleeding to fluctuate in intensity. You may notice that it starts heavy, then lightens, and sometimes increases again. This can be due to the body’s natural process of expelling remaining tissue and the shedding of the uterine lining.

3. Follow-Up Care: You mentioned that your doctor confirmed via ultrasound that the pregnancy tissue was mostly expelled, which is a positive sign. However, it is not uncommon for small amounts of tissue to remain, leading to intermittent bleeding. The presence of brown or coffee-colored discharge is usually old blood and can be a normal part of the healing process.

4. When to Seek Help: While some variation in bleeding is normal, you should seek medical attention if you experience:
- Heavy bleeding (soaking through two or more pads in an hour for two consecutive hours)
- Severe abdominal pain or cramping
- Fever or chills
- Foul-smelling discharge
- Any other concerning symptoms
5. Emotional and Physical Recovery: It’s important to remember that the emotional and physical recovery after an abortion can take time. Hormonal changes can also affect your mood and physical symptoms. If you have concerns about your emotional well-being, consider reaching out to a healthcare provider or counselor.

Conclusion
In summary, your experience of fluctuating bleeding patterns after a medication abortion is generally considered normal. The fact that you have had follow-up ultrasounds and tests that indicate a clean expulsion of the pregnancy tissue is reassuring. Continue to monitor your symptoms, and don’t hesitate to reach out to your healthcare provider if you have any concerns or if your symptoms change significantly. It’s essential to prioritize both your physical and emotional health during this time.

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