Medication Abortion: Common Concerns and Questions - Obstetrics and Gynecology

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Understanding medication abortion can be a complex process, especially when it comes to monitoring and managing the effects of the medication used. In your case, it seems that you have undergone a medical abortion using mifepristone and misoprostol, which are commonly prescribed medications for this purpose.
When a medical abortion is performed, it typically involves taking two different medications. The first medication, mifepristone, is taken to block the hormone progesterone, which is necessary for the pregnancy to continue. The second medication, misoprostol, is taken a few days later to induce contractions and help expel the pregnancy tissue from the uterus.

In your situation, you mentioned that you took the first dose on August 12 and the second dose on August 14. After that, you had a follow-up appointment on August 25, where the doctor assessed that the abortion was not complete and prescribed uterotonics (medications that induce contractions) for three days. Following this, you returned on September 1, and the doctor indicated that everything appeared to be "clean" based on your report of no bleeding, despite not performing an ultrasound.

However, you experienced a return of brownish discharge and bleeding on September 9. It is not uncommon for some women to experience intermittent bleeding or spotting after a medical abortion, especially as the body continues to expel any remaining tissue. The presence of brown blood typically indicates older blood that is being expelled from the uterus, which can be a normal part of the healing process.

Here are some key points to consider regarding your situation:
1. Bleeding After Abortion: It is normal to experience some bleeding after a medical abortion. This can vary from light spotting to heavier bleeding, and it may last for several days to weeks. If the bleeding is light and not accompanied by severe pain or large clots, it is usually not a cause for concern.

2. Follow-Up Care: It is essential to have follow-up appointments after a medical abortion to ensure that the process is complete. If you have concerns about your bleeding or if it becomes heavy, or if you experience severe pain, it is crucial to contact your healthcare provider. They may recommend an ultrasound to check for any retained tissue.

3. Signs of Complications: While some bleeding is normal, you should seek medical attention if you experience any of the following:
- Heavy bleeding (soaking through two or more pads in an hour for two consecutive hours)
- Severe abdominal or back pain that is not relieved by over-the-counter pain medication
- Fever or chills
- Foul-smelling discharge
4. Emotional Support: Undergoing a medical abortion can be an emotional experience. It is important to seek support from friends, family, or counseling services if you feel overwhelmed or need someone to talk to.

5. Future Contraception: After a medical abortion, it is advisable to discuss contraception options with your healthcare provider to prevent unintended pregnancies in the future.

In conclusion, while some bleeding after a medical abortion can be normal, it is essential to monitor your symptoms and maintain open communication with your healthcare provider. If you have any concerns about your health or the process, do not hesitate to reach out for professional guidance. Your well-being is paramount, and your healthcare provider can offer the best advice tailored to your specific situation.