Post-Medication Abortion Complications: Causes of Prolonged Bleeding

Medication abortion issues

Hello doctor, I have been experiencing intermittent bleeding and occasional lower abdominal discomfort since I started medication for a medical abortion on July 17, and it has continued until now, September 10.
Could you please advise what might be the cause? Thank you.

Yvonne, 20~29 year old female. Ask Date: 2022/09/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is possible that it hasn't completely dried out.
I recommend following up with your original obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2022/09/10

More Info

Prolonged bleeding after a medication abortion can be concerning and may arise from several factors. Understanding the underlying causes is crucial for appropriate management and reassurance.
Firstly, it is important to recognize that medication abortion typically involves the use of two medications: mifepristone (RU486) and misoprostol. After taking these medications, it is common for individuals to experience bleeding that can last for several days to weeks. This bleeding is often heavier than a typical menstrual period and may include blood clots. However, if bleeding persists beyond a few weeks or becomes excessively heavy, it may indicate complications.

One potential cause of prolonged bleeding is incomplete abortion. This occurs when some of the pregnancy tissue remains in the uterus after the abortion process. If the body does not expel all of the tissue, it can lead to ongoing bleeding and cramping. In such cases, a follow-up ultrasound may be necessary to determine if any tissue remains and whether further intervention, such as a surgical procedure, is required to clear the uterus.

Another possible reason for prolonged bleeding is uterine atony, where the uterus fails to contract effectively after the abortion. This can lead to continued bleeding as the uterus struggles to return to its normal size and function. Medications such as oxytocin may be administered to help stimulate uterine contractions and reduce bleeding.

Additionally, hormonal fluctuations following an abortion can also contribute to irregular bleeding patterns. After the termination of a pregnancy, it may take some time for the menstrual cycle to regulate, leading to variations in bleeding intensity and duration.
Infection is another critical consideration. If there is an infection in the uterus, it can cause prolonged bleeding and abdominal pain. Symptoms of infection may include fever, foul-smelling discharge, or severe abdominal pain. If any of these symptoms are present, it is essential to seek medical attention promptly.

Lastly, coagulation disorders or other underlying health issues may also play a role in prolonged bleeding. If there is a history of bleeding disorders or if the individual is on anticoagulant medications, this could exacerbate bleeding issues.

Given your experience of ongoing bleeding and occasional abdominal discomfort since July 17, it is highly advisable to consult with a healthcare provider for a thorough evaluation. This may include a physical examination, ultrasound, and possibly blood tests to assess for infection or other complications.
In summary, prolonged bleeding after a medication abortion can result from incomplete abortion, uterine atony, hormonal changes, infection, or underlying health issues. It is crucial to seek medical evaluation to determine the exact cause and receive appropriate treatment. Early intervention can help prevent complications and provide peace of mind.

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