Persistent Bleeding After Medication Abortion: When to Seek Help?

Since the early August medication abortion, I have been experiencing bleeding that has continued until now, September 28?

In early August, I discovered I was pregnant and underwent a medical abortion at around six weeks, taking two doses of medication.
I followed up with the doctor 2-3 times, and the ultrasound showed that everything was clear.
However, I continued to experience persistent bleeding.
I returned for follow-up visits and received a strong uterine contraction medication, but the bleeding did not improve.
Due to a busy work schedule, I stopped going for follow-ups.
Initially, at the end of August, the bleeding was minimal, and I didn't think much of it, assuming it was just some residual discharge from the uterus.
However, in September, the bleeding became intermittent—sometimes heavy, sometimes light.
Occasionally, I would notice blood when wiping, and at times, it was enough to require overnight sanitary pads.
What could be the issue? Should I get a Pap smear? Is there a possibility of cervical cancer?

zero zero, 20~29 year old female. Ask Date: 2022/09/28

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors contributing to vaginal bleeding are numerous, including age, environment, lifestyle, stress, emotional instability, weight changes, medications, post-coital contraceptives, diet, polycystic ovary syndrome, lesions of the uterus or cervix, infections, ovulation, pregnancy, miscarriage, and breastfeeding, among others.
It is advisable to consult a gynecologist if the symptoms persist or worsen.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2022/09/28

More Info

Persistent bleeding after a medication abortion can be concerning and warrants careful attention. It is not uncommon for women to experience some bleeding following a medication abortion, as the body expels the pregnancy tissue. However, if the bleeding is continuous and does not seem to improve over time, it may indicate an underlying issue that needs to be addressed.

In your case, since you have already undergone a medication abortion and have had multiple follow-up appointments where ultrasounds indicated that the uterus appeared clear, the persistent bleeding could be due to several factors. One possibility is that there may still be some retained tissue in the uterus, which can lead to ongoing bleeding. This is sometimes referred to as retained products of conception (RPOC). The administration of a uterine contraction medication (such as oxytocin) is typically aimed at helping the uterus expel any remaining tissue, but if bleeding continues, further evaluation may be necessary.

It is also important to consider other potential causes of persistent bleeding. Hormonal imbalances, infections, or even structural issues within the uterus, such as fibroids or polyps, could contribute to abnormal bleeding patterns. While the concern for cervical cancer is valid, especially if there are other risk factors present, it is less likely to be the cause of your symptoms at this stage without additional concerning signs.

Given your situation, here are some recommendations on when to seek help:
1. Increased Bleeding: If you notice that the bleeding becomes heavier, such as soaking through a pad in an hour or passing large clots, you should seek medical attention immediately.

2. Duration of Bleeding: If the bleeding persists beyond a few weeks without improvement, it is advisable to return to your healthcare provider for further evaluation.

3. Accompanying Symptoms: If you experience severe abdominal pain, fever, chills, or any signs of infection (such as foul-smelling discharge), you should seek medical care promptly.

4. Follow-Up Appointments: It is crucial to keep follow-up appointments with your healthcare provider, even if you feel busy with work. These appointments are essential for monitoring your recovery and addressing any complications that may arise.

5. Consider Additional Testing: If the bleeding continues, your healthcare provider may recommend further testing, such as a pelvic ultrasound or a hysteroscopy, to assess the uterine cavity for any retained tissue or other abnormalities.

6. Cervical Cancer Screening: While it is unlikely that your persistent bleeding is due to cervical cancer, if you are due for a Pap smear or have not had one recently, it may be a good idea to discuss this with your healthcare provider.

In summary, while some bleeding after a medication abortion is normal, persistent bleeding that does not improve should not be ignored. It is essential to communicate openly with your healthcare provider about your symptoms and concerns. They can provide the necessary evaluations and treatments to ensure your health and well-being. Remember, your health is a priority, and seeking help when you have concerns is always the right choice.

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