Abnormal Bleeding After Abortion: Causes and Concerns

Abnormal bleeding after abortion?

Hello, doctor.
I took the first dose of RU486 on January 26, 2024, and the embryo was successfully expelled.
After that, I took the uterine contraction medication prescribed by the doctor for nearly a month.
Some tissue remained at the uterine fundus and could not be expelled naturally with just the contraction medication.
Therefore, on February 24, I underwent a vacuum aspiration procedure to remove the remaining tissue.
I experienced bleeding for about 3-4 days, which then stopped.
Thinking everything was clear, I had intercourse on March 5, using withdrawal as a method of contraception.
However, this morning, March 8, when I went to the bathroom, I noticed some blood when I wiped—pinkish in color.
I would like to know if this is an early onset of my menstrual period or if it is residual bleeding from the procedure last week.
Additionally, I have some breast tenderness and am unsure if this is related to my menstrual cycle or something else.
The doctor mentioned that menstruation would typically return about a month after a miscarriage.
Should I count one month from January 26 or from February 24?

J, 30~39 year old female. Ask Date: 2024/03/08

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, it is difficult to make a determination.
Typically, we start counting from the date of the last surgery.
I recommend that you consult with an obstetrician-gynecologist for evaluation.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2024/03/08

More Info

Abnormal bleeding after an abortion can be a source of concern for many individuals, and understanding the potential causes is essential for addressing any worries. In your case, it seems you have undergone a medical abortion followed by a surgical procedure to ensure that all tissue was removed. After such procedures, it is not uncommon to experience some bleeding, but the nature and timing of that bleeding can vary significantly from person to person.

Firstly, let's discuss the timeline of your procedures. You took RU486 on January 26, which is the first step in a medical abortion. Following this, you experienced some bleeding, which is typical as the body begins to expel the pregnancy tissue. You mentioned that some tissue remained, necessitating a vacuum aspiration on February 24. After this procedure, you experienced bleeding for about 3-4 days, which is also within the normal range as the uterus heals and expels any remaining tissue.

Now, regarding the bleeding you experienced on March 8, which was pink in color, there are a few possibilities to consider:
1. Residual Bleeding: It is possible that the bleeding you are experiencing is residual from the procedures you underwent. After an abortion, the uterus can take time to fully return to its normal state, and some spotting or light bleeding can occur as the lining sheds and heals.

2. Hormonal Changes: After an abortion, hormonal levels can fluctuate significantly. This can lead to irregular bleeding patterns, including spotting or light bleeding before the next menstrual cycle begins. The breast tenderness you are experiencing could also be attributed to these hormonal changes.

3. Menstrual Cycle Resumption: Typically, menstruation can resume anywhere from 4 to 6 weeks after an abortion, depending on individual factors such as hormonal balance and the body’s recovery process. Since your medical abortion began on January 26, you might expect your first period around late February to early March, but this can vary. If your body is still adjusting, the bleeding could be an early sign of your menstrual cycle returning.

4. Infection or Complications: Although less common, it is essential to rule out any potential complications such as infection or retained tissue, which can cause abnormal bleeding. If the bleeding persists, increases in volume, or is accompanied by other symptoms such as fever, severe pain, or foul-smelling discharge, it is crucial to seek medical attention promptly.

In terms of your question about when to start counting the month for your menstrual cycle, it is generally advisable to count from the date of your last procedure (February 24) rather than the initial medication date. This is because the surgical procedure is more likely to reset your cycle and allow for a more accurate assessment of when your period might return.

In conclusion, while some light bleeding or spotting after an abortion can be normal, it is essential to monitor the situation closely. If you have any concerns about the amount or nature of the bleeding, or if you experience any additional symptoms, it is always best to consult with your healthcare provider. They can perform a thorough evaluation to ensure that everything is healing correctly and that there are no underlying issues that need to be addressed. Your health and peace of mind are paramount, and seeking professional guidance is the best course of action when in doubt.

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