Post-Abortion Bleeding: When to Seek Medical Advice - Obstetrics and Gynecology

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After a medical abortion, it is common for women to experience some bleeding, known as lochia, which can last for several weeks. However, the duration and amount of bleeding can vary significantly from person to person. In your girlfriend's case, it seems she has been experiencing bleeding for over two weeks, with heavier bleeding initially followed by lighter bleeding. This pattern can be normal, but there are important considerations to keep in mind.

Firstly, it is crucial to differentiate between normal post-abortion bleeding (lochia) and potential complications such as retained products of conception (RPOC). Retained products can occur if some tissue from the pregnancy remains in the uterus, which can lead to prolonged bleeding and may require further medical intervention. The fact that her doctor mentioned there might be some tissue left suggests that this is a possibility.

In general, the following signs and symptoms should prompt immediate medical attention after an abortion:
1. Heavy Bleeding: If your girlfriend experiences soaking through two or more pads in an hour for two consecutive hours, this is considered heavy bleeding and requires urgent evaluation.

2. Severe Pain: While some cramping is normal, severe or worsening pain that is not relieved by over-the-counter pain medications should be assessed by a healthcare provider.

3. Foul Odor: If the bleeding has a foul smell, this could indicate an infection, which is a serious concern.

4. Fever: A fever over 100.4°F (38°C) can be a sign of infection and should be evaluated promptly.

5. Prolonged Bleeding: If bleeding continues for more than four weeks, it is advisable to seek medical advice, especially if there are no signs of menstruation returning.

Regarding your girlfriend's situation, since it has been over a month and she has not yet had her menstrual period, it is important for her to follow up with her healthcare provider. The absence of menstruation could be due to several factors, including hormonal changes following the abortion, retained products, or other underlying health issues.
It is also concerning that she has not been adhering to the prescribed medication regimen. This could potentially complicate her recovery and delay the return of her menstrual cycle. Encouraging her to communicate openly with her healthcare provider about her fears and concerns may help her feel more comfortable and willing to follow medical advice.

In terms of next steps, I recommend the following:
1. Schedule a Follow-Up Appointment: It is essential for her to see her healthcare provider for a thorough evaluation. This may include a pelvic exam and possibly an ultrasound to check for retained tissue.

2. Discuss Symptoms: She should be prepared to discuss all symptoms she has been experiencing, including the nature of the bleeding, any pain, and her menstrual history.

3. Consider Counseling: If her fear of gynecological exams is significant, she might benefit from speaking with a counselor or therapist who specializes in reproductive health issues.

4. Monitor Symptoms: Keep track of any changes in her symptoms, including the amount of bleeding, pain levels, and any new symptoms that may arise.

In conclusion, while some bleeding after a medical abortion is normal, prolonged bleeding and the absence of menstruation warrant further investigation. It is crucial for your girlfriend to seek medical advice to ensure her health and well-being.