Prolonged Bleeding After Abortion and Hormonal Treatments

Prolonged bleeding after abortion and hormonal medications?

Hello Doctor, I live abroad.
In September 2009, my urine test confirmed pregnancy.
Due to the healthcare system here, I could only apply for an abdominal ultrasound after 11 weeks of pregnancy.
When I was 13 weeks pregnant, I had the ultrasound, but they informed me that they could not detect an embryo.
Later, when I inquired whether the absence of an embryo indicated a possible ectopic pregnancy, they confirmed it.
They explained that the embryo had stopped developing early in the pregnancy, which is why it was not visible in the uterus at 13 weeks.
That same day, I was given RU486 to terminate the pregnancy.
However, after the medical abortion, I experienced intermittent spotting until February 2, 2010, when they said I needed a dilation and curettage (D&C) because the previous medical abortion was incomplete.
After the procedure, they did not prescribe any medications—no uterotonics, no pain relievers, or anti-inflammatory drugs.
I continued to experience bleeding until February 17, 2010.
On February 18, I returned for a follow-up, and they provided me with hemostatic medication, but it was ineffective, and I continued to bleed.
A week later, I returned for another visit, and this time they prescribed hormonal medication, stating that there were no abnormalities in my uterus.
Today, March 3, 2010, I have been taking the medication for five days, but I am still bleeding, although not as heavily as before.
My questions for the doctor are: Should the bleeding stop after taking hormonal medication? Are there different strengths of hormonal medications? Why am I still bleeding after taking the medication for five days? If there is poor uterine contraction, could that lead to continuous bleeding? Is it possible to take uterotonics and hormonal medications simultaneously? I apologize for the lengthy message and thank you for your response.

unlucky, 30~39 year old female. Ask Date: 2010/03/03

Dr. Chen Changfu reply Obstetrics and Gynecology

Based on your description and considering my own clinical experience in obstetrics and gynecology, your obstetrician should have already considered and ruled out an ectopic pregnancy, diagnosing you instead with a missed miscarriage (with a nonviable embryo remaining in the uterus).
This is why you were prescribed Ru-486 in hopes of inducing a natural miscarriage (the use of Ru-486 to induce natural miscarriage in cases of missed abortion is a debated method among some physicians; however, it is not the cause of your ongoing bleeding).
After the medication induced the natural miscarriage, you continued to experience intermittent spotting, which led to the diagnosis of incomplete miscarriage, prompting the scheduling of a dilation and curettage (D&C) procedure.
Following the treatment, if you still experience uterine bleeding two weeks later, it is advisable to return for a follow-up and consult your physician about checking your blood or urine for human chorionic gonadotropin (HCG) levels to confirm whether a complete miscarriage has occurred.
Then, you should patiently wait a few more days, as uterine bleeding should gradually resolve, since the healing of the endometrial lining after a miscarriage or D&C can sometimes take longer.

Reply Date: 2010/03/03

More Info

Prolonged bleeding after an abortion, particularly following a medical abortion with medications like RU486 (mifepristone), can be a distressing experience. It’s important to understand the physiological and hormonal factors that contribute to this situation, as well as the treatment options available.

After a medical abortion, it is common for women to experience bleeding as the body expels the pregnancy tissue. This bleeding can vary in duration and intensity. In some cases, the bleeding may be light and sporadic, while in others, it can be heavier and more prolonged. The duration of bleeding can be influenced by several factors, including how far along the pregnancy was, the individual’s hormonal balance, and whether the abortion was complete.

In your case, it appears that the abortion was not complete initially, leading to the need for a dilation and curettage (D&C) procedure. Following this procedure, it is not unusual for some women to continue experiencing bleeding for a period of time. The fact that you were prescribed hormonal medications suggests that your healthcare provider is trying to regulate your menstrual cycle and help your body return to its normal state.

Hormonal medications, such as those containing estrogen and progesterone, can help stabilize the uterine lining and promote healing. However, the effectiveness of these medications can vary from person to person. Some women may respond well and see a reduction in bleeding, while others may continue to experience prolonged bleeding despite treatment. This variability can be due to individual differences in hormone levels, uterine tone, and overall health.

Regarding your question about whether the bleeding should stop after taking hormonal medications, it is important to note that these medications can take time to exert their effects. If you have been taking the medication for five days and are still experiencing bleeding, it may be a sign that your body is still adjusting or that additional treatment may be necessary. Hormonal medications can indeed vary in strength and formulation, which can affect their efficacy in managing bleeding.

If uterine contractions are inadequate, this can lead to continued bleeding. In such cases, medications that promote uterine contractions, such as oxytocin or misoprostol, may be considered. It is generally safe to use uterine contraction medications alongside hormonal treatments, but this should always be done under the guidance of a healthcare provider.

Given your ongoing bleeding and the fact that the hormonal treatment has not resolved the issue, it is crucial to follow up with your healthcare provider. They may want to perform additional evaluations, such as an ultrasound, to ensure that there are no retained products of conception or other complications. If the bleeding persists, they may consider adjusting your treatment plan, which could include different medications or further interventions.

In summary, prolonged bleeding after an abortion can be influenced by various factors, including hormonal imbalances and uterine contractions. While hormonal medications can help, their effectiveness can vary, and additional treatments may be necessary. It is essential to maintain open communication with your healthcare provider to address your concerns and ensure appropriate management of your symptoms. If you feel that your current treatment is not effective, do not hesitate to seek a second opinion or request further evaluation. Your health and well-being are paramount, and it is important to find a treatment plan that works for you.

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