Uterine Blood Clots After Medical Abortion: Key Insights

Q: Uterine Blood Clots After Medical Abortion: Key Insights

Hello： After a miscarriage, the first menstrual period usually occurs about one to one and a half months after a complete miscarriage. <br>However, the actual timing of menstruation may be influenced by various bodily factors. <br>If there is an infection or inflammation in the u

Uterine blood clots

On November 16, a medical abortion was performed using RU486 at 6 weeks of gestation, along with two doses of a contraction-inducing agent.
After two days, a follow-up appointment with the physician indicated that the situation was stable.
An abdominal and vaginal ultrasound was conducted, and after three days of a different contraction-inducing medication, bleeding ceased within five days.
However, in early December, there was a small amount of dark red, coffee-colored discharge, prompting a visit to another obstetrician.
The ultrasound revealed that the physician estimated the actual menstrual period would not arrive until December 25, and he prescribed hemostatic medication, which was not completed (the bleeding lasted about six days).

Menstruation began on December 17, presenting as a deep red, coffee color with a heavier flow lasting five to six days.
As the New Year approached, there was again a significant amount of bright red blood.
Sexual intercourse occurred on the third, with the male partner using a condom.
The bleeding stopped, but mild abdominal pain began (which had not been an issue the previous month), primarily on one side near the ovary, accompanied by slight nausea.
On January 6, a follow-up appointment revealed retained blood clots in the uterus.
An abdominal and vaginal ultrasound suggested possible mild inflammation, and the physician prescribed three days of anti-inflammatory and pain relief medication, explaining that it would be necessary to wait for the next menstrual period to determine if normal ovulation could occur.
After completing the medication, abdominal pain resumed at 00:03 on the 10th, with decreased appetite and a dull pain in the uterine area.

I would like to ask the physician which instance was the true menstrual period? Are the blood clots remnants from the abortion? Is there a chance that the blood clots will be expelled with the next menstrual period? Can the timing of the next menstrual period be estimated? Was the sexual intercourse a mistake that could have pushed the expelled blood clots back into the uterus? If I visit the doctor next Monday, will it be timely? Thank you for your assistance.

vaccili, 20~29 year old female. Ask Date: 2014/01/10

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello: After a miscarriage, the first menstrual period usually occurs about one to one and a half months after a complete miscarriage.
However, the actual timing of menstruation may be influenced by various bodily factors.
If there is an infection or inflammation in the uterus, abnormal bleeding may occur.
Given that you are still experiencing abdominal pain, it is advisable to seek care from an obstetrician-gynecologist.
If there is an ongoing infection, further treatment will be necessary.
If the infection has resolved but you are still experiencing irregular menstruation, appropriate adjustments and treatments should be made.
Thank you!

Reply Date: 2014/01/10

More Info

After undergoing a medical abortion using mifepristone (RU486) at six weeks of pregnancy, it is common to experience various symptoms and changes in menstrual patterns. Your situation involves several key points that warrant clarification regarding uterine blood clots, menstrual cycles, and the implications of sexual activity post-abortion.

Firstly, it is important to understand that after a medical abortion, the body goes through a process of expelling the remaining tissue, which can include blood clots. These clots can vary in size and color, often appearing dark red or brown, which is typical as the blood is older. The presence of these clots can indicate that the uterus is still clearing out remnants from the pregnancy.
In your case, the ultrasound indicated that there were still blood clots left in the uterus, which could explain the continued bleeding and abdominal discomfort. The fact that you experienced a significant amount of bleeding around December 17, followed by more bleeding after sexual intercourse on January 3, suggests that your body is still adjusting and may not have fully expelled all the tissue.
Regarding your question about which instance was a true menstrual period, it is likely that the bleeding you experienced around December 17 could be considered your first menstrual cycle post-abortion, especially if it was accompanied by the usual symptoms of menstruation. However, the irregularities in timing and the presence of blood clots complicate this assessment.
The blood clots you are experiencing could indeed be remnants from the abortion, and there is a possibility that they may be expelled with your next menstrual cycle. However, if the clots remain in the uterus, they can lead to complications such as infection or prolonged bleeding, which is why your healthcare provider has recommended monitoring the situation closely.

As for the sexual activity you engaged in, it is generally advised to avoid intercourse until you have been cleared by your healthcare provider, especially after a medical abortion. Engaging in sexual activity can potentially introduce bacteria into the uterus, increasing the risk of infection, and may also disrupt the natural expulsion process of any remaining tissue. However, it is unlikely that the sexual activity itself would push the blood clots back into the uterus.

If you are experiencing increased abdominal pain, decreased appetite, or any other concerning symptoms, it is crucial to seek medical attention promptly. A follow-up appointment with your healthcare provider is advisable to assess the situation further, especially if you are still experiencing pain or abnormal bleeding. They may perform another ultrasound to evaluate the status of the uterus and determine if any further intervention is necessary.

In summary, your symptoms and experiences are not uncommon following a medical abortion, but they do require careful monitoring. The presence of blood clots and irregular bleeding can be concerning, and it is essential to maintain open communication with your healthcare provider to ensure that your recovery proceeds smoothly. If you have any doubts or concerns, do not hesitate to reach out to your doctor for guidance.

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