Post-Abortion Bleeding: What to Expect and When to Seek Help

Abortion procedure

Hello Dr.
Lu, I had a miscarriage at 8 weeks due to a lack of fetal heartbeat, and I underwent a surgical procedure last week.
For the first two days post-operation, I experienced very little bleeding, but later I noticed some brownish or bright red spotting.
Occasionally, I felt some soreness in my thighs.
During my follow-up appointment today, the doctor performed an abdominal ultrasound and confirmed that my uterus is clear and the endometrial thickness has returned to 0.3 and 0.4, which is all normal.
However, I found it strange that today the bleeding suddenly increased (and it is bright red).
Therefore, the doctor prescribed me a five-day course of uterine contraction medication.
I would like to ask: 1.
Is it normal for the bleeding to be more than in the previous days? 2.
When doctors say that bleeding should not be as heavy as menstruation, does this refer to comparing it to days 2 and 3 of the menstrual cycle (when bleeding is heaviest)? 3.
If the bleeding continues for more than two weeks, should I return for a transvaginal ultrasound for a more detailed examination?

Xiwang xue kuai ting, 30~39 year old female. Ask Date: 2015/09/30

Dr. Lü Lizheng reply Obstetrics and Gynecology

Although there is an increase in bleeding, if it does not exceed the maximum menstrual flow, it is still acceptable to observe for a few days.
If the bleeding decreases, that is fine.
However, if there is persistent heavy bleeding, bleeding that lasts more than 10 days, or significant abdominal pain, a follow-up appointment is necessary.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/09/30

More Info

After undergoing a surgical abortion due to a non-viable pregnancy, it is common to experience some bleeding as your body begins to heal. Understanding what to expect during this recovery period is crucial for your peace of mind and health.

1. Is it normal for bleeding to increase after a few days?
Yes, it can be normal for bleeding to fluctuate after an abortion. Initially, you may experience light bleeding or spotting, which can be followed by heavier bleeding a few days later. This can be attributed to the uterus contracting and expelling any remaining tissue. However, if the bleeding becomes significantly heavier or is accompanied by severe pain, it is important to seek medical attention.

2. What does "not more than a menstrual period" mean?
When doctors advise that bleeding should not be heavier than a menstrual period, they are typically referring to the average flow experienced during the second or third day of menstruation, which is when bleeding is usually at its heaviest. If you find that you are soaking through a pad or tampon every hour for several consecutive hours, this could be a cause for concern and warrants a visit to your healthcare provider.

3. What should I do if bleeding continues for more than two weeks?
If you continue to experience bleeding beyond two weeks, it is advisable to return to your healthcare provider for further evaluation. An ultrasound may be performed to ensure that the uterus is clear of any remaining tissue and to assess the thickness of the endometrial lining. Prolonged bleeding can sometimes indicate retained products of conception or other complications that may require medical intervention.

In addition to these points, it is essential to monitor for other symptoms that could indicate complications, such as:
- Severe abdominal pain: While some cramping is normal, severe pain that does not improve with over-the-counter pain relief may indicate a problem.

- Fever: A fever over 100.4°F (38°C) could suggest an infection.

- Foul-smelling discharge: This could also indicate an infection and should be evaluated by a healthcare provider.

The medication prescribed to help your uterus contract is a common practice to assist in the recovery process. It is important to take it as directed and to follow up with your doctor if you have any concerns about your bleeding or overall recovery.

Lastly, emotional recovery is just as important as physical healing after an abortion. It is normal to experience a range of emotions, and seeking support from friends, family, or a mental health professional can be beneficial.

In summary, while some fluctuations in bleeding are normal after an abortion, it is crucial to remain vigilant for signs of complications. If you have any doubts or concerns, do not hesitate to reach out to your healthcare provider for guidance and reassurance. Your health and well-being should always come first.

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