Abnormal Menstrual Bleeding After Medication: What to Expect - Obstetrics and Gynecology

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Abnormal menstrual bleeding after medication, particularly following the use of medications like RU486 (mifepristone) and misoprostol, can be concerning and confusing for many women. It is important to understand the expected outcomes and potential side effects of these medications, as well as what constitutes normal versus abnormal bleeding in this context.

RU486 is commonly used for medical abortion and works by blocking the hormone progesterone, which is necessary for maintaining pregnancy. Following the administration of RU486, it is typical for women to experience bleeding as the body expels the pregnancy tissue. This bleeding can vary significantly in terms of volume and duration. Some women may experience light spotting, while others may have heavier bleeding, including the passage of blood clots.

In your case, you mentioned that you took three RU486 pills on October 22 without any bleeding, followed by two doses of misoprostol on October 24, after which you began to experience bleeding. This timeline aligns with the expected response to these medications. The bleeding you are experiencing now, especially with the passage of palm-sized blood clots, can be considered a part of the process of expelling the pregnancy tissue. However, it is crucial to monitor the bleeding closely.

Here are some key points to consider regarding your situation:
1. Duration of Bleeding: After taking these medications, it is common for bleeding to last anywhere from a few days to several weeks. The bleeding may start heavy and then taper off. If you continue to bleed heavily or if the bleeding does not decrease after a week or so, it is advisable to seek medical attention.

2. Blood Clots: Passing blood clots, especially those that are small to medium-sized, can be normal during this process. However, if you are passing large clots (larger than a golf ball) or if you soak through two or more pads in an hour for two consecutive hours, you should contact your healthcare provider immediately, as this could indicate a complication such as retained tissue or excessive bleeding.

3. Signs of Complications: In addition to heavy bleeding, watch for other signs that may indicate a problem, such as severe abdominal pain, fever, or foul-smelling discharge. If you experience any of these symptoms, it is essential to seek medical care promptly.

4. Follow-Up Care: It is crucial to have follow-up appointments with your healthcare provider to ensure that the abortion process is complete and that there are no complications. Your provider may perform an ultrasound to check for retained tissue if there are concerns about the amount of bleeding or if you have persistent symptoms.

5. Emotional and Physical Recovery: The emotional and physical recovery after a medical abortion can vary. It is important to take care of yourself during this time, both physically and emotionally. If you find yourself feeling overwhelmed, consider reaching out to a counselor or support group.

In summary, while some bleeding and the passage of clots can be normal after taking RU486 and misoprostol, it is important to monitor the situation closely. If you have any concerns about the amount or duration of your bleeding, or if you experience any alarming symptoms, do not hesitate to contact your healthcare provider for guidance. They can provide personalized advice and ensure that you receive the appropriate care during your recovery.