Medication Abortion: What to Expect and When to Follow Up

Medical abortion

Due to a missed miscarriage, I chose to undergo a medical abortion.
Although I was nine weeks pregnant, the gestational sac measured only six weeks.
On the 4th, I took the first pill at the obstetrics and gynecology clinic.
The doctor said the first pill was just to terminate the pregnancy and that I shouldn't expect much bleeding or pain.
However, on the night of the 5th into the 6th, I started bleeding quite heavily, with some clots, and I experienced significant abdominal pain.
I was wondering if I had naturally miscarried.

On the 7th, during my follow-up appointment, the doctor gave me a second pill, stating that it would induce more bleeding.
I mentioned that I had already started bleeding two days prior and asked if I still needed to take the medication if everything had already passed.
The doctor insisted that I must take it to ensure the process was complete and did not perform an ultrasound to confirm.
The doctor advised that I should only seek medical attention if I experienced very heavy bleeding or unbearable pain; otherwise, I could wait until my follow-up on the 14th.
After taking the second medication, I only felt abdominal pain and some nausea, and the bleeding decreased.
It was not as heavy as the doctor had indicated it would be.
The next day, the blood turned brown and was minimal, and now I only have very light brown discharge.
Is this normal? Many people say that the success rate of the medication is low, and if the abortion is incomplete, I might need surgery.
I've also heard that some people see the embryo or gestational sac pass, but I haven't seen anything.
Does this mean the process was successful? Should I wait until the 14th for my follow-up, or should I go back sooner for confirmation? Additionally, how long should my husband and I wait before trying to conceive again?

A, 20~29 year old female. Ask Date: 2016/03/09

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it should still be considered normal.
It is recommended to return for a follow-up appointment as per the original instructions from your obstetrician.
Wishing you good health.

Reply Date: 2016/03/09

More Info

Medication abortion, also known as medical abortion, is a safe and effective method for terminating an early pregnancy. It typically involves taking two different medications: mifepristone and misoprostol. Understanding what to expect during this process and when to follow up is crucial for your health and peace of mind.

From your description, it seems you have already taken the first medication, mifepristone, which is designed to block the hormone progesterone, necessary for the pregnancy to continue. The bleeding you experienced after taking this medication is common and can occur as your body begins to expel the pregnancy tissue. The presence of blood clots and abdominal pain you mentioned are also typical symptoms during this process.
After taking the second medication, misoprostol, which is usually taken 24 to 48 hours after mifepristone, many women experience increased bleeding and cramping as the uterus contracts to expel its contents. However, every woman's experience can vary significantly. Some may have heavy bleeding and intense cramps, while others may have milder symptoms. The fact that your bleeding has decreased and turned brown could indicate that your body is transitioning to the post-abortion phase, which is also normal.

Regarding your concerns about the success of the medication abortion, it is important to note that while the success rate is generally high (around 95-98% for pregnancies up to 10 weeks), there is a small chance that the abortion may not be complete. If the abortion is incomplete, it may lead to complications that could require further medical intervention, such as a surgical procedure.
You mentioned that you did not see any tissue or the embryo itself. It is not uncommon for women to not visually identify these during the process, as the tissue may be expelled in a way that is not recognizable. The best way to confirm whether the abortion was successful is through a follow-up appointment, typically scheduled for about one to two weeks after taking the second medication. During this visit, your healthcare provider may perform an ultrasound or a blood test to check for the presence of pregnancy hormones.

If you experience heavy bleeding (soaking through two or more pads in an hour for two consecutive hours), severe abdominal pain that is not relieved by over-the-counter pain medications, or any other concerning symptoms, it is essential to seek medical attention immediately.
As for your question about trying to conceive again, it is generally recommended to wait until you have had at least one normal menstrual cycle before attempting to get pregnant again. This allows your body time to heal and ensures that you can accurately date your next pregnancy. However, some healthcare providers may give the green light to try sooner, depending on individual circumstances. It’s best to discuss this with your doctor during your follow-up appointment.

In summary, your current symptoms seem to align with a typical medication abortion experience, but it is crucial to attend your follow-up appointment to confirm the procedure's success. If you have any concerns or experience severe symptoms, do not hesitate to reach out to your healthcare provider sooner. Your health and well-being are the top priority.

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