Expert: Doctor Early Options - 10/20/2008

Question
Dr. Joan,

I had a termination at 8 weeks pregnant (medical ab).  Everything went as is should, I was fine at the 1-week follow up, the bleeding slowly tapered off and I felt fine.  

I got my first post-abortion period 33 days after.  It was extremely heavy, maybe more than expected, I couldn't even move with tampon/pad combination without leaking through my clothes.  I needed both (knowing tampons are not ideal during this kind of bleeding) to get through that day at work.  I was passing huge clots.  

The bleeding somewhat slowed down but kept on coming at times. At least once a day I would gush blood with medium sized clots lasting for a few minutes.  When the bleeding didn't stop after over a week and I was getting dizzy, I went back.  Nothing showed on the ultrasound except one clot sitting on the cervix.  My iron was down to critical level, they suggested transfusion if nothing changed.  I was given Ergonovine, to be taken 4x day, with a total of 8 pills) and told to take iron 3 times daily.  I had a huge 'explosion' on the last day of taking this drug, bled through everything in a second and expelled a very large clot. After that, I kept having these sudden gushes of bright red blood with clots (of all sizes) every few days with moderate to heavy bleeding in between.  

When I went back for the follow up, the ultrasound looked the exact same as before.  A D&C was suggested.  I decided to give it another week, trying to avoid the surgery that I was so afraid of.  About a weak had passed and I started bleeding very heavy again and passing clots, only this time it wouldn't stop. It lasted for over 30 minutes before I called the clinic and was still bleeding on the heavier side (although less than when I called) and passing clots.

They gave me a shot (something like Ergonov.) plus one tablet of Ergonovine to take later on and D&C was scheduled next morning.  

During the surgery, they found a mass on/near my cervix, thought it was polyp or a hardened left over clot.

I felt great after and bleeding was minimal.  Dark blood with clear mucus.  I thought it was over.  But about a week had passed and bleeding picked up, bright red again, moderate flow.  Well, during 4 hours at night I must have 'exploded' again, since I woke up covered with blood and still bled on the toilet afterwards, passing small clots. Back to being dizzy and freaked out.   

I went back, still nothing on the us, uterus looked 'great', has been back to its size for quite some time, cervix closed, pregnancy test negative, all other negative, iron went up to 'normal' during that one week (from 26 to 32% I think).

Another shot and also bc pills to try this time (Ortho Tri-Cyclen Lo)to help with the bleeding.

What's wrong with me?  I wonder if there is something still left over, not seen on the ultrasound.  Fibroids? More polyps?  I've read those are not seen on the vaginal us.  But they said they cleaned my uterus out and didn't find/feel anything else...  Hormones out of whack? Something seriously wrong with my uterus? Should I go to a specialist?  I tried calling several clinics a couple of weeks ago but no one was willing to take me in, they kept saying to go back to the clinic...which I was doing...I just wanted a second opinion.  I don't have health insurance.

I have no pain other than discomfort in my cervix from time to time.

Not only I've bleeding for almost 3 months, going through some nerve wrecking times and embarassing moments, I'm worried something else is wrong and I will eventually have to have the uterus removed.  I desperately want children now, after realizing I always took my body and health for granted.

Is there any other alternative as to why I'm still bleeding?  Could bc pills help (or make it worse)? I have another follow up in a few days.  The clinic staff is wonderful, they're all extremely nice and helpful.

I've had medical abortion before with no problems.  

(USA)

Answer
Dear Nikki - I am so sorry this happened to you.  I have been providing the pill for over a decade, and this is the worst story I have heard.  

My first thought is that the clot was not completely removed from the cervix.  I have seen quite a few patients like you, where there is a firm, hardened clot that forms in the cervix, and needs to be removed. The clot should have been removed on the first visit where the clot was identified.  Perhaps it was not completely removed during the procedure.  It can be hard to see these clots on ultrasound.

The other possibility is that the clot was completely removed, but then you had a second complication of bleeding after the D&C.  If you then passed the clots and the ultrasound looks fine, everything may be o.k. now.  

It is possible that there is something else going on (hormones, polyp), but much less likely.  

Are you still having heavy bleeding?  If you live in New York City, I will be glad to see you.  Where do you live?  I may know someone to refer you to.  

The good news is that while the bleeding you had was very scary, it does not mean there is anything wrong with your uterus, or that you will have trouble with a future pregnancy.  There is no medical reason to be concerned about this at this time.  

You can follow up with an email, or feel free to call me at my office.  I will be there from 9-4 tomorrow.  Just ask for Dawn, my office manager, and she will connect you to me.

I'm sorry this has been so difficult.
Doctor Joan
EarlyAbortionOptions.com
New York City