Expert: Dr. Harriet Johnson - 10/24/2009

Question
It's nearly 8 am and I am lying awake in bed, worrying myself sick. I've been reading things online all night hoping to find an answer, but no luck

Nearly 3 months ago to date, I had an abortion at 16 weeks. I had some bleeding afterwards, which I was told to expect.

About 5 weeks ago, the night of September 16, I thought I'd started my regular period again. It was normal as it could possibly be. The second day, I had put in a tampon before leaving home and felt something coming out down there about an hour later.  I had already bled through my tampon. Thinking it may be b/c this was my first period since the bleeding from the abortion stopped, it was a little heavy.  It only took less than 30 minutes after the first gush to decide to go to the ER.

I was passing clots and a bit of blood about the size of a quarter at first, and by the time I got to the ER, the bleeding had worsened and the clots were getting bigger. I passed clots that at times were nearly the size of a tennis ball, and they seemed to just shoot out of my body.  I was completely hysterical, and the ER doctors said I must have retained product from abortion, ordered an ultrasound and called in an emergency surgeon ob/gyn.

During my ultrasound, before the ob/gyn got there, the radiologist came in the room himself and said that he noticed something that may be an "AVM", but could not tell because of the large number of clots in my vagina and uterus. He didn't seem to lean favorably toward it being an AVM, which I was told can rarely occur after an abortion?

When the ob/gyn got there, she said I did not need surgery like the ER docs said and that I didn't have retained product because my pregnancy test was negative. My blood tests were okay and negative for infection, and my counts were good. She gave me Provera to take for ten days at a time for the next three months and said while she didn't believe I had this "AVM", I should follow up with a MRI if I could afford it somehow. The ob/gyn believes that my cervix did not allow my uterus to flush itself out(despite the fact that I bled moderately or lightly for 3 weeks after my abortion) and that when my body's hormones realized I wasn't pregnant and caused me to ovulate, it's causing all this crazy bleeding. She sounded to really know her stuff, but it just doesn't seem normal at all.  

The most severe bleeding took place from around 2pm until 6pm the day of my hospital visit, with the first gush coming at 11am. I began my Provera the next day, and started keeping a diary of my bleeding. I wasn't detailed regarding the # of pads, but it went like this:

17-went to the hospital (notes above) 18-Started provera.19-20 Darker blood, heavy still, no big clots 21-Heavier bleeding w/ small clots 22-Same 23-Much heavier w/ bigger clots and brighter red 24-Sucked. Really, really heavy, I could feel it running out, but noticed no clots, blood was the brighter red 25-Super heavy red liquid bleeding during the day, then almost no bleeding from 7pm on. Just a light bit of spotting 26-730am could feel blood before i even got out of bed, heavy until 915am, nothing from 915a-3pm a bit of bleeding until 730, heavier around 7pm. No noticeable bleeding until 10pm, soaked a pad from 10-230am then no overnight bleeding, just a trace of spotting. 27-Bleeding started at 1230 when I would use the bathroom, a little spotting on pads and yucky cramps, heavier in aftn. and night, no overnight bleeding again 28-Bad cramps, light bleeding. 29-Bleeding seemed to taper to spotting only and stop for awhile. OCTOBER 18- Started Provera, still no bleeding since last month 19-21no bleeding 22- normal heavy period flow, darker blood. 23-Heavy gushing all day long with tiny clots here and there. Soaked an overnight maxi from 630p-915pm. 915-1047pm changed pad again, more for comfort but it was maybe half soaked 2-4am, a lot of liquid coming out, every time i stand up it seems to have a gush. the blood is brighter red in color

And I've felt two or three smaller gushes since 4am.

When I say heavy gushing, I mean there is enough blood that I can feel it coming out of my body. I don't have insurance so going to a doctor is a last resort. When I called last month b/c I was concerned with the amount of bleeding, she said not to be terribly alarmed unless it got to the point or worse than when I came to the ER & if I was soaking 1 pad per hour for 2-3 hours in a row, but if I got scared to come in for a check up. That costs a lot of money I don't have & the local free clinics take weeks and weeks to even schedule an appointment.  I doubt that an ER doc is going to offer any kind of expertise regarding the situation.  

Just to give me some peace of mind, does it sound likely that this is going to correct itself when my hormones straighten out or should I be as scared as I am right now?


Please help ASAP. I'm scared


Answer
Hi Julie,

I'm concerned that you may have AVM, however it may just be your hormones. When your body returns to normal, the bleeding should stop. If you experience this kind of bleeding again, go back to the hospital. But for now, because you cannot afford to go to the hospital, you need to rest, don't exercise, don't lift anything heavy, as these can cause the bleeding to worsen. Try not to worry yet as the OB/GYN at the hospital is most likely right and the Provera she gave you will help control the bleeding. I hope I helped and good luck!