Expert: Doctor Early Options - 11/11/2009

Question
Hi Dr. Joan,

I took the abortion pill the first week of Sept and was about 5-6 weeks pregnant. I had heavy bleeding and cramping the day I took the second set of pills, about 20 min after taking them. I continued to have bleeding for about a week after that. Also, another piece of information that may be important: I had a baby April of this year. So the abortion was only 5 months after giving birth.
I didn't go to the follow up appointment after taking the abortion pill because I was frightened to go back. it was a hard decision for me to make and could not go back to the place where I felt I had "killed my baby". I know I should have gone, but I just couldn't bring myself to do it.
I had my period the last week of October and hadn't felt ill or anything after the abortion. Now, I have started spontaneously bleeding. It started Saturday (11/07/09). My husband and I had intercourse and in the middle of it, my husband stopped and said I was bleeding. I stood up and blood seemed to gush from my vaginal opening. I ran to the restroom and there once more a gush/blob of blood came out and then the blood coming out just lessened. I went to bed and the next day no blood was coming out. Yesterday (11/10/2009) while at work I stood up and felt a gush of blood starting to come out, so i went to restroom and blood gushed out again. This time I put a tampon in and resumed my day. When I removed the tampon there was no blood on it, so I thought I was okay again. Later on in the evening, I did a few sit ups. About an hour later I was sitting on a chair and when I stood up I felt the gush of blood starting to come out again and ran to the restroom. The blood came out and then another gush of blood came out. Since then, I have been bleeding lightly. In the blood I have seen small clots and what looks like tissue.
Now, before all this, I did think maybe I had a UTI, as those were common during my first pregnancy. There was a discharge that I didn't mind too much and just drank cranberry juice. Also, just in the past couple days I have felt like something is slightly moving in my tummy on the right side, but it could be just my imagination since I am paranoid that the abortion wasn't complete and now the baby is still alive.
I know I need to go to a Doctor, but I don't have health insurance at the moment and can't afford to pay the visit on my own.
I don't know what is wrong with me or what to do???

Answer
Dear B,
Unfortunately the bleeding you are describing is fairly common and normal with the Abortion Pill.  I have seen many women have sudden heavy bleeding, sometimes with clots or tissue, days, weeks, or even months after taking the Abortion Pill.  It indicates that there was some tissue that did not come out.  The tissue can still be attached to the uterine wall, and can cause bleeding. The blood can often sit in the uterus before coming out, and then cause a gush of blood.  It is common and normal for the heavy bleeding to occur after sex or exercise, because this stimulates the uterus to contract and expel the tissue and blood.  This bleeding should stop on its own. If it continues like this for more than a few more days, you will need to get an evaluation.  

The tissue you are seeing is called "decidua." It is the dense connective tissue that forms around the uterine cavity to support the pregnancy. It is common and normal that some of this tissue is delayed in being expelled from the uterus.  

From what you describe, it would be highly unusual that the Abortion Pill wasn't successful, and that you have a continuing pregnancy.  You could go ahead and take a pregnancy test to reassure yourself.  Get the test with 2 lines.  If the second line is negative, or faintly positive, you can be reassured.  If it is clearly positive, you should get an evaluation.  

There is more information on bleeding after the Abortion Pill on my website: http://www.earlyabortionoptions.com

I hope this is helpful, and that the heavy bleeding has stopped.
Doctor Joan
Early Abortion Specialist
New York City