Expert: Doctor Early Options - 11/10/2009

Question
Dear Doctor,

I recently had a medical abortion, in which the first set of pills did not completely work. I then took the pills another time, which after a check-up with the doctor was successful. Two weeks after the first set of pills I had sex with my husband. The following day and for the past 3 days I have had moderate bleeding, clots and at time severe cramps. (In this time as well, I have flown twice and was wondering if that impacts any bleeding?)

I was told by my nurse that I still had many clots and blood that would still be leaving my body, however; I am just slightly nervous that something maybe wrong. I am just wondering if this these are normal side effects?

Thank you for your time.  

Answer
Dear Mary,
Thank you for your question about bleeding and cramping after the Abortion Pill. It is common and normal to have bleeding that stops for weeks, and then starts again after taking the Abortion Pill.  Sex stimulates the uterus to contract, and helps the uterus to expel any residual blood, tissue, or clots that are remaining in the uterus.  This should be seen as a positive sign, and need not make you worry.  Cramping that comes and goes is normal.  Cramping that is constant for more than 24 hours, keeps getting worse and does not respond to 800 mg of ibuprofen needs to be evaluated.  These symptoms can indicate that some tissue got "stuck" in your cervix, and needs to be evaluated.  

Bleeding after the Abortion pill can be erratic. Blood flow that is like a period is normal.  Blood that is red like a period, or brown, like discharge is normal. Sometimes the blood flow can be much heavier, and have clots.  This is also normal. The bleeding can happen daily, or it can stop and start.  

Irregular bleeding from the Abortion Pill can go on for weeks to months.  The average length of irregular bleeding is 6 weeks.  This kind of bleeding is the main reason women are unhappy with the Abortion Pill.  However, your period will come back to normal.  Usually when women understand that it is normal, the bleeding can be more annoying that upsetting.

Bleeding that should be evaluated after the Abortion Pill includes: heavy, gushing bleeding and clots for more than 24 hours, bleeding associated with severe cramping, or daily bleeding like a period (or more) that lasts more than 4 weeks.  If you are not sure if your bleeding patterns are this heavy, it is best to call the doctor who prescribed the Abortion Pill.  

There is much more information on bleeding and cramping with the Abortion Pill on my website: http://www.earlyabortionoptions.com  

I hope this is helpful and reassuring,
Doctor Joan
Early Abortion Specialist
New York City