Expert: Doctor Early Options - 11/18/2009

Question
Dear Doctor Joan,

    For two weeks Ive been reading your medical advice on abortion as i had one last october 21. Abortion is illegal here in the Philippines so i took 6 tablets of misoprostol only bought from the black market. I experienced cramping and one passing of a blood clot about the size of the whole length of a thumb. Since that day I have been bleeding..sometimes it stops overnight and comes back again the next morning. I am now very concerned. I see blood on my fingers when i insert them inside me just to check, though my sanitary napkins do not have blood on them. My latest pregnancy test strip was a faint positive.

    Doctor, I am very much concerned about my bleeding. As much as possible I do not want a D and C. Please help me resolve my questions to put my mind at ease. Thank you very much.

Answer
Dear Jennie,
Thank you for your question about bleeding after a medical abortion with misoprostol.  It sounds like everything is normal.  The amount of bleeding in a medical abortion depends on how far along the pregnancy is - if it is under 6-7 weeks, there is often little bleeding as you describe.  It sounds like the pregnancy tissue itself passed with the clot you describe - it often comes out at one time. If you were over 7 weeks, you might expect more bleeding. It is normal to continue to bleed for weeks to months after any kind of medical abortion - this is normal, and nothing to be concerned about.  Most likely the bleeding will stop and start. You may have spotting, or some clots.  

It sounds like the misoprostol was successful.  If the test strip is only faint positive, this indicates that the medical abortion was complete. As long as you don't develop pregnancy symptoms (nausea, breast tenderness), it sounds like there is nothing to be concerned about.

There is more discussion of bleeding after medical abortion on my website: http://www.earlyabortionoptions.com

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