Expert: Doctor Early Options - 11/15/2009

Question
hello.
I had an abortion 5 weeks ago when I was around 4 weeks pregnant.
I have recently started bleeding heavily with large clots. is this normal?
I also had a feeling I was pregnant again but with this heavy bleeding that wouldn't be possible would it?
thankyou.
Caitlin x

Answer
Dear Caitlin,
Thank you for your question regarding heavy bleeding after a very early abortion at 4 weeks.  It is fairly common to have heavy bleeding with clots weeks or even a month after an abortion.  It simply indicates that there was some tissue remaining after the abortion, and that it was not completely expelled during the procedure.  This is normal, and not a complication.  The bleeding should resolve within days.  If it does not, you should get an evaluation to see if there is still a significant amount of tissue in the uterus.  You can help your uterus to expel the tissue and blood by exercise, heat and uterine massage (deep massage to your lower belly in a warm bath, heating pad or hot water bottle) or by having sex (if you feel like it).  Don't be afraid if you pass clots.  It is normal and healthy.  

If you were only 4 weeks pregnant when you had an abortion, I would be concerned to make sure that you are no longer pregnant.  An abortion at 4 weeks is considered a "very early abortion" - before you can identify the pregnancy on ultrasound.  It has a higher failure rate of about 5%. Did you have a follow up appointment?  You're right - with this amount of bleeding it would be unlikely that the abortion failed.  It is also possible that the pregnancy continued, and now you are miscarrying.  You may first want to check a pregnancy test - if it is negative, then you are fine.  If it is positive, it could be from retained products or from a continuing pregnancy (that most likely is miscarrying now, or much less likely, is still viable).  If the test is a strong positive, I would get an evaluation.  If it is faint or negative, there is no need to see a doctor.  

There is more information on retained products and bleeding after abortion at: http://www.earlyabortionoptions.com

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