Expert: Doctor Early Options - 1/23/2010

Question
Hi there. I was 5 weeks and 6 days along when I decided to abort using the RU486 Pill. I went to my local clinic on Jan 7th and received the oral pill and the 4 tablets to insert later. I took the pill that afternoon, I was going to insert the pills on the 9th due to my work schedule, but when I got home Friday evening I started to bleed very heavily. I called the clinic and they said that I must have miscarried already, and I should just insert the 4 tablets now since its already happening. I did as they said. I went through alot of pain that night until about 4 in the morning. The next day everything was much better. I went to my follow-up visit on the 14th one week later. They said everything went fine and I was no longer pregnant. At this point I was bleeding pretty light. I asked about birth control methods and decided to go with the Nuva Ring. The doctor there said I could put it in that day. After inserting the ring my bleeding stopped. I had sex on the 18th. The next day I started bleeding again lightly, and now the bleeding has gotten heavy again with clumping. My question after this long drawn out story is..... should I have not had sex, and did that do something. Also should I take the Nuva ring out, is it causing the bleeing to come back? Is it normal that you can go from light to heavy again? Thanks so much for taking your time to answer thanks.  

Answer
Dear Hillary,
Thank you for your excellent question about bleeding after the abortion pill, sex, and birth control. There is no concern with the bleeding you are having.  What you are describing with heavy bleeding at first, going to light bleeding, stopping, and then bleeding heavily again with clots is common and normal after taking the abortion pill.  This kind of irregular bleeding can go on for weeks to months, and does not mean there is any problem.  It can be annoying because you never know when and how much you are going to bleed.  However, it is not harmful in any way, and your periods should come back to normal.  If you are having daily, heavier bleeding for weeks, that is when you should see a doctor.

You did everything right as far as sex and birth control.  As long as you start birth control within a week of having your abortion, it is effective immediately.  So it was fine for you to have sex 4 days after you inserted it.  When you have sex, it stimulates your uterus to contract, and it can expel any blood that is in the uterus.  This is normal and healthy, and of no concern.  It may help to get you back on cycle.  DO NOT take the nuvaring out.  That is the  most common mistake women make in this situation.  Just take it as directed, and it will also help you get back on cycle and of course prevent another unwanted pregnancy.  

There is more information on my website about the abortion pill, sex after abortion, and birth control at: http://www.EarlyAbortionOptions.com

Doctor Joan
New York City