Bleeding After an Abortion

Experiencing bleeding after an abortion is a common concern for many people. Whether the abortion is medical (using medication) or surgical, bleeding is a normal part of the process as the body expels the products of conception and begins to heal. However, the amount, duration, and nature of the bleeding can vary significantly from person to person, depending on factors such as the type of abortion, individual health, and gestational age at the time of the procedure.

Understanding what constitutes normal bleeding and recognising signs that might indicate a complication can help you feel more confident and prepared during your recovery. This guide provides a comprehensive overview of what to expect regarding bleeding after an abortion, when to seek medical attention, and practical tips for managing the experience comfortably and safely.

What is Normal Bleeding After an Abortion?

After an abortion, it is entirely normal to experience some bleeding, and this can vary depending on whether the abortion was medical or surgical.

Bleeding After a Medical Abortion

A medical abortion, often performed up to 10 weeks of pregnancy, involves taking two medications: mifepristone and misoprostol. The first medication, mifepristone, blocks the hormone progesterone, which is necessary for pregnancy to continue. The second medication, misoprostol, induces uterine contractions to expel the pregnancy tissue.

What to Expect

Bleeding typically starts within a few hours after taking the second medication misoprostol. The bleeding is usually heavier than a regular menstrual period, with clots that can be as large as a lemon. This intense bleeding usually lasts for a few hours, until the products are passed but can continue with lighter bleeding or spotting for up to 2–3 weeks.

Duration

The heaviest bleeding generally occurs within the first 4–6 hours after taking misoprostol and should start to lessen within 24–48 hours. However, light bleeding or spotting can continue intermittently for several weeks in some women.

Normal Symptoms

Heavy bleeding with clots, similar to a heavy menstrual period, is normal during this time. Some cramping and discomfort, akin to strong period pains, are also typical.

Bleeding After a Surgical Abortion

A surgical abortion, which includes vacuum aspiration or dilation and evacuation (D&E), involves the physical removal of the pregnancy tissue from the uterus. This type of abortion is typically performed up to 24 weeks of pregnancy.

What to Expect

Bleeding after a surgical abortion tends to be lighter than after a medical abortion. Some people experience little to no bleeding immediately after the procedure, while others may have bleeding similar to a menstrual period.

Duration

Bleeding can vary, lasting from a few days to a couple of weeks. It is usually lighter and resolves faster than bleeding after a medical abortion.

Normal Symptoms

Light to moderate bleeding, sometimes accompanied by small clots, is normal. Mild cramping and spotting may also occur.

What is Considered Abnormal Bleeding?

While bleeding is a normal part of the abortion process, certain signs may indicate a complication. It is essential to know what is considered abnormal so that you can seek medical attention if needed.

Excessive Bleeding

Passing large clots (larger than a lemon) for more than 2 hours, soaking through two or more maxi pads per hour for 2 consecutive hours, or feeling dizzy or lightheaded can indicate excessive bleeding. This may suggest that not all of the products have been expelled or that there is an infection or injury to the uterus.

Prolonged Heavy Bleeding

Heavy bleeding lasting more than two weeks, especially if it is accompanied by severe cramping, fever, or foul-smelling discharge, can be a sign of an incomplete abortion or infection.

Sudden Onset of Heavy Bleeding

If you initially have minimal bleeding that suddenly becomes very heavy, this could indicate retained tissue or other complications.

Foul-Smelling Discharge or Fever

A fever over 38°C (100.4°F), chills, or a foul-smelling vaginal discharge may indicate an infection, such as endometritis (infection of the uterine lining) or sepsis, which requires immediate medical attention.

Severe Pain or Cramping

While some cramping is expected, severe pain that doesn’t improve with over-the-counter pain relief, especially if it is localised to one side or is accompanied by heavy bleeding, may be a sign of complications such as an incomplete abortion or ectopic pregnancy (when the pregnancy grows outside the uterus).

If you experience any of these symptoms, it’s important to contact your healthcare provider or go to the nearest emergency department for evaluation.

Factors Influencing Bleeding After an Abortion

Several factors can influence the pattern and duration of bleeding after an abortion:

Gestational Age: The length of pregnancy can affect the amount of bleeding experienced. Generally, the further along you are, the more bleeding you are likely to have.

Type of Abortion: Medical abortions often cause more bleeding initially compared to surgical abortions, but the overall duration of bleeding can vary.

Individual Health Factors: Conditions like clotting disorders, certain medications (e.g., anticoagulants), and overall health can impact bleeding.

Uterine Tone and Size: If the uterus does not contract properly, it may lead to heavier bleeding. This is more common in pregnancies that are further along or in people with certain medical conditions affecting the uterus.

Infections or Complications: Infections, retained tissue, or injury to the uterus can cause abnormal bleeding.

Managing Bleeding After an Abortion

Bleeding after an abortion can be uncomfortable, but there are several ways to manage it effectively:

Use of Sanitary Pads: Using pads instead of tampons is recommended in the weeks following an abortion to monitor the amount and nature of the bleeding and to reduce the risk of infection.

Stay Hydrated and Rest: Drinking plenty of fluids and resting can help your body recover. Gentle movement, like short walks, can also promote circulation and reduce cramping.

Pain Relief: Over-the-counter pain relievers, such as ibuprofen or paracetamol, can help manage pain and cramping. Always follow the dosing instructions, and consult your healthcare provider if you have any questions.

Monitor for Signs of Infection: Keep an eye out for fever, foul-smelling discharge, or any other signs of infection. Prompt treatment can prevent more serious complications.

Avoid Intercourse and Insertion of Objects: To reduce the risk of infection, avoid sexual intercourse, douching, or inserting anything into the vagina (like tampons or menstrual cups) for at least two weeks or as advised by your healthcare provider.

When to Seek Medical Attention

While most people will recover from an abortion without complications, it’s important to know when to seek medical help. You should contact your healthcare provider if you experience any of the following:

• Heavy bleeding that soaks through more than two maxi pads per hour for two consecutive hours.
• Severe pain that is not relieved by over-the-counter pain medication.
• Fever of 38°C (100.4°F) or higher, or chills.
• Foul-smelling vaginal discharge.
• Feeling weak, faint, or dizzy.
• Sudden heavy bleeding after a period of little or no bleeding.

Conclusion

Bleeding after an abortion is a normal and expected part of the recovery process. However, understanding the difference between normal and abnormal bleeding is crucial for your safety and peace of mind. Most people experience manageable symptoms and recover fully within a few weeks. By following aftercare instructions, monitoring your symptoms, and knowing when to seek medical attention, you can ensure a safe and healthy recovery.

Always reach out to your healthcare provider if you have any concerns or questions about your symptoms. Remember, you are not alone, and help is available to guide you through this time.