What Are the Possible Causes of Bleeding after Abortion?

Bleeding after abortion is typically considered a normal side effect of the procedure, and women shouldn’t usually be alarmed if they see blood or spotting in the weeks after the abortion has been performed. In most cases bleeding is one of the body’s ways to recover and restore a reproductive status quo. Women who have had medical abortions, which is to say abortions triggered by drugs rather than surgery, usually expect to see blood as a sign that the medication is working. Drugs in this category force contractions of the uterus or trigger menstruation, both of which result in blood. Severe bleeding or large blood clots are usually cause for concern no matter what, though, since these might indicate damage to internal organs from instruments used in the procedure or hemorrhage, and may require surgical repair. Infection also may cause bleeding after abortion if tissue remains in the uterus. When severe cramping occurs, it might indicate postabortal syndrome, meaning the uterus fails to contract to expel blood and clots.

Normal Recovery

A woman might bleed for six weeks during the abortion recovery period, and small clots usually pass with the blood. Normal menstruation commonly returns one or two months later, and menstrual bleeding after abortion might appear different than before the procedure. Hormonal changes may trigger heavier-than-normal periods, or lighter bleeding may occur when normal menstrual cycles return.

Cramping is also common and might be eased with abdominal massage. This helps the uterus contract and return to its pre-pregnancy size as blood and clots are expelled. Massage is also used after childbirth to accomplish the same outcome.

Bleeding With Medication

Women who use drugs known as “abortion pills” might also experience increased bleeding, which experts think occurs in about one of every 100 patients. The process usually consists of three medications over a period of three days, which in most cases is suitable for early abortion up to about 49 days' gestation. A doctor normally evaluates the patient a couple of weeks later to determine if the medication successfully aborted the fetus.

In some cases the blood a woman sees after an abortion may simply be menstruation. This is most common very early in the pregnancy, and typically with the use of emergency contraceptives sometimes called the “morning after pill.” These types of medications can usually only be used within the first few hours or days of a possible pregnancy, and their main role is to trigger menstruation and a shedding of the uterine walls, which would include a fertilized egg if it is present. There is some debate when it comes to whether or not this is a true abortion, but it nonetheless causes bleeding — and this is perfectly normal.

Importance of Gestational Age

The amount of bleeding a woman experiences might also depend on the stage of pregnancy, since this stage often dictates the sort of procedure and its relative simplicity. Up until about 12 weeks’ gestation, a woman will typically receive a general anesthetic before the doctor uses a machine to suction the fetus from her uterus. A medical instrument called a curette scrapes out any remaining tissue. Bleeding here is often a normal reaction to the change in condition, and is the uterus’ way of stabilizing and adapting.

Things are often more complicated once a woman enters the second trimester of pregnancy. During the second trimester, bleeding after abortion might resemble bleeding after full term or premature childbirth. The patient will typically receive medication to stimulate uterine contractions in a hospital labor and delivery room. After several hours, the fetus and placenta detach and are expelled from the uterus. Medical attendants will often have to physically scrape the uterus to be sure that all fetal tissues and placental parts have been evacuated.

Hemorrhage or Organ Damage

Bleeding that continues for more than a few weeks, that seems to be getting heavier with time, or that includes large clots is usually a sign that things aren’t healing the way they should. The most common causes in these cases are hemorrhage, usually as a result of tissues from the pregnancy that remain attached in the uterus, or organ damage, frequently a perforated uterus. Abortion providers who have slipped or made errors with their instruments can sometimes not only rupture the uterine wall but may also damage nearby organs through the uterus, which can lead to extensive damage, not to mention great pain. If these conditions aren’t promptly diagnosed and treated they can lead to serious complications including death.

Infection

Leftover tissues also run the risk of becoming infected, which frequently leads to bleeding. Women who have uterine infections usually also have a fever, experience chills, and feel nauseated. Infections can sometimes be treated with antibiotics, but the offending tissues often need to be removed surgically, as well.

Other Common Side Effects

Some women experience pregnancy symptoms months after an abortion. It generally takes little while before hormones adjust to pre-pregnancy levels. In addition to bleeding during this time, a woman might experience morning sickness, feel tired, or become emotional. Depression might also develop in some women. Anyone who is concerned about certain symptoms should usually talk to a healthcare provider.

Discuss this Article

khubb84
Post 8

I had an abortion at eight weeks and things went south. I was rushed to the hospital by ambulance. After hours of pain, bleeding and fear, I finally found out that the doctor had perforated my uterus. I was kept for three days and was discharged on strict bedrest. (Thank the Lord, it was decided that surgery wasn't necessary). Because my bleeding had slowed and the pain was slowly getting better, they decided to monitor me, have me rest and heal on my own.

I just went back to work Monday after nine days of bedrest. Things seemed okay, but then Tuesday, I had a very sudden downpour of bright red blood. I soaked two pads in 10 minutes time

. After ten min or so, I felt an urge to push and passed the biggest blood clots I've ever seen. One was the size of a large egg from the grocery store, and one was a little bigger about the size of a lemon. It felt foreign – weird – and the second I passed those huge clots the bright red bleeding stopped! I was in shock from what happened because I have never seen or felt something like that.

Well, after that, I was barely spotting for days and felt great until tonight! I was on the phone with the bank handling finances when all of a sudden I completely soaked my underwear, three pads and my bottoms, with bright red blood! It poured and poured, soaking the floor and my legs and then I felt something being pushed out of me. Once again, a huge, egg-sized blood clot – a thick, heavy, nasty, huge clot! Once again, the bleeding stopped almost immediately! That happened two hours ago and I've been cramping and having lots of gas in my tummy ever since. I thought I was healing and in the clear, but I know in my heart, the huge amount of bright red bleeding, followed by the enormous clots just isn't normal, not to mention having the downpour of bleeding stop almost the second the clot passes makes me even more concerned.

I would go straight to hospital but I have no insurance, not to mention my 1, 3, and 8 year old children are asleep and I don't want to wake them and bring them to the ER with me. My husband and I have recently separated so I would have no help with them in hospital. I can't seem to shake the worry, though, so I thought I would post in search of answers or suggestions. Does anyone have experience with this? Is this normal or to be expected?

samee
Post 7

I had an abortion through the mva process. I was at 7 weeks gestation. My problem is still i m bleeding and now it's the 54th day. Please help me.

anon357688
Post 6

I had a surgical abortion and I didn't take the contraction pills. Can my uterus naturally contract to its pre-pregnancy state?

anon350182
Post 5

I had an abortion and bled lightly for two weeks, then my period came on the fourth week. Around the sixth week, I bled very heavily for two weeks. The doctor told me to start taking my birth control to thicken up my lining in my uterus. Well my question is, is that normal or could something have gone wrong with my procedure?

anon327561
Post 4

I had an abortion one month ago, and am still bleeding. Is this normal?

literally45
Post 3

@simrin-- Yea, the morning after pill also causes bleeding because it basically triggers menstruation. With menstruation, ovulation and implantation of a fertilized egg is prevented. So the bleeding is not very long, it usually lasts about five or six days, that's how long most women's menstruation takes.

candyquilt
Post 2

@simrin-- There is a lot of bleeding with medical abortion (the pill abortion that aborts the fetus, not the morning after pill). There has to be bleeding because that's how the fetus and placenta are aborted. This is not like surgical abortion where the doctor takes care of this part. There is some bleeding after surgical abortion too but not as much as medical abortion.

If someone takes medical abortion pills and doesn't bleed, it means the medication didn't work. So, in that sense, bleeding after medical abortion is necessary. But if the bleeding continues for weeks on end, then it indicates some kind of complication like tissue that didn't get expelled.

I think it's best to go back to the doctor for an ultrasound after medical abortion to make sure everything looks okay. This way, if there needs to be an additional procedure to cleanup any remaining tissue, it can be done early before the woman bleeds excessively.

SteamLouis
Post 1

Okay, so bleeding after abortion is expected, in fact necessary. I guess it would be more worrisome to have no bleeding after abortion than to have it.

What about the morning after pill? Does that cause bleeding as well?

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