Duration of Bleeding After Medical Abortion
Bleeding after a medical abortion typically lasts 9-16 days on average, but can continue for up to 30 days or occasionally longer in some women. This duration is longer than what is typically experienced after surgical abortion methods.
Normal Bleeding Pattern After Medical Abortion
The bleeding pattern after medical abortion follows a characteristic timeline:
- Initial bleeding: Often begins after taking mifepristone (before misoprostol) in about 21% of women 1
- Heavy bleeding: Typically occurs within 4-6 hours after misoprostol administration
- Duration of heavy bleeding: Usually 1-3 days
- Total bleeding duration:
Factors Affecting Bleeding Duration
Several factors can influence how long bleeding persists:
- Gestational age: Longer bleeding duration and heavier blood loss correlate with more advanced gestational age at the time of abortion 3
- Individual variation: Wide individual differences exist in both amount (14-512 ml) and duration of bleeding 3
- Method comparison: Medical abortion typically results in longer bleeding duration (average 14 days) compared to manual vacuum aspiration (average 9 days) 2
When to Seek Medical Attention
Patients should be advised to seek immediate medical attention if they experience:
- Soaking through 2 or more maxi pads per hour for 2 consecutive hours
- Persistent heavy bleeding beyond 2-3 days
- Severe pain unrelieved by medication
- Fever (>100.4°F or 38°C) lasting more than 24 hours
- Foul-smelling vaginal discharge
- Bleeding that continues beyond 30 days
Signs of Potential Complications
Prolonged or heavy bleeding may indicate:
- Incomplete abortion: May be associated with persistent bleeding lasting ≥21 days 4
- Retained tissue: Often associated with endometrial thickness ≥15 mm on ultrasound 4
- Continuing pregnancy: Rare (occurs in approximately 1.5% of cases) 5
Intervention Considerations
Curettage after medical abortion is relatively uncommon:
- Overall rate: Approximately 2.6% of women require curettage 5
- Timing of interventions: Typically bimodal - either within the first week (38%) or during weeks 3-5 (37%) 5
- Main indications: Persistent bleeding (53%), patient request (31%), and continuing pregnancy (15%) 5
Contraceptive Use After Medical Abortion
- Combined oral contraceptives can be started immediately after medical abortion
- Contrary to what might be expected, oral contraceptive use does not decrease bleeding duration after either medical or surgical abortion 2
- IUDs can be inserted within the first 7 days after abortion, including immediately post-abortion 6
Remember that while prolonged bleeding can occur, persistent heavy bleeding or bleeding lasting beyond 30 days warrants medical evaluation to rule out complications such as incomplete abortion or infection.