What should I do if I haven't had my period yet, a month after a medical abortion?

Management After Medical Abortion Without Return of Menstruation

It is normal to not have a period for up to 8 weeks after a medical abortion, and you should take a pregnancy test if you haven't had a period by 4-6 weeks post-abortion to rule out ongoing or new pregnancy.

Normal Timeline for Menstrual Return

After a medical abortion, the return of normal menstruation varies significantly between women. This delay is expected and usually not concerning for the following reasons:

• The hormonal changes triggered by pregnancy take time to normalize
• The endometrial lining needs time to rebuild after the abortion
• Individual variations in cycle length affect when periods resume

When to Take Action

Follow this algorithm to determine appropriate next steps:

1. At 4-6 weeks post-abortion with no period:

   • Perform a home pregnancy test
   • If negative → Continue waiting, as menstruation may take up to 8 weeks to return
   • If positive → Seek immediate medical attention to rule out:
     • Ongoing pregnancy (failed abortion)
     • New pregnancy
     • Retained tissue

2. At 8+ weeks post-abortion with no period:

   • Schedule an appointment with your healthcare provider for:
     • Pregnancy test
     • Possible ultrasound to check for retained products of conception
     • Evaluation of other causes of amenorrhea

Warning Signs Requiring Immediate Medical Attention

Seek immediate medical care if you experience:

• Heavy bleeding (soaking through more than 2 pads per hour for 2+ consecutive hours)
• Severe abdominal pain not relieved by over-the-counter pain medication
• Fever over 100.4°F (38°C)
• Foul-smelling vaginal discharge
• Continued pregnancy symptoms (nausea, breast tenderness, etc.)

Risk Factors for Medical Abortion Failure

Research shows certain factors increase the risk of incomplete abortion:

• Very early pregnancy at time of abortion
• Uterine anomalies or unusual positioning 1
• Minimal bleeding during the abortion process
• Continued pregnancy symptoms after the abortion

Contraception After Medical Abortion

If you wish to prevent pregnancy, consider starting contraception immediately:

• Progestin-only methods (pills, implants, IUDs) can be started immediately after abortion 2
• Combined hormonal methods can be started after confirming complete abortion
• Non-hormonal methods (copper IUD, barrier methods) are also excellent options 3

Key Points to Remember

• Absence of menstruation for 4-6 weeks after medical abortion is common and usually normal
• A pregnancy test at 4-6 weeks post-abortion is a simple way to ensure the abortion was successful
• The most important indicator of a successful abortion is the resolution of pregnancy symptoms and appropriate bleeding at the time of the abortion