Timing of Bleeding After Mifepristone Administration
Bleeding typically starts within 1-3 days after taking oral mifepristone, with most women experiencing bleeding before misoprostol administration. 1
Bleeding Pattern After Mifepristone Alone
- In studies examining mifepristone for early pregnancy termination, 48 out of 50 women (96%) started to bleed within 1-3 days after taking a 600mg dose of mifepristone 1
- When mifepristone is used alone, approximately 21% of women experience bleeding before misoprostol administration 2
- The longer the interval between mifepristone and misoprostol administration (24,48, or 72 hours), the more likely women are to experience bleeding before taking misoprostol 2
Factors Affecting Bleeding Onset
- Gestational age: Earlier pregnancies may have faster onset of bleeding after mifepristone 3
- Dosage: Standard dosing for medication abortion is 200mg mifepristone followed by 800mcg misoprostol (buccally or vaginally) 3
- Individual variations: Some women may not experience bleeding until after misoprostol administration 2
Bleeding Patterns in Combined Regimens
- Of women who have no or minimal bleeding before misoprostol:
- 80% will begin bleeding within 4 hours of misoprostol administration
- 98% will begin bleeding within 24 hours of misoprostol administration 4
- By day 7 after mifepristone administration, 95% of women will have completed the abortion process 4
Duration and Intensity of Bleeding
- Bleeding after mifepristone-misoprostol regimen lasts an average of 9-16 days 3
- Bleeding is typically more copious than normal menstruation for most women 5
- Severe hemorrhage requiring intervention is rare (0.4% with mifepristone alone, 0.14% with combined regimen) 5
Important Clinical Considerations
- Cramping and bleeding are expected effects of medication abortion 3
- Lack of bleeding after mifepristone does not indicate treatment failure, as some women will not bleed until after misoprostol administration 2
- Patients should be counseled that bleeding patterns vary and cannot reliably predict treatment success 2
- Excessive bleeding requiring intervention is uncommon but possible 5
Warning Signs
- Soaking through more than two maxi pads per hour for two consecutive hours may indicate excessive bleeding requiring medical attention 3
- Persistent heavy bleeding beyond two weeks warrants clinical evaluation 3
Remember that while most women will experience bleeding within 1-3 days after mifepristone, individual responses vary, and the absence of bleeding before misoprostol administration does not indicate treatment failure.