Duration of Bleeding Post-Abortion
Bleeding after abortion typically lasts 9-14 days, with medical abortion causing longer bleeding duration (approximately 14 days) compared to surgical abortion (approximately 9 days), though spotting may continue for several additional weeks in both methods. 1
Medical Abortion Bleeding Patterns
Duration and characteristics:
- Mean bleeding duration is 14 days following medical abortion with mifepristone and misoprostol 1
- Median bleeding duration is 13 days (range 1-44 days) when using mifepristone and gemeprost 2
- Spotting continues for approximately 10 additional days after the primary bleeding phase 1
- Total vaginal bleeding time ranges from 5-25 days (mean 10.8 days) in treated patients 3
Factors affecting bleeding duration:
- Increasing gestational age predicts more bleeding days after medical abortion 1
- Blood loss increases significantly with advancing gestation, with median loss of 74 mL (range 14-512 mL) 2
- Oral contraceptive use does not decrease bleeding duration after medical abortion 1
Surgical Abortion Bleeding Patterns
Duration and characteristics:
- Mean bleeding duration is 9 days following manual vacuum aspiration (MVA) 1
- Spotting continues for approximately 10 days, similar to medical abortion 1
- Gestational age does not predict bleeding duration after surgical abortion 1
Blood loss comparison:
- Surgical evacuation has significantly lower rates of prolonged bleeding compared to medical management 4
- Estimated blood loss with surgical abortion ≤14 weeks is typically 50 mL or less in 78% of cases 5
Clinical Implications and Management
Expected bleeding patterns to counsel patients:
- Bleeding commonly begins after mifepristone administration and before prostaglandin administration in medical abortion 2
- Prolonged bleeding is not rare and occurs more commonly with medical abortion than surgical abortion 1
- Bleeding after early medical abortion persists longer than previously appreciated regardless of contraceptive method used 1
Warning signs requiring evaluation:
- Hemorrhage (excessive bleeding) occurs in fewer than 1% of abortions but may cause significant morbidity 6
- Bleeding beyond expected duration may indicate retained tissue, requiring additional intervention 4
Post-abortion contraception timing: