Medical Abortion Bleeding: What to Expect, When, and Why

 

Heavy vaginal bleeding is a part of a medical abortion process. It is a normal side effect, often indicating that the MTP Kit pills are working as expected. Misoprostol from the medicine pack causes uterine contractions. In turn, the pregnancy exits the body through bleeding. With endometrial lining shedding, facilitated by Mifepristone, you can experience hormonal fluctuations, related to pregnancy and abortion.

To give you an overview about medical abortion bleeding, we have compiled some information so that you understand what happens in your body, timeline for the bleeding, and how to manage the consequences safely.

What Causes Bleeding During a Medical Abortion?

As discussed, the anti-progesterone activity of Mifepristone detaches pregnancy from the womb. Thus, the endometrial lining breaks and pregnancy tissues come off from the uterine wall. After administration of Misoprostol, uterine contractions are triggered via prostaglandin activation. Thus, the pregnancy sections and the thick lining of the uterine get discharged from the vagina.

This causes vaginal bleeding, and you can also expect large blood clots containing the tissues. It is not hemorrhaging in the proper sense. The bleeding is controlled but like a heavy period, mimicking a natural miscarriage.

Stage 1: Pre-Misoprostol Spotting (Day 1)

Let us start by visiting the entire medical abortion process from the time of first pill intake. You can use Mifepristone 200mg either at home or at the clinic. Mostly, you can self-initiate the intake abortion pill without medical supervision. Take the medicine orally with water. You may not start bleeding after dosage.

In some cases, women can encounter light spotting within a few hours. The blood is like a slight trickle or spotting, usually brownish or pinking resembling the bleeding during implantation. In the initial 48 hours, there are no other side effects, including cramps or serious shifts in hormones. But the pregnancy is gradually detaching from the uterus inside.

Stage 2: Peak Heavy Bleeding (4-24 Hours Post-Misoprostol)

After using Misoprostol 24 to 48 hours later to Mifepristone, uterine contractions begin. These increase in the first one to four hours. You can expect vaginal bleeding to begin in a couple of hours, and sometimes 4 to 6 hours after the cramps begin. You must use sanitary napkins to keep a check on the blood flow.

The bleeding is heavy and lasts for 4 to 12 hours, and in some cases, it is beyond moderate flow. It is rather intense depending on gestational age. The bleeding is lower for earlier pregnancies. Since pregnancy is less developed in the initial 4 weeks, the bleeding is little less in this case. But it may increase thereafter.

Stage 3: Tapering Off (Days 2-7)

The blood flow becomes lighter to menstrual bleeding level with shade dark red to brown eventually. You begin releasing less clots. Slowly, the bleeding may turn to spotting or continue lightly until the tissues and lining eliminate from the body. The length of the process goes for 5 to 7 days.

Stage 4: Lingering Spotting (Weeks 1-4+)

Once one week is over after the medical abortion, the bleeding is now like light bleeding or discharge. The flow is sticky or watery with brown color. It may continue for a week to four, depending on pregnancy weeks. It can take another two to six weeks for pregnancy hormones to deplete completely. Full menstrual cycle resumes in 4 to 6 weeks.

What Influences Bleeding Intensity and Duration?

Here are factors that affect vaginal bleeding in pregnancy termination:

·       If the gestational age is less than 7 weeks, the bleeding is light to moderate lasting for 9 to 12 days or more. If the pregnancy is beyond 9 weeks to 12 weeks, the bleeding is heavier lasting for 16 to 24 days or more.

·       If you use Misoprostol vaginally, the bleeding is heavier compared to oral (buccal or sublingual) use of the medicine.

·       The cervix is tighter if it is your first pregnancy. Because of cervix softening, the blood flow can come out faster, but still not as easily if the pregnancy is your second or later. So, the bleeding duration may be longer.

·       If you start with over-the-counter medicines to reduce bleeding or cramps, the bleeding and side effects may reduce accordingly. Make sure not to overdose on OTC meds, or it may affect the activity of prostaglandins.

·       If the pregnancy termination is incomplete, the bleeding can be heavier requiring emergency care. So, is the case of using abortion pills in ectopic pregnancy. Or, if there is an infection.

·       Medical abortion is a longer process compared to surgical pregnancy ending procedure. Thus, the bleeding is for a longer duration as well.

Normal vs. Abnormal Bleeding: Spot the Difference

The normal bleeding entails use of one to two maxi pads per hour for less than 2 hours. The blood clots are less than lemon size or similar. The blood shade is bright red initially and then fading to brown. You may experience abdominal pain and cramps along with nausea. However, if you soak more than 2 pads per hour for over 2 hours, it can be a sign of excessive bleeding. The blood clots are larger than lemon size.

In case of complications, the fever may exceed 100.4°F as an immune response. Also, if there is an infection causing heavier bleeding, it can be accompanied with foul-smelling discharge. If there is no bleeding even after a day of using Misoprostol, it can mean the pills are not working as intended, or there is an ectopic pregnancy. Hemorrhage symptoms are severe dizziness and pale skin.

Frequently Asked Questions (FAQs)

Here are the common FAQs about medical abortion bleeding:

1.       How heavy is the bleeding compared to a period?

The abortion bleeding on MTP Kit is like a heavy period initially. You may soak around 2 large pads in an hour or two with passing blood clots. The blood flow eventually reduces to light flow or spotting in a couple of weeks or more as the uterus empties.

2.       When does bleeding start after taking Misoprostol?

You may experience light spotting in one to two hours of taking Misoprostol. However, the bleeding surges after two to four hours. The blood flow is at the peak at 4 to 6 hours, as your body passes the pregnancy tissues and sections.

3.       Is it normal to have no bleeding after Mifepristone?

Yes, bleeding may not always begin after Mifepristone administration. Some may experience slight spotting but that’s it. The heavy vaginal bleeding begins mostly after the use of Misoprostol pills. So, you have nothing to worry about the absence of bleeding on using the anti-progesterone medicine.

4.       How long can spotting last after medical abortion?

The blood flow becomes light and then turns to spotting, continuing for one to four weeks as pregnancy hormones clear out. If heavy bleeding continues over 2 weeks with no changes in the amount, consult a doctor and do not miss the follow-up.

5.       What reduces bleeding during medical abortion?

You can take medicines that would reduce bleeding in case of excessive flow. Avoid aspirin, but you can depend on Ibuprofen 600mg every 6 hours. Take rest and stay hydrated on electrolyte liquids. It would normalize the bleeding soon.