The menstrual cycle or having periods after getting an abortion differs from patient to patient (1). There are many factors which affect the way your menstrual cycle resumes after an abortion (1). It depends on the kind of abortion and the kind of menstrual cycle a patient has had before getting the abortion.
How Different Is The Post-Abortion Bleeding From Menstruation?
Bleeding after an abortion is normal and it may seem like your regular monthly period; however, it is not. The bleeding after the abortion occurs because the uterus is expelling the tissue remaining from the aborted pregnancy.
There are a few people who do not experience bleeding after an abortion and won’t experience any bleeding till their menstrual cycle.
Timing of Bleeding Post Abortion: When the bleeding starts to occur after an abortion depends on the type of abortion had; if it is a procedural or a medication abortion.
Medication Abortion: The patient is given two types of medications for medication abortion and these are misoprostol and mifepristone. The first medication is mifepristone given usually in the hospital, which breaks the uterine lining so the pregnancy stops growing. There are some patients who start bleeding after taking this medication. The second medication which is misoprostol is taken after the patient leaves the hospital and is responsible for triggering the uterus to release its contents. The patient can start to bleed around 2 to 4 hours after taking this medicine.
The bleeding increases until the whole remnants of pregnancy have been passed, which typically is about 4 to 6 hours of taking the second pill, however, the bleeding can be delayed in some patients. Patient can experience heavier flow and some clots also. The increase in the bleeding can reduce after some hours. After this, the bleeding resembles a usual period.
If the patient is having heavy bleeding where two pads get soaked for two consecutive hours or more then it can mean there is something wrong or some serious complication going in within the patient’s body and requires urgent medical treatment (2).
Procedural Abortion: Patient having a procedural abortion can start to bleed immediately after getting the procedure done. There can be some patients who can start bleeding after a few days. The bleeding after this type of abortion can be lighter than the regular period. The bleeding can stop completely or can persist till the next period. In case it continues, then it gets milder or lighter with time.
Duration of Bleeding After Abortion
The normal period of time of bleeding after abortion is usually 1 to 2 weeks irrespective of the type of abortion. In some patients the blood flow can stop and then resume again. The bleeding then gradually slows after a couple of weeks or so. There may be some spotting or light bleeding for some days till the next period.
Characteristics of Bleeding After Abortion
The blood flow after abortion resembles a regular period with the changes being the color can be more brown than red. The flow of the blood is heavier with a medication abortion than compared to procedural abortion. The bleeding can be more when a person is active or exercises and is less at rest. The patient can also pass blood clots which is normal and nothing to worry about. The clots can be of various sizes and if they are accompanied with heavy bleeding for more than 2 hours, then patient should seek immediate medical evaluation.
Patient can also have blood-tinged discharge, which can be mucus like; however, the color should not be green or yellow and the discharge should not be foul-smelling, as all these point towards an infection (1).
Other Side Effects or Symptoms of Abortion
Depending on the type of abortion, the side effects can consist of: nausea, cramps, vomiting, fever, diarrhea, chills, fatigue and headache. Fever can also indicate infection, so if the patient is having fever along with heavy bleeding, body aches and pelvic pain, then it is imperative that the patient seeks medical consultation. Some of the side effects of procedural abortion are: cramps, nausea, vomiting, sweating and tiredness.
What Period Products Are Recommended Post Abortion?
It is advised to avoid using menstrual cups or tampons for a minimum of two weeks after getting any type of abortion. The patient is recommended to use period underwear or menstrual pads till the doctor gives the go ahead to use other products for the flow.
What to expect in the First Period after an Abortion?
Getting an abortion resets or restarts a patient’s menstrual cycle. The regular periods of the patient should resume within a month or so after getting the abortion.
Characteristics of First Period after the Abortion
As mentioned, the first period post abortion can be heavier than usual if the patient has had medication abortion, as the body strives to expel all the extra tissue from the uterus. The patient will also pass some blood clots. The periods after getting a procedural abortion can be mild initially and get back to regular after some months have passed. The bleeding or any discharge after the abortion should not be foul smelling, as this can be a sign of infection and needs medical attention.
Timing of the Periods Post Abortion
The patient’s periods should resume within a month to 6 weeks after getting abortion. The duration of time which passes before getting the first period after the abortion depends partly on the duration of the pregnancy. The hormones of the pregnancy can persist in the body even for some weeks after getting the abortion done that can cause delay in the menstrual cycle. If a month has passed after the abortion and the patient still hasn’t had their period, then it is advised to take a pregnancy test or consult a doctor to make sure the abortion was successful.
Duration of the First Period after the Abortion
The first period of the patient who had undergone an abortion can be shorter in duration if it was a procedural abortion; and in case of medication abortion, it can be longer when compared to the patient’s previous periods before abortion. This irregularity in the menstrual cycle after the abortion is because of the hormones and resumption of menstrual cycle.
Other Symptoms of Periods after Abortion
The patient can experience more cramping than is normal in the following few periods after the abortion. Other symptoms are the same, which are experienced in the previous menstrual cycles such as: headaches, bloating, breasts tenderness, moodiness, muscle aches and tiredness.
Period Products Post Abortion
After the two weeks have passed post abortion, then the patient can get back to their normal period product regime.
The Second and All the Subsequent Periods Post Abortion
After getting the first period post abortion, the patient usually gets into a semi-typical menstrual cycle. It is normal to have irregular menstrual cycles for the first few months after getting the abortion. The periods can be longer or shorter than normal for some months after the abortion. In case of medication abortion, the bleeding can be more than the regular periods, which is absolutely normal and nothing to worry about. By the time the second period occurs, the patient can use whatever period product she wants to use.
Birth Control Methods Post Abortion and How They Affect Menstrual Cycles
The patient can start using most of birth control methods, such as the patch, pill, condom, IUD, implant within a few days or immediately after the abortion. If the patient has had a second-trimester abortion, then it advisable to wait a month before using any method, which requires insertion, such as IUD, cervical cap or diaphragm. The use of hormonal birth control, such as the pill can reduce the bleeding and the duration of bleeding after getting an abortion (3). If the patient is on the pill, then the regular menstrual cycle starts more rapidly with the pill.
Sex after Abortion
Experts recommend waiting till the post-abortion bleeding has completely stopped, which is about a couple of weeks post abortion before having vaginal sex (4).
How soon is Pregnancy Possible Post Abortion?
After the pregnancy has ended via abortion, the ovulation in the patient should start about two weeks post abortion, which means that the patient can get pregnant again even if she hasn’t had her period yet (4, 5).
Does Abortion Affect the Fertility of the Patient?
In most of the patients, the fertility remains unaffected with abortion. However, if the patient gets repeated procedural abortions, then there is risk of scarring (intrauterine adhesions) in the uterus from the instruments used in abortion. This scarring can be a potential cause for infertility in some patients.
When to Contact a Doctor Post Abortion?
Patient should seek immediate medical attention in the following cases (1):
- In case of passing blood clot which is bigger in size than a lemon.
- If the bleeding is such that two or more sanitary pads get soaked in one to two hours.
- If there is fever of more than 100.4°F (38°C) along with chills.
- Acute pain in the back or belly.
- If the pain is not receding even with pain medications.
- If there is green or yellow discharge.
- If there is foul-smelling discharge.
Consult your doctor if there is no bleeding within 24 hours after a medication abortion to exclude ectopic pregnancy or to take second dose of the medication if needed. In such cases, the patient might have had a partial abortion or can still be pregnant and needs follow-up treatment (6). If there is no period even after two months of getting the abortion, then you should again consult your doctor.
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