Early Options™

Questioner: Jessica
Subject: Abortion pills, blood clots, heavy bleeding
Date Answered: 2010-02-16 AllExperts

Question:
I decided to have an abortion on the 6th week of my pregnancy. I was given the abortion pill at the clinic which was one by mouth In front of the doctor and 4 tiny pills to be inserted by hand. The doctor told me that It would be ok for me to Insert the pill after 24 hours and i did. I had heavy clotting the first day, The color was red and white, the bleeding was average like that of a normal period. it continued to be this way for a week and then the bleeding stopped. I thought I was clear and had protected intercourse with my boyfriend.  two days after the bleeding stopped It began again. this time with huge clots. Every time went to urine at least one or two would come out. the bleeding was heavier than my first week when the actual abortion was happening. I don’t bleed constantly to the point where I fill out pads to quickly, but when I do It feels like my body pumps out plenty of blood, when this happens I wonder If I messed my pants. Please let me know If this Is normal. Should I go to the emergency room?

Answer:
Dear Jessica,
Thank you for your question about the abortion pills, blood clots, and heavy bleeding.  Typically what you are describing with the abortion pills is completely normal.  It is common and normal to have large blood clots.  Passing blood clots can be frightening, but they generally do not indicate that there is a problem; it just indicates that the blood sat in the uterus before it came down, so it formed a clot.  It is also common and normal to bleed heavier the second week, than at the time of the actual abortion.  Usually this type of heavy bleeding you are describing only lasts days.

I usually do not recommend going to the emergency room when you have bleeding from the abortion pills.  It is much better to go back to the doctor who prescribed the pills.  Doctors in the emergency room are not trained in medical abortion, and they will usually recommend a D&C surgical procedure, which is usually unnecessary.

Reasons to go back to your doctor would be: the bleeding continues for more than a few days as you are describing that does not start to get lighter; you start to get strong lower abdominal cramping; or you had anemia before you took the abortion pills.

I hope this is helpful and that the bleeding slows down,

Dr. Joan
Allexperts.com

Questioner: a
Subject: Unsuccessful Herbal Abortion
Date Answered: 2010-01-25 AllExperts

Question:
I attempted an herbal abortion that was unsuccessful, and now I am wondering if I have limited my options.

This was my attempt:
I started taking Vitamin C (6000mg every 24 hrs)and Parsley one day before my period was due, and continued that for one week without any signs of of my period. I continued the Vitamin C and stopped the Parsley and began to take 2 560mg pills of Dong Quai every 4 hours except when I was sleeping. After a few days I felt mild cramping so I decided to add Black Cohosh drops to encourage my period, taking 300mg every 3 hours. 2 Days off that caused a tiny amount of blood and 2 full days of severe cramping and nausea.

Two days ago at 2 weeks late and with sever cramps, I went to the emergency room and they told me that my cervix was fully closed and that it appeared the fetus was in the correct place but that I also have a fibroid in my uterus. I did not tell the doctors that I had attempted an herbal abortion. They told me the cramping could just be part of the pregnancy. They diagnosed me as “First trimester pregnancy, Intramural uterine fibroid, discomfort of pregnancy.”
I am wondering now what my options are. I am only 6 weeks along and know that I can take the Pill Abortion up to 9 weeks.

I have read that once a person has attempted a herbal abortion there are risks of birth defects.

Is there a way to tell if any damage has been done to the fetus?
If I have already caused damage in some way to the fetus from the herbal abortion attempt I want to follow through with the pill abortion.

I know that I do not want to have a surgical abortion because I do not want to risk the chances of future pregnancies.

Answer:
Dear A,
Thank you for your question about your options after taking herbs to terminate a pregnancy. Your question about herbal abortion is very helpful to others in this situation.  Many women end up taking either herbs or misoprostol alone to end pregnancy, without realizing that they may not be successful and that they can cause birth defects.  I believe herbal abortion is only effective 50% of the time, and misoprostol alone is effective about 80% of the time.  I know misoprostol can cause serious birth defects, but I am less educated about the risks of different herbal protocols. It’s important for women to have a back up plan if they are not successful in terminating the pregnancy with these methods.

I did some research to try to answer your question, but I am clearly not an expert in this area.  I believe there is limited information on the risks of continuing a pregnancy after taking the herbs that you did.  If you are seriously considering continuing the pregnancy, I would try to contact an herbalist who has experience with this.

My overall impression is that it is not worth taking the risks to continue the pregnancy.  If you did carry the pregnancy to term, and there were problems with the baby or the pregnancy, you would always blame yourself.  That would be a very heavy burden to bear. At this stage, it is still simple to end the pregnancy, and there is no harm done.  If you have changed your mind and want to be pregnant, you can always try again.

I would recommend the Abortion Pill or Manual Vacuum Aspiration to terminate the pregnancy.  Unfortunately, it can be hard to find a doctor who performs Manual Vacuum Aspiration – if there is a way you can come to New York City I could do your procedure.  There are other doctors listed on http:/www.EarlyAbortion.com.  I would also recommend the Abortion Pill.

I have spent over a decade trying to make these simple, reliable, non-surgical methods widely available to women so that they are not in the situation you are in. Good luck with your decisions, and let me know if I can be of further help.
Doctor Joan

Allexperts.com

Questioner: J
Subject: When should I start birth control after non-surgical abortion
Date Answered: 2010-01-25 AllExperts

Question:
HiDr.Joan,                                                                                                                                                    I had an unwanted pregnancy and chose the non-surgical method of abortion. I took the first round of pills on the 4th of this month and had the second round inserted on the 6th. I had very heavy cramps and bleeding on the first day, and moderate bleeding after that. I went for my check-up and doctors advised me to have the left over blood sucked out to prevent any problems, as I was going out of the country for a week. Following their advise, I had the suction on the 11th. I have had sex since then. The doctors said that I shouldn’t take birth control pills until I have my next period. I’ve been reading the advice you had given to other women in similar circumstances and thought that it is perhaps wrong to wait. My question is, when should I start taking birth control pills? Should I be worried about getting pregnant again? I used condoms, but they tend to be unreliable, judging from my last experience. Since I had the suction on the 11th, I have not started to ovulate, correct? I really need your advice…Thank you for your time Dr. Joan.

 
Answer:
Dear J,
I am so happy you asked this question about when to start birth control after abortion.  I see so many women who wait to start birth control until they get their next period, and then end up getting pregnant again.  I do not agree with your doctor’s advice. It is best to start birth control within the first week of having an abortion.  That way, it is effective immediately.  I do not advise that you wait until your next period starts.  It can be hard to know when your next period starts, because there can be intermittent bleeding or a delayed period after abortion.

For you, determining the risk of pregnancy is a bit confusing.  You had the abortion pill on the 6th, but then had the suction on the 11th.  It’s hard to know if and when you may have ovulated.  If you used condoms, though, you should be fine.  My advice would be to start the pills right away.  Take them as directed.  You may have intermittent bleeding or spotting while you are taking the pills, and your period may not come as expected the week you are off the pills.  No matter what your bleeding pattern, take the pills daily as instructed.

Thanks for your question and I hope this helps,
Doctor Joan
 

Allexperts.com

Questioner: Hillary
Subject: bleeding after the abortion pill, having sex, and birth control
Date Answered: 2010-01-23 AllExperts

Question:
Hi there. I was 5 weeks and 6 days along when I decided to abort using the RU486 Pill. I went to my local clinic on Jan 7th and received the oral pill and the 4 tablets to insert later. I took the pill that afternoon, I was going to insert the pills on the 9th due to my work schedule, but when I got home Friday evening I started to bleed very heavily. I called the clinic and they said that I must have miscarried already, and I should just insert the 4 tablets now since its already happening. I did as they said. I went through alot of pain that night until about 4 in the morning. The next day everything was much better. I went to my follow-up visit on the 14th one week later. They said everything went fine and I was no longer pregnant. At this point I was bleeding pretty light. I asked about birth control methods and decided to go with the Nuva Ring. The doctor there said I could put it in that day. After inserting the ring my bleeding stopped. I had sex on the 18th. The next day I started bleeding again lightly, and now the bleeding has gotten heavy again with clumping. My question after this long drawn out story is….. should I have not had sex, and did that do something. Also should I take the Nuva ring out, is it causing the bleeding to come back? Is it normal that you can go from light to heavy again? Thanks so much for taking your time to answer thanks.

Answer:
Dear Hillary,
Thank you for your excellent question about bleeding after the abortion pill, sex, and birth control. There is no concern with the bleeding you are having.  What you are describing with heavy bleeding at first, going to light bleeding, stopping, and then bleeding heavily again with clots is common and normal after taking the abortion pill.  This kind of irregular bleeding can go on for weeks to months, and does not mean there is any problem.  It can be annoying because you never know when and how much you are going to bleed.  However, it is not harmful in any way, and your periods should come back to normal.  If you are having daily, heavier bleeding for weeks, that is when you should see a doctor.

You did everything right as far as sex and birth control.  As long as you start birth control within a week of having your abortion, it is effective immediately.  So it was fine for you to have sex 4 days after you inserted it.  When you have sex, it stimulates your uterus to contract, and it can expel any blood that is in the uterus.  This is normal and healthy, and of no concern.  It may help to get you back on cycle.  DO NOT take the NuvaRing out.  That is the  most common mistake women make in this situation.  Just take it as directed, and it will also help you get back on cycle and of course prevent another unwanted pregnancy.

I hope you find this helpful,
Doctor Joan
Allexperts.com

Questioner: Sarah
Subject: bleeding and spotting after surgical abortion
Date Answered: 2010-01-22 AllExperts.com

Question:
I had a surgical abortion about three weeks ago.  I’ve stopped bleeding for about a week now, and I was told at the clinic that I would start my period 3 to 4 weeks after the procedure.  I began bleeding yesterday (nothing heavy or strange), and I assumed it was my period.  I’ve started taking birth control pills very recently as well.  Today, I’m not bleeding at all.  Do you think this is a side effect of the birth control, just normal spotting from the abortion, or something else?  I’m not extremely worried, but my period has never been regular (I’ve bled for 3 to 4 weeks straight before, and it’s also not uncommon for me to be 2 weeks late either.), so it’s so hard for me to tell what this could be from.

Answer:
Dear Sarah,
It is common and normal to have irregular bleeding and spotting for weeks to months after a surgical abortion.  It can also be caused by starting birth control pills.  It can also be your usual irregular periods.  There is no way to know.  The most important thing is to remain on the birth control pills, and take them as directed.  This is important so that you are sure to not get pregnant again.  Many women are under the false impression that if they are bleeding they cannot get pregnant.  If the irregular bleeding is from the abortion it should resolve on its own in the next month. If it continues after that, you may ask your doctor to try a different brand of birth control pills.
I hope this is helpful,
Doctor Joan

AllExperts.com

Questioner: Rida
Subject: Multiple abortions in a span of 3 months, what are the risks?
Date Answered: 2010-01-22 AllExperts.com

Question:
Hi Joan, i had an abortion recently, i.e. 2 months back and again my pregnancy test appears to be positive. I am planning to go for abortion again due to personal issues…I have consulted doctor and they saying me not to go for any abortion, because i may face fertility issues for my next pregnancy…please help me on this…

Answer:
Dear Rida,
Thank you for your question about the risks of multiple abortions.  First of all you may not be pregnant.  Sometimes a pregnancy test can remain positive after an abortion for several months.  So, before you do anything, you should confirm that you actually have a second pregnancy. The doctor can do this by either checking an ultrasound, or by checking several blood tests.

If it is confirmed that you are pregnant, there is minimal risk in having a second abortion, or even more.  In some countries, like Russia, women often have more than 5 abortions in their lifetime, and they do not have additional fertility problems.  That said, the safest abortion methods are: 1) Manual Vacuum Aspiration; 2) the Abortion Pill; 3) “suction curettage” abortion.  Both Manual Vacuum Aspiration and the Abortion Pill are endorsed by the World Health organization as the safest abortion methods.  They are considered non-surgical methods. Manual Vacuum Aspiration is a simple gentle method that uses a little handheld device to bring down an early pregnancy.  There is no scraping, no electric machine, and no need for general sedation.  Unfortunately it is hard to find a doctor who offers the Aspiration Procedure.  The abortion pill is more widely available, but not as easy to take.  However it has been shown to have no risk at all for future fertility.  “Suction curettage” is a surgical abortion (electric suction) without the scraping.  If there is no scraping there is minimal risk of scarring, and therefore minimal to no risk for problems with future pregnancies.  So, if the doctor does do a surgical abortion, ask that he does not scrape the uterus.  It is completely unnecessary in early abortion.

I hope this is helpful and a relief to you.
Doctor Joan

Allexperts.com

Question:                                                                                                                                                                                                                                                                                                                                                                    I had an abortion at the end of October for my own personal reasons.  After procedure I bled about 7 days and everything seemed normal.  I started orthotricycline.  End of November I got my period, lasted about 1 week, was normal.  End of December when it was time for my period it started out very dark brown, almost black…with small fibers/clots.  After about 4 days, it turned red and then finished.  Now I started spotting one week early, but its only brown blood.  I am not done with my pill pack till Saturday but I have been bleeding small amounts of brown since last Friday.  I went back to the abortion clinic on Monday and had the doctor check me, on the ultrasound he seen the area where I’m about to shed my period, but another white area that looks like old blood.  He told me to change the birthcontrol at end of this period to LoEstrin 24.  He said he never really seen this problem and isn’t sure why the old blood would be there.  I am very concerned and dont know if I should just go to a gyn and have them look or should I try what he said and wait till next month.  Is this brown/black blood going to hurt me?  I have no infection, smell, irritation or pain.  I’m petrified.

 
 Answer:
Dear Deanna,
There are no concerns about having brown or dark bleeding for months after an abortion.  For the first months it is common and normal, and usually indicates that there is blood in the uterus that does not come down immediately, so it turns brown before it comes out.  Clots are also common and normal, and indicate the same thing – that the blood stayed in the uterus and started to clot before the uterus expelled it. 
 
Dark brown bleeding that continues for more than a few months often indicates something called “retained products.”  Technically, “retained products” is an abortion complication, but I like to think of it as more of a minor problem that can occur after any pregnancy.  Retained products sounds frightening, but it is usually harmless.  Early pregnancy tissue consists of a lining (like a period) that forms around the cavity, called “decidua.” This tissue is thicker than a period and has a firm consistency, and is tan or brown in color.  It is common and normal for some of this tissue to remain in the uterus after any pregnancy (after a full term birth, after a miscarriage, after abortion with the pill and after abortion with a procedure.)  Typically the uterus just expels the small amount of remaining decidua on its own time.  Sometimes the remaining decidua stimulates additional bleeding. 
 
There is usually no problem with having remaining tissue in the uterus.  It does not typically cause infections.  If you do not have a strong odor and a discharge, there is no reason to think you have an infection.  It does not cause problems with future fertility.  Some people with a minimal amount of “old blood” or decidua get significant cramping.  The doctor then recommends that a procedure is repeated to remove it, so that the cramping resolves.  However, in your situation, you are not having cramping, so it is optional to just wait until it passes on its own, or repeat a procedure to bring it down, and resolve the issue of ongoing irregular bleeding.  I usually leave that decision up to the patient – some women find it disturbing, and want it out.  Others are relieved to know that there is nothing to be afraid of, and that there are no consequences to having a little tissue in the uterus and that it will eventually pass on its own. 
 
I hope this is relieving to you.  If you live in New York City, we are happy to repeat an ultrasound and give you a second opinion. 
 
Doctor Joan

Questioner: Tess
Subject: bleeding and spotting after abortion
Date Answered: 2010-01-17 AllExperts.com

Question:
I had a abortion in december, i bled heavy for 2 weeks and then had a lot of spotting throughout the rest of the month at least 6 different times, then all bleeding stopped, now im still waiting on a period mid january. I was just wondering what could be going on? when should I start my period?

Answer:
Dear Tess,
The bleeding you are describing after an abortion at this point sounds normal.  It is common and normal to bleed for the first weeks after an abortion – it can be light spotting, like a period, or heavier than a period. It is also common and normal to have spotting for the next month or so.  It can be difficult to know when your next period will arrive.  I usually tell my patients 3-6 weeks is the typical time period, but I have seen it take longer without any concern.  Just be careful to protect yourself, so that you don’t get pregnant again.  YOU CAN GET PREGNANT WHILE YOU ARE BLEEDING.

However, if this bleeding continues into next month and does not get better, I would call the doctor’s office where you got the procedure and get a follow up visit.  Also, if you start to have cramping or significant pain, or you should be evaluated.  These symptoms, with extended bleeding, can be signs of “retained products” and should be evaluated by your doctor.
I hope this is helpful,

Doctor Joan

AllExperts.com

Questioner: Dani
Subject: Period, bleeding after Aspiration Abortion Procedure
Date Answered: 2010-01-17 AllExperts.com

Question:
I had the aspiration procedure Dec. 10th. I began taking birth control pills on Dec. 13th. I went back for my check up two weeks after the procedure, and the doctor said my body was healing just fine and to expect my period in a couple of weeks. That was Dec. 29th. I finished my first pack of birth control pills then quit taking them because I decided I wasn’t ready to have sex anytime soon. I’m concerned because as of now, January 16th, I still don’t have what I recognize as a period. Should I be alarmed? Last week I had one day of bleeding, but it was very dark and I only used one tampon. For the next two days, I had brown spotting only when I went for my daily run. This occurred after I stopped taking the pills. Does this count as a period? I had no cramping and none of my usual pms symptoms.

Answer:
Dear Dani,
Thank you for your question regarding bleeding after an aspiration abortion procedure. There is nothing to be concerned about.  It is common and normal to have a delayed period after an abortion, as long as you are not pregnant again.  It is also common and normal for birth control pills to cause a change or delay in periods, especially when you first start them.  From what you describe, everything sounds normal.  Your period should come in the next few weeks and may even take another month or two without indicating a problem. Your period may be irregular for the next few months. Don’t worry, it will come back to a normal cycle.

I hope this is helpful,
Doctor Joan

Allexperts.com

Questioner: Leslie
Subject: preventing pregnancy after medical abortion, Plan B
Date Answered: 2010-01-15 AllExperts.com

Question:
my friend just had a medical (pill)abortion one week ago. she started bleeding and everything they told her would happen did and she does not believe she is pregnant anymore. however, she made the decision to have sex with her boyfriend last night (6 days after abortion) and the condom broke. she is wondering what the chances are that she may be pregnant or get pregnant from this incident. and what she should do to take care of it if there is a chance. thank you!

Answer:
Dear Leslie,
Your friend can rest assured that she did not get pregnant one week after a medical abortion.  However, after one week, there is some risk, so she should be careful going forward.  In general, she should know about Plan B emergency contraception.  These are pills that you can take after you have unprotected sex, and they prevent pregnancy.  The sooner you take them the better they work (>90%), but they still have some effectiveness up to 5 days after the incident (around 80%).  In this situation, she doesn’t need to take them given that she should not have been fertile that soon after a medical abortion.  If this would have happened in the second week, however, I would have advised taking Plan B as soon as possible.

For our readers in New York City, we sell Plan B at our Early Options offices for only $20 (it usually sells for $60 in pharmacies).

I hope this is helpful to you and your friend,
Doctor Joan

Allexperts.com