Question #1:

I had surgical abortion in 6 pregnancy week it was 3 weeks ago after that I had no bleeding at all, from last week have just brown discharge. The pregnancy test is still very strong positive.  After ultrasound the doctor told me that there was a small amount of remaining tissue that would come out with my period.  I’m afraid, because I had unprotected sex with my boyfriend since then, and I’m wondering if I could have a new pregnancy.   How do I check?  Is it too early for another scan?

Answer: You should see a doctor.  After six weeks, you should not have a strong pregnancy test after an early surgical abortion. 

Question #2:

I had the abortion pill over 6 weeks ago.  I was six weeks pregnant.   My pregnancy test is still positive.  Could I still be pregnant? 

Answer:  It is important that you see the doctor.  A pregnancy test staying positive for six weeks if you only had a six week pregnancy is not normal. 

More information:

A positive pregnancy test after an abortion is confusing.  It can either be: 1) normal; 2) a continuing pregnancy (abortion was not successful); 3) retained products (incomplete abortion); or 4) a new pregnancy. 

Pregnancy tests can stay positive for a few weeks after a surgical abortion or aspiration procedure.  If the pregnancy was less than 9 weeks pregnant, typically, a pregnancy test will become negative (or faint positive) in 2-3 weeks.  In the case of the abortion pill, it can stay positive for over a month. 

The most simple test is to check a pregnancy test now.  Save it, and compare it to another test one week from now.  Make sure to get the pregnancy tests that have two lines.  See if the line is the same, lighter, or darker.  If it is lighter it  is likely normal.  If it is darker, you need to see a doctor.  You may either have a new pregnancy, or the abortion was not successful.  If it is the same, it may be normal, or you may have “retained tissue.”  This is not necessarily a problem and usually resolves on its own, unless you are having bad cramping, passing clots, or having an unusual odor. 

The other option is to go to the doctor.  They  will check a blood test.  The doctor would check the blood test for “quantitative hCG” and then check it again at least 48 hours later to see if the levels are going up or going down.  If the doctor is concerned, they would also repeat an ultrasound scan. 

I hope this is helpful.

Doctor Joan

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The abortion pill is a common name for a combination of pills used to terminate early pregnancy.  The first medication is Mifepristone (other names are Mifeprex®, or RU486).  Mifepristone blocks the hormones of pregnancy, and causes the pregnancy to start to detach from the uterus.  The second medication is Misoprostol or Cytotec®.  Misoprostol causes the uterus to contract and the cervix to dilate.  This causes the pregnancy lining to be expelled.  

The abortion pill can be used to nine weeks of pregnancy. 

I hope this is helpful,

Dr. Joan

Question: Hi Dr.Joan:

   I had abortion (D&C) in late August, and I didn’t bleed for 3 days because I was on meds/fluid. However, I started bleeding lightly after, and now I am still spotting after 4 weeks. My blood pattern can be described as light pink/red, then turns into brown. Same thing repeated a few times already. I believe my discharge has odor smells (more like medication smells) and I also discharge light thin tissues. I have no pains or any symptoms, my ultrasound came out fine few days after abortion.
   My doctor thinks that I am having an infection, so she prescribed me antibiotics. I’m not sure if I should wait for another two weeks to see if I stop bleeding, or I should take the antibiotics for a week  and see if it works.
   Also, I was told that I have cervical erosion after abortion. I was told to not worry about it, just make sure it doesn’t go worse. Is it caused by pregnancy/abortion procedure?
   I am also afraid of having intercourse for another 2 months, even I was told that as soon as stop bleeding, am I correct?
Thank you so much
best, L

Dear L,

I will try to answer your questions as best as I can, without all of the medical information from your chart or from an examination. 

1) Typically discharge with an odor after an abortion is a normal overgrowth of bacteria called “bacterial vaginosis” and is usually treated with Flagyl or a vaginal cream such as metrogel or cleocin.  It is typically not something to worry about – it is just an overgrowth of normal bacteria.  This type of bacteria has a funny smell.  Bacterial vaginosis can happen normally, like a yeast infection.  Pregnancy predisposes you to either bacterial vaginosis or yeast because of a change of pH balance of the vagina from the hormonal shift. 

That said, sometimes a bad odor after an abortion can indicate that there is tissue that hasn’t passed.  If the odor doesn’t respond to antibiotics, you should have another examination and ultrasound.  There is no need to wait until you have stopped bleeding to start antibiotics.

2) Cervical erosion – I’m not sure what this means without doing an examination.  This is not likely to be caused by pregnancy or abortion.  It would be best for you to follow up with your primary care doctor or gynecologist after you have stopped bleeding to get an evaluation and pap test.

3) Sex after abortion.  There is no medical reason to wait to have sex until you have stopped bleeding, as long as you are protected against getting pregnant again.  In fact, sex helps your uterus to contract and expel any remaining blood or tissue from the procedure.  So, don’t be alarmed if you bleed a little heavier after sex or pass a clot.  That would be normal and healthy. 

There is more information about common issues after abortion on our main website.

I hope this is helpful to you,

Dr. Joan

The Aspiration Procedure is the most quick safe and simple method to remove early pregnancy tissue from the uterus.  It can be used for treatment of miscarriage, early abortion, or incomplete abortion.  The procedure is completed with a handheld manual vacuum device that gently and naturally releases early pregnancy tissue from the wall of the uterus.  It takes a few minutes longer to complete than a pap test.   The Aspiration procedure does not utilize scraping, metal instruments, electric suction, or general sedation, thus avoiding all major complications of D&C surgical procedures.  It can be done in a regular examination room, and avoids the frightening experience of an operating room and recovery room.  There is no trauma, so most women leave the office able to resume their normal activities.  Pregnancy symptoms start to resolve within hours. 

The World Health Organization advocates for the use of manual aspiration for early abortion, and does not recommend surgical D&C procedures. 

Despite all of these advantages – why is it so impossible to find a doctor who offers it?  Why have you never heard of it?

The short answer: The aspiration procedure is a non surgical procedure, and women’s health is mainly in the hands of OB/Gyn specialists, who are surgeons and prefer surgical procedures. 

The long answer:  Abortion has been provided in clinic settings since the 1970′s, when it was legalized.  Because of its controversiality, abortion services were established in segregated settings, and not included in mainstream medicine.  This means that for three decades (the 70′s to the 90′s), abortion was not offered as part of most standard residency training programs except for the occasional D&C procedure completed in an operating room setting.  Abortions were done in separate facilities without an academic affiliation, and these facilities usually were privately owned and operated. 

It is only in the past decade that grant funded efforts created training opportunities for doctors to go to abortion clinics to learn how to offer outpatient abortion procedures.

Most abortion clinics operate on a “surgical” model of care – meaning that the procedure itself is the “center” of the visit.  Patients are “prepped” for the operating room.  They move station to station and get their vitals, their blood drawn, their ultrasound, their counseling and consents, and then wait in line to go into the operating room.  The surgeon sees them in the operating room for a few minutes prior to the procedure.  They are then moved to a recovery room.

For decades, this system has been completed in an efficient manner, allowing surgeons to complete a high volume of procedures in a small amount of time.  Some clinics now say they are offering the aspiration procedure  – but they are providing it incorrectly.  They are simply replacing an electric vacuum pump with the manual device,with the same surgical model of care.  This does not offer women the full benefits of the aspiration procedure. 

At Early Options® we have created a primary care approach to treating miscarriage and early abortion.  The patient has a scheduled visit with the doctor.  She sits down and talks to the doctor with her clothes on.  All care is conducted in a regular examination room.  The doctor completes the ultrasound, and the aspiration procedure is completed in minutes, like a pap test.  There is immediate recovery in the same examination room. 

If abortion clinics were to adopt this primary care based model of care, everything would have to change: different doctors, different examination rooms, different staffing, different scheduling, different malpractice.  These kinds of changes would take a serious investment to complete.  In the mean time, since there are so few doctors who provide the aspiration procedure correctly, women haven’t been informed of the most safe and simple way to end early pregnancy.

I received a call yesterday from a woman who was extremely upset.  Her pregnancy had failed at 11 weeks.  She had started to bleed, and then went to the doctor and had an ultrasound.  The pregnancy had stopped growing.  She was having a miscarriage. It was devastating.  She had of course told all of her family and friends, and had already started planning for her baby. 

On top of this, while waiting to schedule a D&C procedure in a hospital operating room, she started to pass the pregnancy “naturally” and went through heavy cramping and bleeding for days.  She missed work, and stayed home, needing to stay near her bathroom at all times.  After the heavy bleeding passed, she went for an evaluation only to find out that there was still some remaining tissue in the uterus. 

Unfortunately, I hear this story all too often.  Most women don’t know that there is a quick safe and simple solution to treat early miscarriage.  The Aspiration procedure is a non surgical option that can be completed in a regular doctor’s examination room.  It takes a few minutes longer than a pap test.  The doctor inserts a speculum, and then inserts a thin, smooth, flexible tube through the natural opening of the cervix.  She then attaches a small handheld device.  The device provides a gentle suction that naturally releases the early pregnancy tissue.  It takes a few minutes to complete.

The advantage of the aspiration procedure over a D&C is that there is no electric suction, no scraping, no metal instruments, and no need for general sedation.  It’s completed in a regular doctor’s examination room, avoiding a frightening operating room in a hospital setting.  It’s not surgery, so you can eat and drink normally before and after the procedure, and when you leave the office you feel normal.  Pregnancy symptoms start to resolve within hours. 

Unfortunately, women are routinely offered to either “watch and wait” for the pregnancy to pass or to schedule a surgical D&C abortion.  The aspiration procedure has advantages over both approaches.  It is the most quick, safe, and simple treatment of miscarriage under 12 weeks.  Because it is non surgical, you don’t need to wait until your uterus heals.  You can start trying again right away.

I had a patient come to my office last week for an early abortion.  She was clear in her decision to end her pregnancy, but scared to actually get an abortion.  She was relieved when she came across the Early Options website and learned about the aspiration procedure.  She felt confident that the Aspiration Procedure was the best early abortion method.  It was quick, safe and simple, and could be completed in a regular doctor’s office.  She then started doing more research and called different abortion clinics in New York City to compare prices. 

Some clinics said they offered the aspiration procedure.  But, when she asked more questions, she discovered that the clinics did the aspiration procedure in an operating room, and she was told not to eat or drink from the night before.  She asked if they scraped the uterus, and the person on the phone said she didn’t know the answer.  She asked if her husband could come into the room with her, and she was told that he would need to stay in the waiting room. 

Unfortunately, these clinics are not doing the aspiration procedure the right way.  The advantage of the aspiration procedure is that there is no scraping, no metal instruments, no electric suction, and no sedation.  This avoids the complications of a surgical D&C procedure.  At Early Options, the aspiration procedure is completed in a regular doctor’s examination room, not a scary operating room.  You can eat or drink normally before and after your procedure. It is a personalized experience, and you can have a companion be by your side. There is immediate recovery and you leave the office feeling ready to resume your normal activities.

Why are some abortion clinics saying they are doing the aspiration procedure when they are clearly not offering it in the right way?  Abortion clinics don’t offer personalized care.  They do not specialize in early procedures.  They are concerned with efficiency, not quality of care. 

This patient was happy that she spent a few hundred dollars more to come to Early Options®.  She left the office knowing that her abortion was completed in the most safe and natural way.  She felt good about her decision and her medical experience.

Questioner: Kimber
Subject: What is early abortion?

Question:
Just wondering what you would consider an early abortion? My friend wants some information.

Answer:
Dear Kimber,
Thank you for your question about early abortion.  Typically, early abortion is defined as under 10 weeks of pregnancy, although first trimester abortion (up to 12 weeks) is sometimes also called early abortion.  Under 10 weeks of pregnancy, there is no visible embryo.  The pregnancy consists of decidua (a thick tissue lining that forms around the inside cavity of the uterus) and a fluid filled “gestational sac”.  Inside the sac are cells that would later form the embryo.  In addition, an early pregnancy can be ended with simple nonsurgical methods of pregnancy termination.  These include the abortion pill (under 9 weeks) and Manual Vacuum Aspiration (best used under 10 weeks, but can be used to 12 weeks).  These methods are safer and simpler than surgical abortion since they do not involve scraping of the uterus, or general anesthesia.  In early abortion where the pregnancy is not yet formed and because the methods are simple, many women do not have the same emotional conflicts and physical difficulties that they would have if they completed a surgical procedure.

The most informative sites on early abortion are: http://www.earlyabortion.com and http://www.earlyabortionoptions.com.  If your friend is fortunate enough to live near New York City, our offices specialize in early abortion services.

I hope this is helpful,
Doctor Joan

Early Abortion Specialist
New York City

Name: Renamae

Question: What are the most natural methods of abortion?

Dear Renamae,
Thank you for your question about natural methods of abortion and herbal abortion.  Our website has a page devoted to natural abortion that I think you will find helpful.  The best website for the specific herbal regiment to use is sisterzeus.com.

 
There is significant misunderstanding about “natural” methods of abortion.  In my opinion, the Aspiration Procedure is the best abortion method because it is simple and nearly 100% effective, even though it is a medical procedure and it needs to be done by a medical professional.  The Aspiration Procedure takes a few minutes.  The doctor inserts a thin straw or cannula through the natural opening of the cervix and attaches a handheld syringe.  Gentle pressure is applied, and the contents of the uterus are expelled without any scraping, electric suction or general sedation.  It is considered nonsurgical because it does not interrupt the cervix of the wall of the uterus.  It simply removes the endometrial lining, which sheds normally with the monthly period.  Unfortunately it can be difficult to find a doctor who offers Aspiration Procedure.  If you can get to New York City, our offices specialize in this approach. 
 
I am also an advocate of the abortion pill, over herbal abortion.  The abortion pill is almost 99% effective whereas herbal abortion is about 50% effective.  The medications used in the abortion pill are safe and are only in the system for days. 
 
I see many women who have tried herbs and they have failed.  They come to me needing to complete the abortion.  They report to me that they experienced significant pain and cramping.  Some even have heavy bleeding but still do not pass the pregnancy.
 
In my experience, making the decision is hard enough.  I have seen women be traumatized by the experience of trying to end it and having that fail.  They tend to blame themselves for the decision.  It is hard to have to go through that decision a second time. 
 
I hope this is helpful to you,
Doctor Joan

As I peruse the latest blogs related to abortion, I see the abortion debate that I see in the news:  extreme views and divisiveness.  As an abortion provider, I see a very different view of abortion: healthy human conflictedness.  If you believed what you saw in the media, you would perceive two rigid camps of people.  Whichever camp you are in, the other group has horns.  People are set in their views and aren’t open to listening to the “other side.”

As an abortion provider for the past 15 years, I find the day to day work in abortion care to be a more complex world.    Of course there are people set in their views.  But mostly, I see people being conflicted.  People are dealing with the experience of being in a position they never wanted to be in, and are having to make some difficult decisions.  I have seen women from all across the spectrum:  anti-choice advocates who need to end a pregnancy for themself, or with their daughter;  pro-choice advocates who find that they feel more conflicted about ending a pregnancy than they would have expected.   I have worked with doctors who are strong defenders of the right to have an abortion, who find it difficult to provide abortions once an embryo can be identified.  I have worked with people who felt one way yesterday, and another way today. 

It is hard to have healthy conflict when the world is filled with “right” and “wrong.”  For if we look at each other as human beings with different backgrounds, different politics, and different ways of seeing the world, we have to come to some agreement on how to proceed.  I see families with widely divergent views on the “right” answer, come to some agreement on how to make a decision and remain a family.  I believe it is important to create new kinds of conversation with each other as part of this process.  I hope that this blog, where we can talk about real life situations, can contribute to that conversation.

There are many misconceptions – both favorable and unfavorable - about the Abortion Pill.  Some women assume that taking a pill to end a pregnancy will be considerably easier than having a procedure.  They think that the Abortion Pill will simply bring on their late period, maybe with some tolerable cramping.  On the other side, women have heard horror stories about the Abortion Pill, and are frightened by stories of uncontrolled bleeding, and intolerable cramping.

What’s accurate?  The simple answer: both sides of the story. 

I’ve been providing the Abortion Pill for almost a decade.  I was one of the original researchers of the Abortion Pill before the FDA approved its use in the United States.   I have seen a wide range of experiences with the Abortion Pill.  I thought it might be helpful to share a doctor’s perspective on realistic expectations.  Also, many women do not know of their other nonsurgical option – the Aspiration Procedure.  This simple gentle procedure has many advantages over both the Abortion Pill, and surgical abortion.  It’s important to compare all of these options.

Most women who take the Abortion Pill have a positive experience with it.  Studies indicate the 90% of those who take the Abortion Pill would choose it again, or recommend it to a friend.  In my experience, it is most important to prepare patients for what their experience will be, and equip them with strong pain medications, anti-nausea medication, and explicit directions on how to take these medications.   With proper preparation and premedication with pain medicines, most women will have a positive experience of the Abortion Pill, and appreciate the ability to induce an early miscarriage  in their own home. 

That said, about 10-20% of women will have a terrible experience, no matter what pain medicines they are given.  We instruct women to take 800 mg of ibuprofen and an anti-nausea medication at the same time they take the misoprostol tablets.  Then, at the first sign of cramping, we instruct them to take acetaminophen with codeine.  It’s important to take this early, before the cramps build, in order for the medications to be most effective. 

Most women who take their medications this way will have a positive experience with the Abortion Pill.  They will experience 1-2 hours of strong period-like cramps, and describe the process as tolerable.  Women who choose the Abortion Pill appreciate being able to be at home, often with their husband or companion.  They often appreciate feeling like the pregnancy passes “naturally,” like a miscarriage, rather than with a procedure.

Most of our patients do well on this protocol.  A minority of women, however, do not.  They experience extreme cramping, sometimes for hours, with no relief.  I often get phone calls from desparate friends and partners, who don’t know what to do, as I hear my patient screaming in pain in the background.  Unfortunately, there is little to do at this stage aside from applying heat and lying on one side in with legs to the chest – and wait for the pain to pass.  I reassure them that they definitely will get better. 

And the bleeding?  A similar story.  Most women find it tolerable – they bleed heavier on the first day, and then it becomes more like a period that comes and goes for 1-3 weeks.  However, 50% of women bleed longer than 6 weeks.  The bleeding typically is intermittent, and more annoying than upsetting – as soon as you think it’s over, you start to bleed again.  In ten years of providing the Abortion Pill I have never seen anyone hemorrhage on the first day of the miscarriage – and this is consistent with national results.   Problems with bleeding occur later. Women who have needed transfusions (less than 1/400) have been women with lengthy bleeding who did not get proper follow up.  If a patient is having extended bleeding, it can be treated with a procedure – preferably the nonsurgical Aspiration procedure, or a surgical procedure – and a transfusion should be avoided.

Personally, I highly recommend the Aspiration Procedure over the Abortion Pill.  This nonsurgical procedure can be completed in minutes, and is noninvasive – it does not involve scraping, electric suction, or general sedation.  It has a higher success rate (>99%) than medical abortion (95-98%).  It only requires one visit to the doctor, rather than two.  There is immediate recovery.  Most women have never heard of the Aspiration Procedure.  In my office when women discover the advantages of this simple gentle procedure, very few choose the Abortion Pill.  Those who do choose the Abortion Pill over the Aspiration procedure  typically want to have a private experience in their own home, or have unusually strong aversions to doctors and medical procedures. 

Unfortunately, most women do not have access to the Aspiration Procedure.  In this situation, I would recommend the Abortion Pill as a sound nonsurgical option.