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

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

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

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

Question:
I had a surgical abortion 2mths ago, and was given antibiotics to prevent an infection. I took this for the prescribed 7 days whilst starting to take the pill again to prevent any further unplanned pregnancys. I had unprotected sex 3 weeks after the abortion and I had a light period that started the next day. This is now the following month I havent had unprotected sex since but my periods late. Is it possible Im pregnant?

Answer:
Dear Mia,
There may be several reasons for a delayed period after a surgical abortion.  From what I can tell, you started on birth control pills within a week of the surgical abortion.   Birth control pills started within a week of an abortion should be effective immediately, and you should not have gotten pregnant when you had unprotected sex two weeks later.  That said, it is possible.  The easiest thing to do would be to check a urine pregnancy test.  By now it should come out negative from the initial pregnancy.

The more likely reasons for a delayed period are 1) that it is common and normal to have missed or delayed periods after abortion.  I’ve seen it take up to 3 months.  2) Birth control pills often cause a missed or delayed period, especially after an abortion.  As long as your pregnancy test turns out negative, there is nothing to worry about, and your period should come back to normal.

I hope this is helpful,
Doctor Joan

You can now get Plan B without a prescription from a pharmacy in the United States.  However, it can be expensive. Here are ways you can get inexpensive Plan B.

1) Discounted Plan B
If you live in New York City, you can get Plan B for $20 at an Early Options™ center. You can get discounted Plan B at their convenient offices in Manhattan and in Brooklyn. Also, if the Plan B doesn’t work, Early Options has the most advanced medical services to end early pregnancy.

2) Do you know you can make your own Plan B?
If you have an extra pack of birth control pills, you can make your own Plan B. Below are instructions on how to make it yourself.

Emergency Contraception in United States of America
Dedicated Products / Progestin Only

Take 2 pills within 120 hours after unprotected sex:
Plan B (available over the counter)
More information: got2planb.com

Dedicated Products / Progestin-Estrogen Combined
Take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later:
Alesse

Oral Contraceptives used for EC / Progestin-Estrogen Combined
Note: in 28-day packs, only the first 21 pills can be used
Take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later:
Ogestrel
Ovral

Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:
Cryselle
Jolessa
Levlen
Levora
Lo/Ovral
Low-Ogestrel
Nordette
Portia
Quasense
Seasonale
Seasonique

Take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later:
Aviane
Lessina
Levlite
Lutera

Take 6 pills within 120 hours after unprotected sex and take 6 more pills 12 hours later:
Lybrel

Our country-by-country information comes primarily from the 2002 Directory of Hormonal Contraceptives, published by International Planned Parenthood Federation (IPPF). We have supplemented their list with reports from the field and welcome additions and/or corrections.
This information was reproduced from: ec.princeton.edu/countryquery.asp.