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

Question:
Hello Mam
i stay in india,i m 24yrs old.i did a abortion by misoprostol. at that time i was 2-3 weeks pregnent.till dat day evening i had a heavy blood loss,clots were also there but not that much pain but afterwards its normal & almost very less till friday,6th mar afternoon.suddenly in the afternoon i started bleeding again ,i have to change my pad after every 5-6hrs & there is lot of pain in my lower abdomen,lower back & right thigh.i m feeling very weak since then…very scared why it started again bleeding?can i take any medicine for pain? for how much tym this bleeding will continue??my mom is asking me why my periods havent stopped yet, what would i answer to her??also my waist n breast size has incresed within 2-3 days,is this the side effect of this medicine?please help me,i m very tensed..

Answer:
Dear Preet,
The second round of bleeding and cramping that you are experiencing is common and normal after taking the abortion pill.  You should take ibuprofen/motrin/advil 800 mg every 6 hours and see if that helps you.  The pain you are experiencing is that the abortion was not complete, so more tissue, blood and clots are trying to come out.  The cramping is simply your uterus trying to push it out – and that is a good thing – nothing to be afraid of.  Other things you can do to help this – take a warm bath and massage your lower abdomen, exercise, and believe it or not – sex.  Sex helps the uterus to contract and push out the tissue.  If the pain is not better in 48 hours, you should see a doctor.  This would likely mean that the tissue is stuck in your cervix and needs to be pulled out, usually with a very simple procedure.  You do not need to tell the doctor you took the pills – he can just assume you are having a natural miscarriage.  And you can tell your mom that you are having a heavy period.

I hope this is helpful,
Doctor Joan