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

Date Answered: 2009-11-15 13:00:02 on allexperts.com

Question:
I’ve recently taken the abortion pill to terminate a pregnancy. I did see huge clots a few hours after taking the pills but there was little bleeding during the days that followed. I actually saw a doctor to get this done when i was visiting a relative and was unable to follow up after I left. Its only been two weeks and I am still testing positive. However, I do feel a slight cramping or pressure (nothing major) in my lower stomach. I want to know whether it may have failed and if it did, is there a chance that i could get an infection because of it? I tried to see a private ob/gyn in Florida where i live but both that I called said that they are unable to see me because they did not administer it and advised that I go to the local hospital instead. I’m wondering if I should wait to see if the pregnancy hormone will eventually wear off in the coming weeks or just go to the hospital to ensure everything is ok… Also, will they even be able to detect an infection so soon? And are there any signs that I should look out for that may indicate that I have an infection?

Answer:
Dear Lian,
Thank you for your question about bleeding and cramping and possibility of continuing pregnancy after the abortion pill.

You should definitely see a doctor, to make sure that the pregnancy didn’t continue. The failure rate for the abortion pill is 2-5%. You should not wait until the pregnancy hormones decline – it can take up to 1-2 months to have a negative pregnancy test after the abortion pill.  I am disappointed to hear that the doctor would not see you because they did not administer the abortion pills.  If you were in NYC, we would see you right away at our Early Options offices.  Planned Parenthood should see you. You do not really need to go to a hospital.  At a minimum, all you need is a blood test, and depending on the outcome, you may need an ultrasound.  If you can’t find a doctor, you can certainly go to the ER.  You may not get the best care there, as the doctors are typically not very educated about the Abortion Pill.

If the pregnancy did not continue, it sounds like you have “retained products” since you did not bleed as much as expected.  Retained products is simply that some of the tissue lining the uterus did not pass.  Retained products does not cause infection.  Slight cramping and pressure would indicate that your uterus is trying to expel tissue, and does not indicate an infection.

Send me a follow up and let me know what happens,
Doctor Joan