Question: I have have a medical abortion (the pills) about 3 – 4 weeks ago.  I am due for my follow up visit now but I am very concerned because I am having a light brown’ish smelly discharge for the last three days, its quite alot aswell, I have had to wear a sanitary pad yesterday and today.  When I had the procedure I bled quite heavily and experienced alot of pain which i took ibuprofen for.  It then started decreasing and i bled on and off for 2 weeks and then it pretty much stopped for a while (about 4-5 days) and now i am having this discharge, it has a slightly sour and foul smell.

I am thinking that i need to go to my doctor but i want to first get more information before i put myself through any unnessesary trauma.  Do you think i should consult my doctor and what could possibly be wrong?

i havent had any further pain, slight cramping when the discharge started but very light cramps and now no pain at all.

Dear Kate,
 
Thank you for your question about discharge after a  medical abortion.  A discharge with a funny odor after a medical or a surgical abortion indicates a harmless infection with a bacteria (not a sexually transmitted infection).  When you see the doctor, they should do an examination to make sure there is no residual tissue in your cervix.  It’s unlikely that you have tissue in your cervix, because this usually causes significant pain and cramping. 
 
The usual name for this discharge is bacterial vaginosis and it can be treated with antibiotics.  Typically, an antibiotic called Flagyl (or metronidazole) is prescribed for this, and it works very well.  Most importantly, there is nothing to worry about.  While this type of discharge can be disturbing because of the strong odor, it is common and normal. The infection is just an overgrowth of normal bacteria, and does not cause any problems now or in the future.
 
I hope this is helpful,
Doctor Joan

Question: What are a natural methods of abortion?
What are the herbal to use?

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

Question: I HAD A MEDICAL ABORTION THAT FAILED NOW I HAVE TO HAVE THE ASPIRATION WHEN IS THE EARLIEST THAT I CAN HAVE SEX AGAIN

Dear Erica,
I assume from your email that you had a medical abortion and the pregnancy did not pass, and that at this time you are waiting to get a procedure to complete the pregnancy termination.  If I’m correct, there is no reason that you can’t have sex now, until you get the Aspiration Procedure.  When you get the Aspiration Procedure, you should ask how long you should wait until you have sex.  At our office where we do not scrape the uterus, we advise that you wait 24 hours after the procedure before having sex. 
I hope this is helpful,
Doctor Joan

Question: Hi, I had an early medical abortion 5 days ago. It went as anticipated, and I took pain relief which worked well. However, 5 days later and on my return to work I was doubled up with bad abdominal cramps. I am concerned as I thought the cramps would have subsided by now. Paracetamol have helped, but I didn’t expect bad cramping at this stage. I have an appt at the doctor tonight. Do you think this is cause for concern? I don’t have a temperature or any other worrying symptoms, just bad pains.

Dear Crampy,
It is not normal to have significant abdominal pain days after a medical abortion.  As you described, it is normal to have pain the day that you take the second medication (misoprostol).  However, that pain should subside within 24 hours.  Cramping that recurs days after a medical abortion is suspicious for a clot that might be “lodged” in the opening of your cervix.  Many doctors miss this on follow up because they do not have enough experience with medical abortion to know to check for this.  Make sure your doctor does a standard pelvic exam and looks at your cervix.  They can also identify a clot if they look carefully at your cervix on ultrasound.  Other causes for cramping can be an incomplete abortion, where your uterus is contracting to expel additional tissue that didn’t pass on the first day. 
 
There is nothing to be afraid of with having a clot in your cervix, or an incomplete medical abortion. The worst that can happen is that you may need to get a quick procedure.  The doctor may need to evaluate your cervix with a speculum.  Often, they can just tug on the tissue with a small forceps and remove the clot.  Occasionally they will need to do an abortion procedure if they cannot remove it.  If you have an incomplete abortion, you may need to repeat the misoprostol a second time.  It does not sound like there is any reason to suspect an infection, from what you describe.  However, the doctor should also make sure you do not have signs of an infection.
 
Good luck with your visit, and let me know what happens.
Doctor Joan

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

Question:
i m shagufta.my last l.m.p was 21 april 2010, i chk and pregnancy report was positive. doctor gave me the medicine and on 13 the april my bleedind stats it was fr 3 days. after 2 days i was suffering frm belching. i retest on 3 jun 2010 the report wis positive. i dnt want to be pregnanat. pls suggest me. my email id-

Answer:
Dear Shagufta,
Thank you for your question. There are three possibilities of having a positive pregnancy test 6 weeks after a medical abortion.  One, you may still be pregnant.  Two, that you have a new pregnancy.  The other, that there is some tissue remaining in the uterus that is remaining from the pregnancy but that it is not viable.   The only way to know which situation you are in would be to see a doctor.  They can either do an ultrasound or check blood tests to see if you are still pregnant.  If you are pregnant, the only option would be to end it in whatever way is best in your country.  If it is just remaining tissue you don’t need to do anything.  It will likely pass on its own.
There is more information on the question of having a positive pregnancy test after abortion at: http://www.earlyabortionoptions.com

I hope this is helpful,
Doctor Joan

Question:
Hello,

On March 31, 2010 I had a medical abortion (I was only six weeks along).  I bled a lot, as expected, and then a month after I had my first period.. On April 28, 2010 to be exact.  I was then supposed to go follow up with the clinic to make sure the abortion worked correct because they said there was a small chance of “the baby not being completely out”.  Well, I didn’t go to the follow up appointment because I strongly felt that I could be pregnant again and couldn’t go through with another abortion.  So, I took a pregnancy test which said negative.. I took another one a week ago that came up positive, and another since then that showed postitive.

I scheduled an appointment with my OBGYN but, they will not answer my question until next week when I go in.  I am wondering if getting pregnant that soon can harm this baby?  I am worried because I never went to the check up that there could be something wrong?

Any outlook or answers on this would help.  Thanks.

Crystal

Answer:
Dear Crystal,
Thank you for your question regarding pregnancy after medical abortion.  There are three possibilities.  Most likely the pregnancy test was accurately negative, and you had a successful medical abortion.  This would indicate that you have a new pregnancy.  The other possibility is that the first test was not accurate, and you have tissue remaining from the first pregnancy.  The third possibility is that the medical abortion was unsuccessful and you have a continuing pregnancy.  This is very unlikely given that you had significant bleeding after taking the pill.

There is only one way to know for sure – and that is to go to a doctor and either get an ultrasound or a set of two blood tests (at least 48 hours apart) to see if your pregnancy hormones are increasing or decreasing.  You can find more information on pregnancy after abortion on my website: http://www.earlyabortionoptions.com.

If it turns out that you are pregnant again, there is no problem with either continuing or ending the pregnancy.  There are no additional risks in carrying a pregnancy immediately after a medical abortion.  There are no additional risks of having a second abortion immediately after a medical abortion.
I hope this is helpful,
Doctor Joan
New York City

Question:
I am 31 and have had 3 abortions and 1 ectopic pregnancy.  The ectopic pregnancy and 1 of the abortions happen within a year.  Now I believe I’m pregnant but can not keep it for many reasons.  But at the same time I want to because I don’t want to lose the chance of being a mom.
The question. . . would I be putting myself in grave danger if I had another abortion? and what contraceptives should I consider?  Thank you so much, grown and confused.

Answer:
Dear Me,
Thank you for your question on whether abortion can cause problems with future fertility.  The risk that an abortion will cause infertility is extremely low.  Surgical D&C procedures in rare instances can cause Asherman’s syndrome.  This syndrome is caused by aggressive scraping of the lining of the uterus during a procedure.  Typically women who have Asherman’s syndrome will no longer have a menstrual period or will have very light periods after an abortion.

There are two early abortion methods that are nonsurgical and do not utilize scraping of the uterus and thus avoid the possibility of Asherman’s syndrome. These methods include the abortion pill and the Manual Vacuum Aspiration procedure, also known as Aspiration Abortion.  You also can request a surgical abortion without the scraping.  Scraping is completely unnecessary for early pregnancy (under 12 weeks).  A surgical abortion without scraping is sometimes called a “suction curettage.” I am not aware of any studies that compare rates of Asherman’s syndrome with suction curettage vs. a surgical abortion with scraping.

There is no reason to think that you have any current problems with fertility from your prior abortions since you were able to get pregnant again and you didn’t mention any menstrual problems.  There is so little risk from surgical abortion, in my opinion you would be safe to get another one.  However, if you want to be absolutely sure that you don’t have problems, I would recommend that you try to find a doctor who offers nonsurgical early abortion methods.  The best source for these doctors is at http://www.earlyabortion.com.  If you are near New York City our offices specialize in these nonsurgical methods: http://www.earlyabortionoptions.com.  There is also more information on this site about health risks of abortion. You may also try gynpages.com and look at the categories of “early abortion” or “medical abortion.”

I hope this is helpful,
Doctor Joan
New York City

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

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