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: I was very relieved to know it rally dosent form till ten wks, my abortion was long sgo. i dont see how it can be invisible to the eye at 7 weeks and then be a pea at 8 wks.  i know this is a stupid worry. i have “ocd” and my brain latches on.  i will never know how pregnant i was ,because i had a short period before i missed my period.  the woman who performed my sonogram said I was about 8 wks. i didnt see anything.  this was way back in 1977.  are the sonograms they show now at 8 wks the real size.  somehow i have less guilt knowing i was earlier and it wasnt formed.

Dear Michelle,
There is much misinformation regarding the size of an embryo on the internet, mostly motivated by politics, not medicine.  
At our offices, we offer to show women the tissue after ending an early pregnancy because it usually helps avoid the feelings you are still having.  I can tell you that when I look at the tissue that comes out with an early abortion I have never seen an embryo at 8 weeks of pregnancy.  At that stage the only tissue that is identifiable is a small gestational sac (about the size of a grape), which later becomes the amniotic sac.  It is a thin membrane that looks a bit like a small cotton ball.  On tissue exam, we see the beginnings of an embryo between 9 and 10 weeks of pregnancy. 
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: Dear Doctor Joan,

I recently had a surgical abortion three days ago. The clinic I went to (Woman’s Health Practice- Champaign Illinois) are treating me like I am fine. I had hardly no bleeding after the operation. They did not check on me in recovery nor check on my vitals. They never told me they retrieved the pregnancy or not as well. The doctor didn’t talk to me, she came in did the proceedure and left. I do have some discharge and painful cramps that come and go.

My concern is that they were unable to terminate the pregnancy. Or that something health wise is wrong with me. Also, I understand I cannot take an at home pregnancy test until two weeks for it may show up “pregnant” because the HGC Levels are still in my system up to two months after the abortion. That this will add more stress onto myself and my significant other.

I am a full time student and work full time as well. Summer classes just began and I am also leaving in 12 days to head to California. I would like to confirm that the proceedure went through okay and that the pregnancy was terminated. And that I am healthy.

What is your advice on this situation as to what I should do?

Thanks for all of your help!

Sincerely & Respectfully your,

J.

Dear Jeannette,
Thank you for your question about follow up after an abortion procedure.  I never like to hear these kinds of stories.  Your doctor should have discussed your procedure with you and explained to you what you should expect.  However, from what you tell me, there is nothing to be concerned about.  Minimal cramping that comes and goes responds to ibuprofin (800 mg) is normal.  If it keeps getting worse, is persistent, or does not respond to ibuprofen, you should see the doctor.  The bleeding you describe also sounds normal.  It is common to have minimal or no bleeding after a procedure.  Don’t be alarmed if the bleeding starts again in a few days.  Sometimes it comes and goes throughout the month.
 
I understand that you are concerned that the pregnancy was not terminated.  There are three ways to confirm this.  1) the clinic either evaluated the tissue on site or sent it to a lab.  This tissue documents that the pregnancy was terminated. You could call the clinic to find out those results.  The nurse should give this to you over the phone. 2) If you had pregnancy symptoms before the procedure, they should be going away by now.  Nausea typically starts to decrease within days.  This is usually very accurate.  3) You can get 2 blood tests, at least 48 hours apart.  You could do this at any doctor’s office.  They would check a “quantitative hCG” and compare the level to the second blood test 48 hours later.  The hormone level should be declining.
 
The easiest option would obviously be for the clinic to give you the results.  I hope they are accomodating to you so that you can be reassured before your trip.
 
I hope this is helpful,
Doctor Joan

Question: Hi – I was 9 weeks along when I got a surgical abortion 4 days ago. I had cramps and little bleeding right after the abortion that same day for about a half hour. I have not bled AT ALL since the day of the abortion nor have I had any cramping. I have only had a bit of white/yellowish discharge. Should I be concerned? Or is this normal?

Dear Jo,
It is normal to have minimal or no bleeding after a surgical abortion.  There is nothing to be concerned about.  Don’t be alarmed if if you get some bleeding and cramping again within weeks of the abortion procedure.  Sometimes it takes some time for the uterus to contract and when it does, it may expel some blood, clots, or tissue.  White or yellowish discharge without an itch or an odor is common and normal.  If you are concerned about a sexually transmitted disease and they did not test you for it during your procedure, you may want to get tested for chlamydia.  Chlamydia is a common sexually transmitted infection that can have no symptoms, or a white or yellow odorless discharge.  There is more information on vaginal discharge after abortion on our website.
I hope this is helpful,
Doctor Joan

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:
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:
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