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:
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

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