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

Question:
I had a surgical abortion about three weeks ago.  I’ve stopped bleeding for about a week now, and I was told at the clinic that I would start my period 3 to 4 weeks after the procedure.  I began bleeding yesterday (nothing heavy or strange), and I assumed it was my period.  I’ve started taking birth control pills very recently as well.  Today, I’m not bleeding at all.  Do you think this is a side effect of the birth control, just normal spotting from the abortion, or something else?  I’m not extremely worried, but my period has never been regular (I’ve bled for 3 to 4 weeks straight before, and it’s also not uncommon for me to be 2 weeks late either.), so it’s so hard for me to tell what this could be from.

Answer:
Dear Sarah,
It is common and normal to have irregular bleeding and spotting for weeks to months after a surgical abortion.  It can also be caused by starting birth control pills.  It can also be your usual irregular periods.  There is no way to know.  The most important thing is to remain on the birth control pills, and take them as directed.  This is important so that you are sure to not get pregnant again.  Many women are under the false impression that if they are bleeding they cannot get pregnant.  If the irregular bleeding is from the abortion it should resolve on its own in the next month. If it continues after that, you may ask your doctor to try a different brand of birth control pills.
I hope this is helpful,
Doctor Joan

AllExperts.com

Question:
I had the aspiration procedure Dec. 10th. I began taking birth control pills on Dec. 13th. I went back for my check up two weeks after the procedure, and the doctor said my body was healing just fine and to expect my period in a couple of weeks. That was Dec. 29th. I finished my first pack of birth control pills then quit taking them because I decided I wasn’t ready to have sex anytime soon. I’m concerned because as of now, January 16th, I still don’t have what I recognize as a period. Should I be alarmed? Last week I had one day of bleeding, but it was very dark and I only used one tampon. For the next two days, I had brown spotting only when I went for my daily run. This occurred after I stopped taking the pills. Does this count as a period? I had no cramping and none of my usual pms symptoms.

Answer:
Dear Dani,
Thank you for your question regarding bleeding after an aspiration abortion procedure. There is nothing to be concerned about.  It is common and normal to have a delayed period after an abortion, as long as you are not pregnant again.  It is also common and normal for birth control pills to cause a change or delay in periods, especially when you first start them.  From what you describe, everything sounds normal.  Your period should come in the next few weeks and may even take another month or two without indicating a problem. Your period may be irregular for the next few months. Don’t worry, it will come back to a normal cycle.

I hope this is helpful,
Doctor Joan

Allexperts.com

Most abortion clinics advise you to wait 2-4 weeks after a surgical abortion before having sex.  With an Aspiration Procedure or the Abortion Pill (both are non-surgical methods) you only have to wait 48 hours.

There is little research done on the subject, and I believe it is fine to have sex sooner than is usually advised with a surgical abortion.  At 13 days I feel comfortable advising you that you can have sex, if you don’t have any problems from the procedure.  You are already on birth control.  As long as you started the birth control within one week of your abortion, it should be effective as soon as you start it.   Condoms give you added protection, and protect against infections. 

Have fun!

Doctor Joan

Date Answered: 2009-11-15 on allexperts.com

Question:
QUESTION: hello im a bit confused i think im pregant five weeks after my abortion, my abortion was oct 10 2009 i was nine weeks i bleed for two weeks. my first sexual encounter was oct 24 2009 i use protection, after that i went to my check up every was fine i tested negative for pregnacy, after that i had unprotected sex on 11 8 2009 he only came in me a little bit, its now the 14 and my breast or tingling im having cramps just like i did when i first found out i was pregnat, so im wondering am i? how soon after the abortion do u ouvulate? and im confused because i never had a period? when should i test for pregnacy? am i worrying to much its keeping me up at night and thats why my period not coming? help.

 ANSWER: Dear Mina,
Thank you for your question about the possibility of being pregnant after your abortion. The best thing you can do to relieve your concerns is to take another pregnancy test.  If it was negative at your check up, then it will be accurate to take another one.  If you don’t get your period in the next few days, you can take the pregnancy test 10 days after when you had unprotected sex – on 11/18.

There is a risk of getting pregnant during the weeks after an abortion, so you do have some reason to be concerned.  However, so far it is normal not to have gotten your period.  It is common and normal to have a delayed period after an abortion.  Some women miss their period completely.  So, a delayed period does not indicate that you are pregnant again.  Cramps and breast tingling can also be normal a month after an abortion.

It sounds like you need help deciding on a better method of birth control for you.  Also, in the future, if you have unprotected sex, you can take Plan B or emergency contraception.  This helps avoid getting pregnant.  The sooner you take it, the better it works.
I hope this is helpful,
Doctor Joan
Early Abortion Specialist
New York City
———- FOLLOW-UP ———-

QUESTION: yes it was very helpful so im going to wait and take the test around the time you said to and see wat happens, so i started to spot and im wondering if this is my period since im having cramps or is it implantaion bleeding? the spotting is brownish color and its not enough to wear a tampon or pad, thanks dr.joan im in need of help. yes im getting on birthcontrol asap i was wondering should i start bc and not wait for my period?

Answer:
Dear Mina,
Yes, brown discharge can indicate you are getting your period.  This is common after an abortion.  If it is your period, it should get heavier, and turn into a more obvious period.  Yes, you can start on birth control right away.  If you wait for the Sunday after your period to start, it will work better with your cycle.  If you start now, before your period starts, you will likely have an irregular cycle while your body adjusts.  This doesn’t cause any problems, and is better than having another unwanted pregnancy. You would go ahead and check the pregnancy tests as we discussed.

Doctor Joan

Question:
Ihad first aboortion on 10th jan, 2009 and i had second on 13th nov, 2009.my ouestion is when i had first abortion it was bleeding very heavily but this time its not bleeding that much, is it normal and when i’ll get my period after this?
Thanks a lot!

Answer:
Dear Kavita,
Thank you for your question about what to expect with bleeding after abortion. It is normal to either bleed heavily or lightly after an abortion.  I would have no concerns about having a different bleeding experience after this abortion compared to your previous experience – it does not indicate a problem.

It can be very difficult to know when you have your next period after an abortion.  You can have irregular bleeding, spotting, or clots in the months after an abortion, so you may or may not be able to tell the difference between bleeding from the abortion and bleeding from your period.  Most women will get there period between 3-6 weeks after an abortion.  Your next period can also be delayed 1-3 months.  This is common and normal.

Irregular bleeding does not indicate a problem.  The most important concern is to not get pregnant again.  Many women do not understand that you can get pregnant, even if you are bleeding after an abortion.  So, make sure you get on birth control or use protection to avoid another unwanted pregnancy.

I hope this is helpful,

Doctor Joan

Question:
I had an abortion 13 days ago and had an IUD placed in the same procedure. I’m in absolutely no pain, except mild cramping only after I walk around A LOT. I went in to set up an appt. to make sure it’s all fine and dandy but they’re booked for another 5 days. I live with my b/f and we’re both sex fiends… so if we can’t hold out 5 more days, you think it’s safe for us to get busy yet? I mean… I’m not worried about getting pregnant again, I figure I’ll take plan B right after and having the IUD, maybe a condom. I’m just curious about the infection possibility. You think 13 days is enough???

Answer:
Go for it!  13 days is long enough – there should be no risk of an infection at this stage (aside from the usual risks of STD’s, which doesn’t sound like this situation).  Also, you don’t need to use Plan B.  The IUD is effective immediately.  Good luck!
Doctor Joan
Early Abortion Options