In New York City, Early Options specializes in private early abortion services.   We do our best to make sure that you have a private experience in our office.  Each patient has a scheduled appointment time, and our staff are devoted to your care while you are in our office.  You have a dedicated clinical assistant who stays with you from start to finish.  We do our best to make sure your medical care is completed in one or two hours.  While you are in the office, all of your care is completed in a private examination room.  Your companion is welcome to be with you for the entire visit.  We specialize in early abortion services.  The non surgical silent aspiration procedure is performed in a regular private examination room, not an operating room.  At Early Options, you sit down and discuss your options with a board certified doctor so that you feel comfortable with your medical care and your decision. 

Many women travel to New York City from around the world to access our private abortion services.  However, if this isn’t an option for you, try to find a clinic that respects your privacy. 

Here are some basic questions to ask when you schedule your appointment:

How many women do you schedule at the same time?   (Early Options NYC: One)

How many seats are in your waiting area? (Early Options NYC: less than 6)

How long will I be in the office? (Early Options NYC: 1-2 hours)

Will I have an opportunity to talk with the doctor before getting a procedure? (Early Options NYC: Yes.  You will meet with the doctor first.)

Will my companion be able to be with me during my medical care?  (Early Options NYC: Yes.  Your companion is welcome for the entire visit.)

Will I be seated in a private examination room?  (Early Options NYC: Yes. You will be in one room, from start to finish.)

By asking these questions, you will be more educated about the options available to you.  If you are unable to find a private abortion clinic, you may want to research getting the abortion pill (medical abortion).  Most clinics have a separate service for medical abortion that is more private than their surgical abortion option.

Answer:  Bleeding for three weeks is completely normal after a medical abortion.  The average length of bleeding after taking the abortion pill is approximately 6 weeks.  As long as you have had your check up, and they have confirmed that the pregnancy is over, there is nothing to be concerned about at this stage.  If the bleeding goes for more than 6 weeks, or becomes much heavier than a period, you should check in with your doctor.  Breast soreness does not indicate a problem at this stage, as long as the pregnancy is over. 

I hope this is helpful,

Doctor Joan

Dear Katie,

It is common not to bleed after a surgical abortion or the aspiration procedure, especially when you are less than 7 weeks pregnant.  That said, it is also common to not have any bleeding, and then a few days later start to have bleeding and cramping.  Either way, it is normal, and there is no reason to be concerned.  Discharge is also common and normal, as long as it doesn’t have an obvious strong odor.

I hope this is helpful,

Doctor Joan

Dear R,

There are no known concerns with getting pregnant after taking Plan B.  It is fine to continue the pregnancy.  Also, there are no concerns from taking the abortion pill 3 months ago.  The medications are out of your system by your next cycle.  This means that even if you had gotten pregnant the month after a medical abortion, you could continue the pregnancy without worry.  Of course, it is always important to check with your midwife or obstetrician and discuss this on your first prenatal visit.

I hope this is helpful,

Doctor Joan

I have had more than a few medical abortions with mifeprex. I know it blocks progesterone. I was wondering if mifeprex will alter your progesterone levels permanently? I ask because I had a miscarriage recently and it was due to low progesterone levels so only a gestational sac and yolk sac developed, but no fetus.  Is there any way that this was caused by my past use of mifeprex? The last time I used it was 5 years ago. Or is there any way to tell?  I was told that it was safe with no long term effects.

Dear Shari,

I’m sorry you recently had a miscarriage.  It can be a difficult emotional experience to go through.

Mifeprex is not known to cause long term problems such as early miscarriage, years after its use.  Mifeprex has a short “half life” meaning that it is out of your system by the next month after its use.   It doesn’t cause a long term block of hormone levels.   Many woman have gotten pregnant and sustained their pregnancy as early as one month after having a medical abortion.

I don’t know the details of your miscarriage, but I’m guessing you were told that you had low hCG levels.  If this is the case, it is likely that the failed pregnancy resulted in low hCG levels (rather than low hCG levels causing the miscarriage).  Early miscarriage is common and normal, and doesn’t mean that there is anything wrong with you or your hormone levels.  Typically, doctors don’t start to evaluating potential causes until you have had three repeat early miscarriages.

There is no reason you can’t start trying again right away.

Good luck,

Dr. Joan

Dear Anxious:

Early abortion is one of the safest medical procedures available.  Please see my website for a summary of the safest abortion methods.   

Of course if you can get to New York City, our Early Options offices offer the safest early abortion methods, recommended by the World Health Organization.  The Aspiration Procedure is the safest method of all, if completed correctly.  It is safer than D&C abortion because it does not utilize metal instruments, electric suction, or sedation. 

If you can’t find a doctor who offers the Aspiration Procedure or don’t have the means to come to New York City, I would recommend the Abortion Pill.  If you need to get a surgical abortion, make sure they do not scrape with a curette – it is completely unnecessary in early pregnancy.  You should also choose local or “twilight” anesthesia – these are the safest options. 

It is normal and common to feel anxious about getting an abortion.  It’s hard to go through ending an unwanted pregnancy.   On top of a difficult personal decision, you are also having to go through a medical procedure, your hormones are “raging” and you have to deal with the controversy over making this choice.  Most abortion clinics have a counselor.  Tell her how you are feeling.  She can probably help you with some medications to make the actual procedure less difficult.

I hope this is helpful.

Doctor Joan

Dear N,

It would be very unlikely to have cramping, bloating, or breast tenderness so long after an abortion, so I don’t think that is the cause.  I assume you have checked a pregnancy test.  If it is negative, then the pregnancy hormones should not be active.  However, these symptoms together usually mean that there is some kind of hormonal imbalance.  If you have these symptoms since May, it could be from the Nuvaring.  If you have had these symptoms only more recently, it is likely from stopping your birth control.  Also, of course you should make sure you are not pregnant again if you are at risk since coming off of the Nuvaring.   If your symptoms continue, it might be a good time to see  a doctor.

I hope this is helpful to you,

Doctor Joan

Founder, Early Options, New York City

Thank you,

B

Dear B,

Thank you for your question about a high level of hCG after an abortion procedure.  A high hCG level (but under 5000) 3 weeks after a procedure would indicate one of three things – 1) normal but slow decline; 2) retained tissue; 3) a new pregnancy.  Since you repeated the test and it did not double in 48 hours, this is not a new pregnancy.  More than likely, this indicated retained tissue. 

Retained tissue is very common and normal.  It can happen after any type of abortion, miscarriage or birth.  It simply means that some of the pregnany lining has not yet passed.  Usually, it will pass on its own. You don’t need to do anything unless it is causing you problems, such as cramping, passing clots or heavy bleeding, or a foul odor.   In this case, the doctor may recommend a repeat procedure.  Often, the biggest issue with retained tissue is anxiety.  There is no need to worry.  Retained tissue does not have any medical consequences. 

Ironically, sex can help the uterus contract and expel early pregnancy tissue.  Of course, be careful that you are using birth control.  Also you can try heat, a warm bath, and massaging your lower belly. 

I hope this helps relieve some of your worry.

Doctor Joan

Founder, Early Options, New York City

Answer:  Dear Michelle,

A pregnancy test should be negative 3-4 weeks after an aspiration abortion.  It depends on how early you were when you had the procedure.  I’m concerned that the pregnancy test was positive at week three.  Just make sure to repeat the pregnancy test.  If it is negative again, you can feel secure that the pregnancy is over.  Sometimes it takes a while for the pregnancy symptoms to disappear.  Wait another week.  If your pregnancy symptoms are getting worse, you should see a doctor. 

As far as the “mucous plug” it’s hard to tell without seeing it.  It is common to pass clots after any kind of abortion, and sometimes these clots contain some “decidua” – the tissue that forms inside the uterus to prepare for the early pregnancy.  It’s also possible that you passed the actual pregnancy “sac” (membrane that forms in early pregnancy).  In this case the doctor may have missed removing all of the tissue.  The sac does appear like mucous.  This would also explain why the pregnancy test was delayed in turning negative.  Either way, it doesn’t sound abnormal, and there is nothing to be concerned about.

There is no concern about that fact that you haven’t gotten your period yet.  It’s common to have a delayed period, especially since your pregnancy test was positive.  I have seen it take 2-3 months to return to normal. 

I hope this is helpful,

Doctor Joan

Dear N,

It is normal not to have any bleeding or pain after an abortion procedure, especially if the pregnancy was early.  You may not have any symptoms, or sometimes the symptoms can come and go.  So, don’t be surprised or anxious if you start to having cramping and/or bleeding a few days from now. 

I’m glad that you’re feeling so well after your procedure.

I hope this is helpful,

Doctor Joan

Founder, Early Options, New York City