Name: Crampy

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

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