Is my bleeding normal?
What is normal bleeding after an abortion
Whether you’ve had a surgical abortion (where a doctor has performed a procedure to take out the pregnancy) or a medical abortion (where you’ve taken pills in order to stop and expel your pregnancy), your bleeding pattern should be similar after the first 1-2 days.
If you chose to do the medical abortion, the day you take MISOPROSTOL (the 4 pills you put in your cheeks or your vagina) you can expect to have strong, intense cramps and vaginal bleeding. This usually starts within the first 2-4 hours after absorbing MISOPROSTOL and lasts approximately 6 hours once it has started. For some women, this reaction is delayed and not as intense, but if you have had no significant bleeding or cramping more that 24 hours after taking MISOPROSTOL, you should contact your healthcare provider to ask for further instructions.
After this initial 24-48 hours, the normal limits of bleeding follow the same pattern, whether you’re recovering from a medical or surgical abortion. You can also see our video on what is normal
The following describes the UPPER limits of normal, which can be divided into 2-week intervals:
Weeks 1 & 2:
During this time, you can bleed daily.
· The quantity of blood is similar to a mild to medium period.
· You should use pads during this time, and try to keep track of how many pads you fill in a day (this is an important question if you ever need to review your bleeding with a healthcare professional).
· It is also normal to have some blood clots during this time.
Bleeding should never be more than a normal period of yours. If it is heavier than what you see with your normal period, you should review this with your healthcare provider. This can be done non-urgently as long as there are no severe symptoms (see below).
During these 2 weeks, it is important to keep active.
· Walk around, don’t lie down or sit for prolonged periods of time.
· It is equally important not to be too active: this is not a time to go jogging, do heavy lifting (including lifting children), or to perform physically intense labour at home or work.
· If you need, you can ask your provider for a work note limiting your work activities to light duties.
It is also normal to have period like cramps during this time. They should be similar to the cramps you get during your periods.
By this time your bleeding should have decreased to mild or none. Some days you may express bright red, dark red, brown or black discharge onto your pads. Some days you may not see any bleeding at all, but other days the discharge or blood may return and this is normal. If you prefer, you can switch to using tampons after you bleeding has become mild.
Your cramps should be gone or very mild at this point.
During these 2 weeks, your regular period is expected to return. You will, therefore, experience an increase in the amount of blood and cramps, which is normal.
· This first period may be a bit heavier, crampier and longer than your normal period; but the amount of bleeding or pain should never be scaring you and should never be severe (see below).
· This first period MAY be more intense, but it does not have to be. If this period is identical to your normal periods that is also reassuring.
· At the end of this first period, you should not bleed in between periods anymore (as long as you are not someone who bleeds in between periods normally).
Your cycles should now be re-established as they were before your abortion.
___________________________________________________________________________________________Severe symptoms should never be ignored and
need urgent trained assessment
· Whatever you would label as severe pain needs a trained pair of eyes to determine if your body is healing normally after the abortion, or if something abnormal is taking place.
· Severe pain should always be assessed in person by a doctor trained in taking care of post-abortion patients.
· If your abortion clinic is open, follow up there immediately. If the clinic is closed, go to the emergency room.
· Unlike pain, severe bleeding is not subjective.
· Severe bleeding is when you are filling over 2 pads in 1 hour for over 1 hour.
· Severe bleeding is also happening if you are seeing blood clots coming out that are bigger than the size of a lemon (or clenched fist).
· Either of these bleeding signs are a bright red flag that you need to see someone in order to stop this bleeding; before you lose too much blood.
Regardless of the amount of blood you estimate you may have lost, if you feel
a. very weak, lightheaded,
b. getting head rushes when to go from lying to standing, lying to sitting or sitting to standing
c. feel like you are going to faint
d. (especially if these are not symptoms you ever feel normally)
you are experiencing severe symptoms which need urgent medical attention. You need to go to your nearest emergency department to make sure you do not need treatment. Do not ignore these symptoms, especially if they are continuing or worsening.
Fever is not chills.
· Chills happen in response to many things inside your body (ex. they are among the side effects of MISOPROSTOL, they can be felt during a normal period, they can be how we feel ourselves developing a fever).
· Fever is a measured temperature over 37.5 C in the ear, or over 37.0 C under the arm.
· If you develop fever over 24 hours after MISOPROSTOL (of if you never got MISOPROSTOL), you cannot ignore this very important sign.
You need to be seen by your healthcare provider or by another trained provider within 24 hours, to make sure this is not an infection that needs urgent treatment.
· It could be a urinary infection, it could be a common cold, it could be COVID, it could be an infected uterus and it could be many other things.
· However, it is important to rule out urgent infection right away.
Wherever you are going to be seen, you need to call ahead.
· This is because the clinic or emergency room may have to employ special precautions in seeing you (to protect other patients and workers).
Pus from the vagina:
Of all the severe symptoms listed above, this is the least subtle. Pus coming from the vagina is not a little bit of changed discharge. It can be very normal to have slightly different smell, colour, texture in the discharge from the vagina after an abortion. The bugs normally living in your vagina have been changed by the hormones of pregnancy, the antibiotics you have taken with the procedure, and/or the solution used to cleanse your vagina during a surgical abortion.
Pus is a very stinky, multicoloured substance that you’ve very likely never seen or felt before. It usually comes along with a lot of pain in the belly as well as fever. If you are worried this is happening to you, you need urgent examination. It cannot be done over the phone and it needs assessment within 24 hours to keep you safe.
If you are experiencing symptoms that are worrying you but do not seem to fit the descriptions above, please call your healthcare providers and review what you’re feeling or seeing. These are trained people, who can guide you and keep you safe.
___________________________________________________________________________________________A note on fertility
Your fertility, your ability to get pregnant, can be back by 5 days after an abortion. This is long before your first period has come and gone. No matter who you are, your fertility is strongest 1-2 years after your periods start out in life, until the last half of your 30s. If you have gotten pregnant once, your fertility for subsequent pregnancies is HIGHER than it was prior to your first pregnancy.
If you would like to start on birth control, it is ideal to have a plan in place prior to having your abortion and to start on that plan ASAP after your abortion is completed (within the first 2-5 days after you started your abortion).
· The birth control pill, patch or ring take up to 2 weeks to be working well.
· The IUDs are working well as soon as they are inside you.
· The implant works well right away if you have it inserted within 5 days of the abortion. It starts working by 7 days of insertion, if it was inserted after this time.
Talk to your abortion provider about birth control.
Take care of yourself
Be kind to yourself