At Cabbagetown Women’s Clinic our patients have the contact number of the physician, should they experience intense symptoms they cannot decipher and may need Emergency attention. One of the most common conversations I have with worried women is around unusual post-abortion cramping.
Cramping after an abortion is complete (meaning that the whole pregnancy has come out of the uterus, there are no products left inside, there is no infection brewing and there is no injury to the uterus) is normally similar to the patient’s baseline period or less. This means that if you’ve had an abortion in the last couple of weeks (whether the pill abortion or the surgical abortion) you should be having period-like bleeding and cramping: even if it’s similar to a heavy period of yours. The pattern for both the bleeding and the pain is a gradual decline over the first 14 days or so. Every day should be the same as the day before or better. The next 2 weeks should involve little to no bleeding (spotting on some days and none on others) and the cramping should be gone or almost gone.
This bleeding during the first couple of weeks is NOT your period. It is ongoing active bleeding from the womb (or uterus) as it heals itself from passing a pregnancy or having it sucked out. The blood that is coming from the walls of the uterus needs to drain out of the vagina. If it doesn’t, it does what blood that stands still is supposed to do: it clots. Large blood clots inside the womb plug up the exit of newly forming blood and this causes more bleeding and more cramping; until the cramping can be very difficult to put up with.
When women call me complaining of unusual post-abortion cramping, the first and most useful piece of advice is to go WALKING. Take pain medication if you need and go for a long walk (Advil or Ibuprofen 400-600 mg every 4 hours and/or Tylenol/Acetaminophen 1000 mg every 4 hours as needed to a maximum of 4000 mg daily Acetaminophen dose). A long (1 hour or so) walk or a light jog will encourage those clots to come out and help empty the uterus. Once it is empty, the uterus quickly decreases its cramping.
Be active ladies. This is not the time to go running a marathon, or lifting weights, but it is also not the time to lie down or sit for long periods (no pun intended). If your symptoms are not improving despite lots of walking you need assessment. Call the on call number you were given or go to an ER. As always, severe pain or severe bleeding, fever or pus coming out of the vagina are also symptoms that need ER assessment.