A medication abortion involves taking two different medications, mifepristone and misoprostol, to end a pregnancy. Bleeding is an expected and necessary part of this process, signaling the expulsion of the pregnancy from the uterus. The experience varies in intensity and duration. Understanding the anticipated timeline and characteristics of the bleeding is important for managing expectations during recovery.
The Initial Phase: Heavy Bleeding and Clotting
The most intense part of the process begins after taking the second medication, misoprostol. This medication causes the uterus to contract, leading to cramping and the expulsion of the pregnancy tissue. Bleeding typically starts within one to four hours of taking misoprostol.
The bleeding in this initial phase is significantly heavier than a typical menstrual period and is often accompanied by the passage of large blood clots and tissue. It is normal to pass clots as large as a lemon or a golf ball, as this indicates the abortion is progressing. This acute, heavy bleeding phase generally lasts between four and six hours and should begin to lessen within 24 hours. Once the pregnancy tissue has passed, the intensity of the cramping and bleeding usually decreases noticeably.
Expected Duration of Light Bleeding and Spotting
After the initial severe bleeding subsides, the flow transitions into lighter bleeding or spotting, which can continue for a variable amount of time. This is a normal part of the body’s recovery as the uterus sheds its lining and returns to its non-pregnant state. The process of clearing the uterus can take several weeks.
Many people experience light bleeding or spotting intermittently for one to two weeks following the heaviest phase. For some, this lighter bleeding may persist for up to four to six weeks. It is common for the bleeding to be irregular, starting and stopping, and it should progressively become lighter over this period. This lingering flow is a sign of normal post-procedure healing.
The post-abortion bleeding cycle concludes with the return of the first menstrual period. This first period usually arrives approximately four to eight weeks after the medication abortion. The first period can sometimes be heavier or longer than usual, reflecting the body’s final adjustment. If a period has not occurred after eight weeks, contact a healthcare provider for a follow-up.
Recognizing Warning Signs and Abnormal Bleeding
While heavy bleeding is expected, certain signs indicate excessive bleeding or a complication requiring immediate medical attention. Seek help if you soak through two or more maxi pads in an hour for two consecutive hours. This rate of blood loss is considered excessive and may signal a hemorrhage.
Passing clots larger than a golf ball or lemon for longer than two hours is also a reason to contact a healthcare provider. Other warning signs include bleeding that stops and then suddenly restarts very heavily, or any bleeding accompanied by signs of infection. Signs of infection include a fever of 100.4°F (38°C) or higher, chills, or vaginal discharge with a foul odor. Severe pain not relieved by over-the-counter pain medication should also prompt a call to a medical professional.