What Are the Possible Causes of Bleeding after Abortion?

Bleeding after abortion is typically considered a normal side effect of the procedure, and women shouldn’t usually be alarmed if they see blood or spotting in the weeks after the abortion has been performed. In most cases bleeding is one of the body’s ways to recover and restore a reproductive status quo. Women who have had medical abortions, which is to say abortions triggered by drugs rather than surgery, usually expect to see blood as a sign that the medication is working. Drugs in this category force contractions of the uterus or trigger menstruation, both of which result in blood. Severe bleeding or large blood clots are usually cause for concern no matter what, though, since these might indicate damage to internal organs from instruments used in the procedure or hemorrhage, and may require surgical repair. Infection also may cause bleeding after abortion if tissue remains in the uterus. When severe cramping occurs, it might indicate postabortal syndrome, meaning the uterus fails to contract to expel blood and clots.

A woman might bleed for six weeks during the abortion recovery period, and small clots usually pass with the blood. Normal menstruation commonly returns one or two months later, and menstrual bleeding after abortion might appear different than before the procedure. Hormonal changes may trigger heavier-than-normal periods, or lighter bleeding may occur when normal menstrual cycles return.

Cramping is also common and might be eased with abdominal massage. This helps the uterus contract and return to its pre-pregnancy size as blood and clots are expelled. Massage is also used after childbirth to accomplish the same outcome.

Women who use drugs known as “abortion pills” might also experience increased bleeding, which experts think occurs in about one of every 100 patients. The process usually consists of three medications over a period of three days, which in most cases is suitable for early abortion up to about 49 days' gestation. A doctor normally evaluates the patient a couple of weeks later to determine if the medication successfully aborted the fetus.

In some cases the blood a woman sees after an abortion may simply be menstruation. This is most common very early in the pregnancy, and typically with the use of emergency contraceptives sometimes called the “morning after pill.” These types of medications can usually only be used within the first few hours or days of a possible pregnancy, and their main role is to trigger menstruation and a shedding of the uterine walls, which would include a fertilized egg if it is present. There is some debate when it comes to whether or not this is a true abortion, but it nonetheless causes bleeding — and this is perfectly normal.

The amount of bleeding a woman experiences might also depend on the stage of pregnancy, since this stage often dictates the sort of procedure and its relative simplicity. Up until about 12 weeks’ gestation, a woman will typically receive a general anesthetic before the doctor uses a machine to suction the fetus from her uterus. A medical instrument called a curette scrapes out any remaining tissue. Bleeding here is often a normal reaction to the change in condition, and is the uterus’ way of stabilizing and adapting.

Things are often more complicated once a woman enters the second trimester of pregnancy. During the second trimester, bleeding after abortion might resemble bleeding after full term or premature childbirth. The patient will typically receive medication to stimulate uterine contractions in a hospital labor and delivery room. After several hours, the fetus and placenta detach and are expelled from the uterus. Medical attendants will often have to physically scrape the uterus to be sure that all fetal tissues and placental parts have been evacuated.

Bleeding that continues for more than a few weeks, that seems to be getting heavier with time, or that includes large clots is usually a sign that things aren’t healing the way they should. The most common causes in these cases are hemorrhage, usually as a result of tissues from the pregnancy that remain attached in the uterus, or organ damage, frequently a perforated uterus. Abortion providers who have slipped or made errors with their instruments can sometimes not only rupture the uterine wall but may also damage nearby organs through the uterus, which can lead to extensive damage, not to mention great pain. If these conditions aren’t promptly diagnosed and treated they can lead to serious complications including death.

Leftover tissues also run the risk of becoming infected, which frequently leads to bleeding. Women who have uterine infections usually also have a fever, experience chills, and feel nauseated. Infections can sometimes be treated with antibiotics, but the offending tissues often need to be removed surgically, as well.

Some women experience pregnancy symptoms months after an abortion. It generally takes little while before hormones adjust to pre-pregnancy levels. In addition to bleeding during this time, a woman might experience morning sickness, feel tired, or become emotional. Depression might also develop in some women. Anyone who is concerned about certain symptoms should usually talk to a healthcare provider.