Is it normal not to have a menstrual period 40 days after an abortion?

Patient's question:

Detailed medical condition and consultation purpose: Solving problems
Duration of the current illness: On October 1st, I had an abortion surgery, and it has been until November 9th without my period. Is this abnormal? Do I need to go to the hospital for a check-up?
Current general condition: Occasionally experiencing abdominal pain, lower back pain, and fatigue.
Medical history: Had two abortions.

Doctor's answer:

The reasons why women do not have their menstrual period after an abortion surgery include the following:
1. Frequent induced abortions. Some women have several induced abortions within a year, and the endometrium is scraped thin, failing to recover in the short term. If the basal layer of the endometrium is completely damaged, it can lead to permanent amenorrhea, while partial damage can cause temporary amenorrhea.
2. Excessive mental stress and anxiety. Fear before the surgery, fear of induced abortion, or the psychological burden of being unable to conceive or bear children, especially for unmarried pregnant women who feel ashamed. If this emotional state does not change after the surgery, it can lead to amenorrhea.
3. Surgical complications. Some patients may develop cervical adhesions due to the surgery, causing blood to accumulate and delay menstruation.
4. Early sexual activity and after surgery. Some women engage in sexual activity with their partners within a few days of the surgery or take without following the doctor's advice, allowing bacteria to enter the vagina and uterus, leading to uterine cavity infection and menstrual disorders, which may result in amenorrhea.
5. Individual differences. Everyone's body is different; some women experience hormonal changes after an induced abortion, with a sudden drop in the level of human chorionic gonadotropin, causing the ovaries to temporarily fail to respond to gonadotropins from the anterior pituitary, leading to the endometrium not changing cyclically and resulting in amenorrhea.
6. Pregnancy. Some patients, ignoring medical advice, may become pregnant again within a month after the surgery if they have sexual activity without contraception, leading to the absence of menstruation. You may be experiencing issues related to points 2 and 5. It is recommended to pay attention and seek early treatment.