Patient's question:
Detailed medical condition and consultation purpose: I had a medication abortion a month ago. After half a month, I had sexual intercourse, and there was a small amount of bleeding, but it stopped the next day. Since then, I haven't noticed any bleeding. Now, 12 days have passed, and there is a small amount of bleeding again. Initially, it was red, but now there is a small amount of brown discharge, but it is very minimal. What is wrong with me?Doctor's answer:
Hello: Generally, the average duration of bleeding after the expulsion of the gestational sac in medication abortion is 18 days. The reasons for prolonged bleeding may include incomplete shedding of the decidua, which affects uterine contraction and hemostasis; or incomplete expulsion of the gestational sac, leading to incomplete abortion. In some cases, post-abortion infection may occur, resulting in endometrial inflammation.If bleeding does not stop two weeks after the expulsion of the gestational sac, a urine pregnancy test and ultrasound examination should be performed. If the diagnosis is incomplete abortion, a Dilation and Curettage (D&C) procedure should be conducted. If the bleeding persists due to incomplete shedding of the decidua but the bleeding is minimal upon consultation, medication or oxytocin injections can be used to promote uterine contraction to expel the remaining decidua. Bleeding will only stop when the embryonic tissue in the uterine cavity is largely expelled and uterine contraction is effective.
It is important to note that women undergoing medication abortion may sometimes experience a sudden increase in bleeding, several times the amount of a normal menstrual period, accompanied by large blood clots. This is due to the incomplete shedding and expulsion of embryonic tissue, requiring immediate medical attention and a D&C procedure to stop the bleeding. Vaginal bleeding after medication abortion may also be intermittent. Patients should not assume it is safe to swim or engage in sexual activity simply because there is no bleeding. Swimming and sexual activity should be avoided until a normal menstrual period has occurred after either medication or surgical abortion. Otherwise, it may lead to pelvic inflammatory disease.