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Abortion and your menstrual cycle
Although medical and surgical abortions are common, you may find that your overall experience is different from someone else’s. How it affects your menstrual cycle, for example, depends on many factors, including the type of abortion and what your period was like before. Here’s what to expect and when to see a doctor.
It’s normal to bleed after an abortion. This bleeding might look like your monthly period, but it isn’t the same. It’s the result of your uterus expelling tissue from the pregnancy.
Some people don’t bleed at all after an abortion. They won’t start to bleed until their next period.
The timing of your bleeding depends on whether you had a medical or surgical abortion.
During a medical abortion, you’ll get two pills. Your doctor or other healthcare professional will administer the first pill. It breaks down the lining of your uterus so that a pregnancy can no longer grow. Some people start to bleed after this first pill.
You’ll take the second pill after you leave the hospital or clinic. This pill causes your uterus to release its contents. You may start to bleed within 30 minutes to 4 hours after you take it.
The bleeding will get increasingly more intense until you’ve passed the pregnancy. This should happen 4 to 5 hours after you take the second pill, but it can take longer in some people. There will likely be a window of 1 to 2 hours where you notice heavier flow and possible clots passing. This increase in flow should lessen after a couple of hours. Afterward, the bleeding should look more like a normal period.
If you have a surgical abortion you might bleed immediately after. Or, you may not start bleeding until 3 to 5 days afterward. In general, the flow is lighter than a period-like flow.
The bleeding may stop or continue until your next period. It if continues, it should get lighter over time.
It’s common to bleed for 1 to 2 weeks after either type of abortion. Some people find that the blood flow will stop and then start again.
The bleeding should taper off after a week or two. You may continue to have some light bleeding or spotting for a few weeks afterward, or until your next period.
The bleeding should look similar to your periods, except the color may be more brown than red. Blood flow is typically heavier with a medical abortion than a surgical abortion.
Certain activities can increase or decrease the amount of bleeding. You may bleed more when you exercise and less when you’re at rest.
You may notice blood clots. This typically isn’t anything to worry about. The clots can range in size from small to large. Some may be as big as a lemon. If clots are occurring with heavy bleeding and last more than two hours, you should call your healthcare provider to discuss whether you need evaluation.
There may be blood-tinged discharge, too. The discharge may be stringy like mucus, but it shouldn’t be foul-smelling, yellow, or green. These are signs of an infection.
Other side effects depend on the type of abortion you’ve had.
Side effects of a medical abortion include:
Because fever can also be a sign of infection, you should call your healthcare provider if you notice a fever, body aches, or increased bleeding or pelvic pain.
Side effects from a surgical abortion include:
Many healthcare professionals recommend that you avoid tampons or menstrual cups for at least two weeks after either type of abortion. You should use sanitary napkins or period underwear until your healthcare provider says it’s OK to use another form of protection.
An abortion restarts your menstrual cycle. Your periods should return to normal within a month or so after the procedure.
Your periods should return within 4 to 6 weeks of your abortion. How much time elapses before you get your first post-abortion period depends, in part, on how pregnant you were. Pregnancy hormones may remain for a few weeks afterward, causing a delay in menstruation.
If eight weeks pass and you still haven’t gotten a period, take a home pregnancy test or see a doctor to make sure you aren’t still pregnant.
Your first period may be shorter than it was in the past if you had a surgical abortion, or longer if you had a medical abortion. This irregularity is due to your hormones and menstrual cycle returning to normal.
Your first period may be heavier than usual if you had a medical abortion because your body has to remove all of the extra tissue from your uterus. You might also pass some small blood clots.
Periods after a surgical abortion may be lighter at first. They should normalize within a few months.
You may have more cramping than usual during your first few periods after an abortion.
Other symptoms will be similar to those you’ve had during past menstrual cycles, including:
- tender breasts
- muscle aches
Once you’ve passed the two-week mark after your abortion, you can go back to your normal sanitary product routine.
Once you’ve had your first period, you should get back into a semi-normal menstrual cycle. It’s normal for some people to have irregular cycles for the first few months after their abortion.
Your periods may be shorter or longer than usual for a few months. You may also bleed more than you did in the past, especially if you had a medical abortion.
By your second period you’ll have your pick of sanitary options. You can use whatever is most comfortable to you.
You can resume using most birth control methods — including the pill, patch, condom, implant, and intrauterine device (IUD) — immediately after, or within a few days of, your abortion.
Hormonal birth control methods like the pill may make your bleeding lighter and reduce the number of days you bleed after an abortion. You may also get back into your normal menstrual cycle faster if you’re on the pill.
Many healthcare professionals recommend that you wait until post-abortion bleeding stops — usually about two weeks — to have vaginal sex after a medical or surgical abortion.
You should start ovulating about three weeks after a medical abortion. Some people start as soon as eight days afterward. This means you can get pregnant again, even if you haven’t had a period yet. Talk to your doctor about birth control options.
Having an abortion doesn’t affect your fertility in most cases. There is concern that repeated surgical abortion may cause scarring in the uterus by the instruments used to remove the pregnancy. This scarring, called “intrauterine adhesions,” could be a possible cause for infertility in some cases.
Seek immediate medical attention if:
- You soak through two or more sanitary pads per hour for more than 2 hours in a row.
- You pass a blood clot that’s larger than a lemon.
- You have severe pain in your belly or back.
- The medications your doctor prescribed aren’t controlling your pain.
- You’re running a fever over 100.4°F (38°C).
- You have chills.
- You have a foul-smelling discharge.
- You have yellow or green discharge.
If you’ve had a medical abortion and you don’t start bleeding within 48 hours, let your healthcare provider know. You might still be pregnant or have had a partial abortion and need follow-up care.
You should also see your provider if your period doesn’t come back within eight weeks after your procedure.