Heavy Bleeding During Medical Abortion: How Much Is Too Much?

A medical abortion uses a combination of two drugs, mifepristone and misoprostol, to end a pregnancy. There are many complications commonly associated with medical abortion. Because medical abortions often occur in a private setting and not in a doctor’s office, it’s critical to be aware of these complications and to seek emergency medical care when necessary.

What Happens During a Medical Abortion?

Commonly called “the abortion pill,” a medication abortion is actually a two-step process. The first medication, mifepristone, works by blocking the activity of progesterone required for the ongoing survival of the fetus. Misoprostol, taken 24-48 hours later, causes the uterus to contract, bleed and expel the pregnancy.

These drugs cause vaginal bleeding and abdominal cramps. Other possible side effects can include: upset stomach, vomiting, fever, chills, diarrhea, and headaches. 

According to the National Library of Medicine, “serious or life-threatening vaginal bleeding may occur when a pregnancy is ended by miscarriage or by medical or surgical abortion.”

What Is Considered Heavy Bleeding?

Because vaginal bleeding and abdominal cramps are an expected part of the medical abortion process, it can be difficult to recognize complications and determine when you should seek medical attention.

Heavy cramping and bleeding with blood clots usually occurs several hours after taking misoprostol. Bleeding will typically lessen in the days following a medical abortion, but light to moderate bleeding can continue for several weeks.

Severe bleeding is generally defined as soaking more than two thick pads within an hour for two consecutive hours. If heavy bleeding continues and won’t stop, contact a medical professional immediately.

Other reasons to seek medical attention include:

• No bleeding 24 hours after taking misoprostol (This could be a sign of ectopic pregnancy or a failed/incomplete abortion[i])
• Bad pain in the stomach area or pelvis
• Fever lasting more than four hours or starts in the days after taking misoprostol
• Foul-smelling vaginal discharge
• Fast heart rate
• Chills or body aches

Other Considerations

Before undergoing a medical abortion, let your care team know if you have a bleeding disorder or are taking any medications to treat or prevent blood clots, as these can make you more likely to suffer bleeding-related complications.

There is currently a difference of opinion within the medical community regarding the need for follow-up care after a medical abortion. The Mayo Clinic now asserts that, if a medication abortion works as it should, follow-up visits with a healthcare professional aren’t necessary. The Cleveland Clinic recommends a follow-up visit or call to ensure that the pregnancy has ended.

Keep in mind that the abortion pill regimen will not end an ectopic pregnancy (a pregnancy that has implanted outside of the uterus). Even a routine medical examination may not be enough to diagnose an ectopic pregnancy. Blood tests and an ultrasound are required to diagnose this life-threatening condition. Choosing to have a self-managed medical abortion without being seen in-person by a medical professional may put you at greater risk of severe complications related to an undiagnosed ectopic pregnancy.

Receive Free Pregnancy Resources

While a medical abortion uses prescription drugs to end a pregnancy, it’s still a serious medical procedure. Make sure you get proper care and support prior to seeking one.

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[i] Clinical Practice Handbook for Safe Abortion. Geneva: World Health Organization; 2014. 3, POST-ABORTION, p. 28. Available from: https://www.ncbi.nlm.nih.gov/books/NBK190099/