Post-Abortion Period & Clots: What to Expect After a Medical Abortion

Question
Hello, I had a medical abortion on Dec. 16 of this year due to my age (38)and having diabetes. I was 7 weeks along. This was the first time I have ever been pregnant and though it was the most difficult decision of my life my husband and I decided to terminate the unplanned pregnancy. My medical abortion went smoothly, although it was very painful. I took the pill Friday night and the worst of it was over in 12 hours.  I felt 100% better, as I had been extremely sick to my stomach for the past two weeks.  I then again had severe cramping on that Monday, in which I believe I actually passed the fetus. I bled heavily for a few days and then normal period bleeding and spotting for another week.  The following month during my menstruation period I didn't have much bleeding about 1 tampon and some heavy spotting.  I am now due to begin my second period since the abortion.   I started my 28-day cycle birth control again the Sunday following taking the medical abortion pills on Friday, as my Dr. had directed.  I still have not begun my period for this month, two days into the reminder pills.  Is this normal following a medical abortion or should I be concerned?  My husband and I waited the suggested 2 weeks before having sex and I have been sure to take my bc pills at exactly the same time each night. I do not want this to happen again and wondered if not having much of a period or skipping a cycle the first couple months after a medical abortion is normal.  Any help you can give me would be greatly appreciated.
Thank you!

Answer
Dear Jack,
The bleeding you are describing sounds completely normal.  Irregular bleeding is common and normal after the abortion pill, and can last for months.  You should continue to take your birth control pill as directed.  Do not stop it!  The most common mistake I see is that people stop taking their birth control pills to get their period, and then they get pregnant.  Your period will come back to normal in the next month or two.  It's best to ignore the bleeding, and just take the pills as directed.  

As far as the severe cramping, where you passed something - it was not the fetus.  If you were early enough to take the pill, a fetus has not yet developed.  You can't see an embryo until after you are 9-10 weeks pregnant.  What you passed was a consolidated "clot" of tissue lining - it looks like a thick ball of tissue.  Most women pass this lining with the second set of pills, bur for some women it takes a week or two for it to come out.  It appears that  lining gets compressed (probably by sitting in the cervix) into this strange looking formed object.  The first time I saw it I was surprised myself!  

I hope this is helpful,
Doctor Joan
Earlyabortionoptions.com
New York City