QuestionQUESTION: Dr. Joan. I am so grateful to have come across your question and answers. I have read through them over the past 2 weeks and they have helped my fears subside until I have an episode. I will explain. On November 18, I went to appointment for a medical abortion. I was 7 weeks and 3 days along. I was giv3n the first medication and told to insert 4 of the second medication vaginally 48 hours later and 4 more 24 hours after that. About an hour after inserting the first 4, I began bleeding, cramping, etc as expected. I bled in those 4 hours as I expected, cramped as expected....all went as planned. By the next day, I was bleeding like a normal period. I inserted the next set as instructed, I assumed I'd experience a similar 4 hours but I didn't...I just bled as a normal heavier period as I had been. I was to return to the clinic in one week to be checked. Near that time, one if my 4 children came down with a virus. I called and asked to reschedule, they said that was fine. A domino affect happened, one by one we all got it so I was now going in for recheck 3 weeks after instead on 1. During those three weeks I felt fine. Bleeding slowed after first week from heavy period to light to like spotting. Nothing alarming, all I expected. The night before my exam, I had a sudden gush of blood, had a few of those and passed some ugly clots. Last, I had a huge gush when a huge clot passed....it was alarming in size, grapefruit sized, a big grapefruit. Then just like that, bleeding stopped. I took a picture of clot to show doctor the next day. At the clinic, I was fused at, the doctor who I initially saw was on vacation, the one there that day was flustered and wanted me to see him! After my insistence, she did an ultrasound and said pregnancy passes, I just had "junk" remaining. I showed her picture and she just said "ice seen bigger". I was given more medicine, told to take 3 by mouth, four vaginally and come back in 2 weeks when original doctor is back. I took the medicine, bleed and passed clots for 24 hours. It finally sliced down after 24 hours. Since then, Its been a week since I took the 3 by mouth, 4 vaginally. I have had 3 episodes of this gushing with clots. 2 very quick, the last I had 4 big gushed over an hour, lots of clots. After reading here, this last episode, I got in a warm bath, massaged for quite a while and just knew the gushed would continue until I got the clots out. And just as the other times, when its done, its done....I go back to mild spotting. I do not have cramps during an episode. No fever or discomfort. No odor, etc. I do feel a little sluggish for a few hours after these episodes. So I rest, drink fluids and take iron 3 times a day. I'm just nervous I harmed myself. I've read this can be normal from you. Does it sound ok to you? When I call the clinic, they just say "it stopped, you are ok, call us If it doesn't". I don't ever get to speak to a doctor. Its just scary.
ANSWER: It sounds like you had a retained clot that has now passed. The uterus when it is filled with a clot can not contract back to normal. The medication held it contract to pass the clots and it seems that you are spotting which means that you are no longer actively bleeding. You should drink plenty of fluids. Taking the iron will help rebuild your blood count. You should follow up to have an ultrasound and make sure your uterus has returned to normal. You should take Motrin 800 mg every 6 hours for cramping. You should call the clinic to have a follow-up. If the bleeding becomes heavy again you should be seen immediately.
If you have not considered birth control, consider having an Intrauterine deice such as the Mirena placed.
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QUESTION: After the big clot 3 weeks after the procedure, I could imagine it preventing my uterus from contracting back to normal. After that, I was told I had passed the pregnancy but still had "junk" in my uterus. So I was given the medicine again....it did cause heavy bleeding and I passed a lot of clots for 24 hours. I thought that had to be "it" and was relieved when bleeding slowed to spotting. However, in the week and 5 days since, I have had 3 episodes of heavy bleeding, passing several clots (quarter sized to double that, nothing like that huge one) and the episodes are quick but big gushes. Back to spotting immediately following it. It isn't everyday. Just 3 times in past 10 days. Could there still be more left even though pregnancy has passed? Is this abnormal? The clinic I went to seems as if I'm ok to wait to be seen until the original doctor returns from vacation. Do you mean if I have another gushing episode go to er even if it stops and goes back to spotting?
AnswerIt would be fine to wait. Gushes of blood can be normal. Passing clots the size of an a 50 cent piece or larger means your uterus has not contracted to normal and you are still bleeding. I would not go to the ER. You can wait for the doctor to come back from vacation.
