Our post-abortion service
Please read the following information and instructions carefully. This
will give you information about the next few weeks, and will give you
an idea as to what is normal, what to expect and what to do if a problem
/ concern arises. Our clinic staff is available to answer any questions.
We would prefer that you call the clinic first if you have any questions
or concerns as we specialize in abortions.
During office hours:
We will inform you of the after-hours emergency number
Complications are very rare. We are open from Monday to Friday from 9
a.m. to 5 p.m., but a doctor is not always present at the clinic. If you
have a concern, please call the clinic if it is within office hours. Call
the after-hours line if you need to speak with a nurse in the evening
or on the weekend. You can reach us by phone 24 hours a day for urgent
questions. If the emergency requires a rapid intervention, please go to
the emergency room of your local hospital.
If you call the after-hours number, please leave a clear numeric message
with your phone number (including area code), and stay by the phone, keeping
the line clear. If you don’t hear from the nurse in a half hour,
We ask that you keep the instruction sheet we will give you in the recovery
room as a reference. All information you give us remains confidential;
your health and privacy are important to us.
Every woman and every pregnancy is different. Bleeding after an abortion
also varies; some women have no bleeding at all after an abortion (common
with small pregnancies), while some may bleed immediately and for 3-4
weeks, and rarely, more.
Intermittent bleeding (bleeding on and off), blood clots, pinkish tissue,
and clear or brownish discharge are normal. Bleeding may also be heavier
after exercise. Some bleed immediately and for two to three weeks, or
have periods of bleeding off and on. Bleeding usually increases three
to four days after the abortion due to normal changes. It is normal to
pass clots when rising in the morning, when sitting on the toilet, or
when doing strenuous activity. It is also normal to have brown, clear
or bright red discharge. Drinking excessive amounts of alcohol, lifting
heavy objects, using marijuana or taking medication such as Midol or Aspirin
may increase bleeding, and should be avoided.
Bleeding that is not normal after an abortion would soak through several
maxi pads in one hour or soak through one maxi pad every half hour for
more than two to three hours. If this should happen, please call the clinic.
If bleeding is heavy, it is helpful to lie down for a while and put up
your feet; increased bleeding may happen after a short period of increased
activity, exercise etc. Wearing sanitary pads may sometimes make it seem
that there is more bleeding than normal. If you are concerned, call the
clinic at the numbers in the instructions.
Cramping after an abortion is normal. The uterus was enlarged and is
returning to its normal size. Cramping can occur off and on for two to
three weeks after the procedure, and may be worse than period cramps.
Many women complain of increasing cramps on the third or fourth day after
the abortion and when they pass clots. Some women do not have cramps.
Some have a feeling of pressure in their lower abdomen or pain in their
lower back or inner thighs. This is normal.
To ease the cramps
- Take one or two tablets of Tylenol extra strength with one or two
tablets of ibuprofen, every 4 hours
- Triatec 8 (Tylenol with codeine) is available over the counter and
may be taken as one or two tablets every 4 hours, as long as you are
not allergic to codeine
- If you usually take Anaprox, ask our doctor for a prescription
Other things that may be helpful are:
- a heating pad on the sore area
- drinking warm fluids
- walking around
- bringing knees to chest with hips up, and changing position frequently
If all this does not relieve the cramps, please call us.
The cervix may remain slightly open for a few days after the abortion
- anything put into the vagina may cause an infection. We recommend that
for one week you follow these instructions:
- no tampons ; use only sanitary pads
- no sexual intercourse with penetration
- no swimming in public pools, no hot tubs or Jacuzzis, no vaginal
- no tub baths ; showers only if you had a second trimester (i.e. 14 weeks or more) pregnancy
If you were to develop a uterine infection, it would most likely occur
two to three days after the abortion. Infections that are detected early
can be treated easily and effectively, often with oral antibiotics. The
usual signs of infection may include fever (of 38°C or more), lower
abdominal tenderness, and abnormal vaginal discharge.
We may prescribe antibiotics to take after the procedure:
Doxycycline / metronidazole / amoxicillin/ azithromycin are antibiotics
to prevent infection and should be taken as directed.
Misoprostol may be given to help contract the uterus and decrease bleeding.
It may cause increased cramping, and it may be helpful to take Triatec
or ibuprofen (Advil or Motrin) with the medication.
Hormonal changes: post-abortion syndrome
There are a few hormonal changes that occur immediately after an abortion
that lead to a syndrome we see with most women, and this is a normal part
of the post-abortion period.
Commonly, women have little to no bleeding for the first two or three
days following the procedure; the cramping usually returns by day 3. Usually
on the fourth or fifth day after the procedure the cramping gets worse
and bleeding becomes heavier, often accompanied by clotting. Abdominal
bloating and breast tenderness often get worse and do not go away entirely
for up to two weeks. Women who had a second trimester pregnancy may have
discharge from their nipples. There is no medical treatment for this and
we recommend that women not squeeze their nipples to relieve the discomfort.
Comfort measures include taking an anti-inflammatory and using cold compresses.
The body temperature increases slightly (to 38°C) for 24 hours
and it is normal to feel feverish or have chills. Women sometimes feel
a bit depressed around this time and some say they feel like crying. It
can be good to rest, treat the symptoms as suggested above, and wait for
them to pass. The syndrome usually lasts for 48 hours.
Most symptoms disappear within a week. Nausea is the first to go, usually
within 24 hours. Some women find that their breasts become painfully swollen
and hard, and some women have discharge. This eases after several days
and is usually gone within two weeks. You should not squeeze or massage
the breasts as this makes it worse. Wearing a snug support bra, putting
ice packs on for 10-20 minutes a few times daily and taking Tylenol may
ease discomfort. Abdominal bloating also gets worse in the first week
and resolves after two weeks.
Resuming normal activities
Some women return to work or school the day of their abortion. Some take
it easy for the rest of the day. Most feel better after a good meal. We
recommend waiting a few days before resuming more strenuous activity such
as high impact fitness activities. Respect your limits.
Resuming sexual activity
Some women are ready to resume sexual activity right away and some find
it takes a few weeks to become comfortable again with penetration. Women
sometimes experience cramping or bleeding with intercourse in the first
month or two, and this is normal. Listen to your body and your needs.
It is important to remember that fertility returns within 7 to 10 days,
even if there is bleeding.
It is possible to get pregnant as early as 7-10 days after the abortion.
We will help to provide and review instructions for the contraceptive
method chosen. We recommend that couples always use a condom if no other
method is used; we do not recommend withdrawal or the calendar method
as effective modes of contraception as ovulation can occur spontaneously
at any time. The condom must be used with spermicide (or with diaphragm
and spermicide) to have 98% effectiveness. We are usually able to supply
a sample of the birth control pill, the contraceptive patch or the Nuva-Ring
if this method is chosen. The first pill should be taken on the first
Sunday following the procedure whether there is bleeding or not, and the
patch is also on the first Sunday after. Depo-provera by injection
is available here. The IUD or Mirena system may be inserted
three weeks after the procedure. Emergency contraception (Plan B) is available at the pharmacy
without a prescription.
Sexually transmitted infections, such as HIV, chlamydia, genital warts,
gonorrhoea, etc. are spread during sexual intercourse. Most contraceptive
methods, such as the contraceptive pill, do not protect you from sexually
transmitted infections; only condoms provide this protection. Safe sex
is a sign of respect, not distrust.
A routine post-abortion check-up is not required if all goes well. We
ask you to do a urine pregnancy test 3 weeks after the procedure if your
pregnancy was at 6 weeks or less and four weeks after if you were more
than 6 weeks pregnant. A urine test may give you a positive result as
it takes 3 to 4 weeks for the hormones to disappear. To avoid the possibility
of complications, we ask you to call us in the event of a positive result.
If you are worried about something, if you have questions, if you would
like to discuss contraception or if there seems to be a problem, we ask
you to call us to make an appointment or to speak to a nurse.
Next menstrual period
It is impossible to predict when the next period will be. Most women
will have a period in 4 - 8 weeks, some later. Often with the first period
women have heavier cramps than usual, heavy bleeding, clotting, clear
or brownish discharge, and some women expel pink or white tissue. The
first period often lasts longer, sometimes up to two weeks. All this is
We will ask you to avoid drinking alcohol for 24 hours after the procedure
to prevent adverse reactions to the medication we give you.
Women of childbearing age who are not immunised against the rubella virus
(German measles) should see their doctor or a community health centre
to get the vaccine.
Emotional reactions after an abortion
It is normal to have some feelings, perhaps strong ones, after the abortion.
There may be a sense of relief following the stress of the decision and
the procedure. However, it is not uncommon for a woman to have some sense
of loss and feelings of sadness. It helps to share these feelings with
Sometimes a woman can experience feelings which seem beyond her control.
She may even find herself depressed or angry to the point of crying. These
reactions can be normal for the first week or so, but if they last longer
or are very disturbing, talking to a counsellor here or getting a referral
for post-abortion counselling may be necessary.