Physical Recovery After an Abortion
These instructions are for recovery after a surgical abortion. Most of them apply to a chemical (medical) abortion as well. Okay, so you've just had an abortion? What physical warning signs should you look for? What can you do, to take care of yourself afterwards as you recover? What about fertility? How soon could you possibly get pregnant again?
On taking care of yourself - Basic things you can do:
- Drink lots of fluids
- Stay off work for a few days if you can
- Take vitamins, eat healthy food, and try to sleep
- Take the antibiotics prescribed by your doctor right away, and for the full amount of days prescribed!
- No exercise for two weeks
- No swimming or tub baths for 2 weeks
- Don't lift anything over 15 pounds for two weeks, don't use ANYTHING vaginally for 2-4 weeks - no sex, no tampons, no douches.
- You can ovulate as soon as two weeks after an abortion, which means yes, you could get pregnant again within two weeks after an abortion!
- After the 2-4 weeks is over, you should NOT have sex again unless you feel physically recovered, and have discussed with your partner what you want to do if an unplanned pregnancy occurs again. Do NOT let yourself be pressured into having sex again before you are physically and emotionally ready, and have had a serious discussion about the course of action for future unplanned pregnancies. You can get pregnant as soon as two weeks after an abortion! Your body normally will go back to it's regular cycle, and release an egg (ovulation) at 2 weeks post-ab. So once you decide you are ready to resume sexual intercourse again, make sure you are using birth control right away. As many of us know, birth control is NOT 100% effective. So it's very important that you don't have sex again until you are healed physically and emotionally, and you have a clear consensus on what will happen if you become unexpectedly pregnant again.
- For women who had an abortion for maternal health reasons, or for a poor prenatal diagnosis, consult your doctor about birth control and future pregnancies.
- If you were 9 or more weeks along in the pregnancy, it is possible that you may have trouble with milk, or a milky fluid leaking from your breasts after the abortion. The further along you were, the higher the chance of having your 'milk come in'. This can be upsetting, but it won't last for long. It's a normal effect of the hormones that your body releases when you are no longer pregnant. These hormones make your body start to produce milk, whenever a pregnancy is ended. Your breasts may feel sore, tight, swollen, and will leak out droplets of clear to whitish fluid. At times the milk may 'let down', and a substantial amount of liquid may come out. To help with this stage, wear a well-fitting/snug bra, and try avoid stimulation of your breasts or nipples. Wear the bra 24 hours a day until your milk dries up. It can take one to four weeks for the milk to dry up. It will not be as painful as it originally feels when the milk first comes in - as the milk is not 'used' the pressure on the milk ducts will cause the milk to 'dry up'. Keep wearing that snug-fitting bra, and take tylenol for the soreness, and this will subside. If you develop a fever, or extreme tenderness in either of your breasts, consult a doctor - there is also a condition where your milk glands can get infected, and this will need to be treated with antibiotics. (This is a rare complication).
- Visit the Recent Abortion Support Board, or the Medical Questions & Problems Board to discuss any of these issues in more detail: Message Board Index
How important is that 2 week check-up afterwards?
It's VERY important! Why?
- It's important that a doctor check you out, and make sure there is no infection in your uterus.
- It's important to see if you are healing properly
- It's important to see that your cervix has 'closed' completely - this takes two weeks or longer after an abortion. Once your cervix has returned to it's normal 'closed' state,then it is safe for you to swim, take a bath, have intercourse, ect. When your cervix is still 'open', there is a chance that bacteria can get up into your uterus, and cause painful and possibly damaging infections.
- It's important to make sure that the abortion was 'complete'. Sometimes there are cases where tissue is still retained - it can be called a 'missed abortion', or an 'incomplete abortion'. This is serious if it does happen, and usually requires you to immediately undergo another D&C to remove the remaining tissue.
Don't avoid the checkup, it could lead to serious pain and complications later! Some women have stated that they cannot bring themselves to return to the clinic again for the two week check-up. That's okay, then call your regular gyn doctor, and tell them you need a check-up right away. When you tell them you've had an abortion, they will pressure you to go back to the same clinic that performed the abortion for the checkup. Because of malpractice issues, doctors don't like to follow up on other doctor's work - but be firm that you CANNOT go back to the clinic, and that you need to be seen. They'll tell you they can't see you, but be firm, and say that you CANNOT ever go back to that clinic, for your own personal reasons - and insist that the doctor see you. If that doctor refuses, then call a new doctor from your health plan, or the yellow pages. Tell this new doctor that you have just switched insurance, and need to be seen. Complain of pain, bleeding and cramping and once you are with the doctor, you can tell the truth about what is going on. There will be a doctor out there who will see you. Just realize that for insurance purposes, they will try as hard as they can to push you to go back to the clinic. If you don't want to go, push back until you find a Doctor that will see you. Don't let them bully you into just skipping your check-up. I used to be extremely embarrassed to say anything to my doctors about my abortions - when I finally told one the truth, I was surprised that he made no comment at all and just noted it on the chart. For some reason I expected a lecture, or judgement or criticism - instead it was like nothing at all, which is how the doctor should react. Most are very non-judgmental, and won't make inappropriate comments when you tell them you've had an abortion.
Physical Symptoms after an abortion that are cause for concern:
- Fever over 100 degrees that doesn't respond to medication - if a fever is present for 48 or more hours, over 100 degrees, call your doctor.
- How much bleeding is normal?:
- bleeding should be no heavier that a heavy flow period at worst.
- small clots are ok, like a quarter or grape size.
- bigger clots are a danger sign, like an apricot, orange or bigger
- bleeding should stay the same or get lighter it should never get heavier - this is a possible danger sign.
- bleeding lasts anywhere from 3 days to 5 weeks after the procedure.
- If the amount of bleeding increases, or if the color of the discharge changes back to a bright red, indicating 'new' bleeding, you should call your Dr. for an appt. to be checked. In the meantime, if you have been doing too much activity, or lifting things, return to bedrest, (or couch rest :), elevate your feet. Stay in bed, let the chores wait, order pizza for dinner, ect. You've had a surgical procedure, and it's important to take good care of yourself physically, and not try to do too much right away.
- Cramping and pain worse than normal heavy menstrual period - there will be some painful cramping, and soreness. If the pain is excessive, or doesn't respond to pain medicine, call your doctor.
- Discharge of tissue
- Foul-smelling vaginal discharge
- Abdominal swelling and/or tenderness
- Continued strong symptoms of pregnancy
- Change in bowel or bladder habits, especially lack of bowel movements
- Blood in stool or urine
- Bleeding from IV sites (call ambulance!)
- Dizziness, fainting, nausea
- There is also a physical complication, called "Postabortal Syndrome" that refers to the blocking of the cervix by either tissue or clots immediately after the procedure, and this can be dangerous, as it does not allow the proper normal evacuation of the uterine comtents, and does not allow the uterus to return to normal size.
Details below from:
Postabortal Hematometra - What Is It?
Postabortal syndrome (also called postabortal hematometra) is severe cramping and discomfort due to the collection of blood in the uterus that can occur following evacuation of the uterus. Postabortal syndrome can present either immediately following the procedure or several days later.
What Causes It?
Normally, following a curettage or aspiration, the endometrial lining and any remaining pregnancy tissue flow out through the cervix. In the case of postabortal syndrome, after the procedure:
The cervical os becomes blocked.
The uterus fills with clots and continues to bleed.
The uterus cannot contract.
What Are the Symptoms and Signs?
The symptoms include:
Vomiting and diarrhea (occasionally)
On exam, the patient may exhibit the following signs:
Uterus is tense, tender, and enlarged on bimanual exam (often equal to or larger than the uterine size before the procedure)
If postabortal syndrome occurs immediately following the procedure, the client generally reports increasing cramping and discomfort rather than the expected decreasing of these symptoms. With delayed onset, the client will usually report feeling well until the sudden onset of symptoms and signs, often with very light or no bleeding following the procedure.
How Is It Treated?
Prompt reevacuation of the uterus produces rapid relief of symptoms. Aspiration will yield blood and clots. There is rarely any remaining pregnancy tissue; however, it should be ensured that the uterus is completely evacuated.
What should you do if you get these symptoms? Call your local emergency room and ask for the "Triage Nurse". These above symptoms are like chest pain -- they can be absolutely no cause for
concern, or they can be a sign that your life is in immediate danger. Only
trained medical personnel can distinguish. The only exception is bleeding
from IV sites, which is a sign of Disseminated Intravascular Coagulopathy
and can be very serious. If you have bleeding from your IV site, call an ambulance and tell them about the abortion and the bleeding from IV sites. If you don't want to talk to the Triage nurse, then call your doctor, and talk to him about it. Clinics will normally brush women off after a procedure, and are known for minimizing post-procedure problems. If you feel like 'something is wrong', trust your instincts and go to a doctor. Or you are having some of the warning signs above, call the Triage Nurse at your local E.R. It's better to be safe than sorry, with medical issues.
For friends and family members - if something seems wrong with your woman who has recently had an abortion, the fact that she is convinced that there's "no cause for alarm" might mean she's going into shock. Women can pass out from hemorrhage --she's lying on the floor, lapsing in and out of consciousness -- telling the paramedics that "she's just fine and that she doesn't want to go to the hospital". Take her anyway! If YOU are alarmed and she's not even concerned, that's a bad sign. Far better to get a professional to check her out.
Most abortions are safe and uncomplicated, and most women have no physical problems afterwards. But like any surgical procedure, there are risks, and there are possible serious complications. So if you don't "feel right", or are worried that something might be wrong, call a doctor or your local ER. Don't worry about being embarrassed or ashamed about calling and telling what is going on with you, or that you've had an abortion. I know for most of us it IS a thing we are embarrassed about, and we will do anything to avoid letting anyone know we have had an 'abortion' - but call and talk to the triage nurse at your local ER anyway. They won't mind, that's what triage nurses are for, to judge whether a problem needs immediate medical care or not.
In the Weeks that follow:
The pregnancy hormones that your body generates to keep you pregnant start to dissipate after the pregnancy has been terminated. Depending on how far along in the pregnancy you were, and how sensitive you are to hormones, you may have pregnancy hormones still in your body for up to a year after an abortion. For the first 2-4 weeks following the abortion, your hormones will make you feel like you are on an emotional rollercoaster ride. You may:
- Cry at the drop of a hat, and for no reason
- Still have problems with nausea
- Still have problems with tiredness and weakness
- May still feel slightly pregnant and swollen
- May still test weakly 'positive' on a pregnancy test
- May feel extremely depressed
- May have no appetite, and no desire for food
- May have trouble sleeping, or concentrating,p>
After the first month, the pregnancy hormones are still there, and are slowly leaving your body. It can take from 6-24 months after an interrupted pregnancy before your body and hormonal systems feel completely 'back to normal' again. This means:
- Each month, your period may come at a different time, even if it was regular like clockwork before. It may come in 25 days, then not come for 35 days, and may be different every month, and may be completely different from your 'normal' period.
- The length of your period (amount of days during which you bleed) may vary from month to month
- The amount of bleeding, and the amount of cramping you have may vary from a little to a lot, and may be different every month, and may be completely different from your 'normal' period.
- You may feel signs of pregnancy again each month before your period starts, which could include: swollen and tender breasts, nausea, tiredness, cravings for foods, fullness in the uterine area, frequent urination, back pain and stronger than usual PMS.
- Your cervix may feel 'tender', and sex may be difficult or painful
- All of these above symptoms and occurrences have been reported again and again by women visiting this site. However if you are having sex, it is also possible for you to become pregnant again, and technically you can get pregnant again within two weeks after an abortion, you can also get pregnant while you are 'having your period'. So be very careful, use lots of birth control, and we know that even birth control is not 100% effective. I recommend having 'alternative' forms of sex when possible. If your partner is loving and understanding, he should be able to work with you while you recover, and find alternate ways to enjoy each other, without slowing your physical recovery, and allowing you the chance for closeness without doing things your body is not ready for.
Some women are extremely sensitive to pregnancy hormones, and this can cause depression, and even severe prolonged depression which may require a doctor's treatment. If two months have passed since your abortion, and you are still having trouble with depression, you should seek out treatment from a doctor. Also, if there is a history of Post-Partum Depression, or Pre-Menstrual Dysphoric Disorder (formerly known as PMS) for you, or any women in your family, be especially alert to this. The same hormones that cause PPD and PMDD are the ones active in your system after an abortion, and can cause severe depression if your system is sensitive to these hormones.