Objective: To prospectively determine patterns and predictors of bleeding after early abortion with mifepristone and misoprostol or manual vacuum aspiration (MVA).
Methods: Women fewer than 63 days from the last menstrual period and desiring termination of pregnancy were offered medical abortion with 200 mg oral mifepristone and 800 micrograms oral misoprostol or MVA under local anesthesia. Women completed a bleeding diary during the six weeks after abortion. Telephone calls were used to encourage diary completion and determine contraception use.
Results: 212 women were enrolled, 80% of whom completed diaries. Mean days of bleeding was higher in the medical (14 days) than MVA (9 days) group, but days of spotting (about 10) was similar in both groups. Increasing gestational age predicted more bleeding or spotting days after medical, but not MVA, abortion. Prolonged bleeding was not rare and was more common in the medical than the surgical abortion group. Combined oral contraceptive (COC) users and non-COC users had similar bleeding patterns after medical or surgical abortion.
Conclusion: Bleeding after early medical abortion persists longer than after MVA and continues longer than previously appreciated regardless of method. Oral contraceptive use does not decrease bleeding after early medical or surgical abortion.