Ask a doctor on the topic of Gynecology

medication abortion and its consequences

May 6, 2011 | 10,00 EUR | answered by Dr. med. Ralf Berg

05.05.2011
Good evening,
my girlfriend had a medical abortion with Cytotec and Mifegyn three weeks ago...
since then, she has been experiencing strong pains repeatedly and according to the gynecologist, there is still a little bit left that has not been expelled, although the pregnancy was definitively terminated on the day of the abortion, with no remnants of the fetus remaining!
she then received 4 more Cytotec pills to help expel the remaining tissue. She was instructed to take 2 pills each on two consecutive days, which resulted in heavy bleeding on both days that then decreased and then increased again...
my girlfriend continues to suffer from strong lower abdominal pains and during a further examination last Monday, her gynecologist prescribed Bella Hexal 35 since there are still remnants present that have not been expelled. According to the gynecologist, she should take Bella Hexal 35 for at least 2 weeks and then stop so that her period can come and bleed heavily to expel everything...
what is currently worrying us are the unbearable pains in her lower abdomen that radiate along the inner sides of the pelvic bones (a stabbing sensation) which worsen when walking, she also experiences pain when taking deep breaths and sitting is also painful...
the bleeding has been somewhat inconsistent for a few days, sometimes a little more and then a little less...
according to her doctor, she can do whatever she wants, including sexual activities. We specifically asked about this, and the doctor told us that it can help psychologically, but we have now read that nothing should be done in the first few weeks at all! However, today, for example, we did something with our fingers, and a few hours later these intense pains occurred, could this be related???
is it harmful if not everything has come out yet or is it dangerous???
what about a follow-up procedure??? because even her gynecologist and the substitute had very different opinions on that!
we are extremely unsure and absolutely want to avoid any kind of operation!
Especially because she has experienced subsequent damage, such as severe period pains, inability to get pregnant again, miscarriages, etc., and she is only 22 years old.
we would appreciate a quick response and hope that you can help us and tell us what else we can do to alleviate the pain (she has been prescribed Ibuprofen 800 for the pain).

06.05.2011

Today the pain is not quite as intense and mainly on the right side.
Her gynecologist, who specializes in medical abortions, has now prescribed her the pill for at least 2 weeks. My girlfriend has also sought advice from another doctor who has a completely different opinion from the gynecologist. He mentioned that the last remnants (not the gestational sac or embryo, but simply mucus remnants located at the bottom of the cervix) need to be removed urgently and one should not wait too long. Now I don't

Dr. med. Ralf Berg

Dear Inquirer,

I can really imagine that as someone affected and not a medical professional, you may now feel completely confused and uncertain after this somewhat unfortunate sequence of events. In medicine, there are often several ways to reach the goal. Therefore, there are also different opinions among medical professionals when there are different treatment options available, especially when the alternative is either a surgical approach or a conservative approach without surgery.

Initially, a surgically induced abortion, as well as a dilation and curettage (D&C) procedure, which would be the case for you, do not necessarily always lead to uncontrollable lower abdominal pain or infertility. Of course, there have been cases where this has happened. And since there is also the possibility of a medical abortion, it is important to thoroughly inform the woman/patient about the risks, even if they are very small.

The problem in your case is that you opted for a conservative method with tablets, but it did not work completely. Even the previous attempts with tablets were not entirely successful. If you absolutely do not want surgery, you may agree with the approach suggested by your gynecologist.

However, it is my duty to also point out to both of you that in my opinion, your risk assessment regarding surgery (D&C) is not realistic. Not only in cases of intentional abortion, but also in cases of miscarriage, this procedure (D&C) is performed as a standard routine treatment under short anesthesia. The risk is even lower than with an appendectomy. The idea that everything will be damaged below after this procedure is simply not true. The intention with the pill is the same as with the scalpel: to detach the uterine lining (corpus and cervix, of course) and any remaining pregnancy tissue. This is a process that naturally occurs in the menstrual cycle and is otherwise perceived as a regular period.

From your letter, I can see that you would have preferred instructions or advice on further medical treatment. But I must honestly give you my independent opinion.

1. I would agree with the colleague who recommends surgery for you.
Reasons: the medical treatment is not working well for you.
2. Given the long time that has passed, I consider a D&C to be a safer method to remove any remaining pregnancy tissue.
3. You can continue with the chamomile baths, but I do not believe this is the best method.

Perhaps this is a suggestion for you to consider:
Gather your courage and determination and present yourself at the gynecological outpatient clinic of a hospital. If they also recommend a D&C there, please take this into consideration in your thoughts and decisions.

With many regards,
R. Berg