What Is Withdrawal Bleeding?
Withdrawal bleeding is the sudden onset of menstruation within 3 days after stopping the use of IPP. It may occur at any time during or after discontinuation of IPP.
The exact cause remains unknown but it appears to be due to the drug causing a drop in progesterone levels which causes uterine contractions. These contractions are then followed by spotting and bleeding between periods.
Some women experience with withdrawal bleeding for up to 5 weeks after stopping IPP. Some women have no menstrual problems while others continue to bleed throughout their cycle.
Abdominal cramps (nausea) and/or bloating, sometimes accompanied by nausea and vomiting. This is usually the first symptom experienced by many users.
Painful or irregular vaginal discharge, which may be light pink in color or dark red in color.
Swelling of the ankles, feet, hands, legs or back.
Numbness and tingling in the extremities. This may be severe enough to make walking difficult. Symptoms may last from several hours to several days.
In some cases, women do not experience any symptoms at all until they have been using IPP for months or even years without interruption.
Helpful Tips to Stop Withdrawal Bleeding
The following tips may help you relieve some of the symptoms of withdrawal bleeding.
Rest: Make sure to get plenty of rest. This may mean cutting down on activities for a few days, but it will help your body physically and mentally heal. Remember to pace yourself during this time.
Exercise: Moderate exercise such as walking can help improve circulation and reduce stress, which can also help make you feel better.
Stay hydrated: You should be drinking lots of water anyhow, but it is even more important when your body is going through so many changes.
Acupressure: You can try self-acupressure to help relieve some of the pain and discomfort. Press and rub firmly on the fleshy webbed area between your thumb and index finger on both hands. Do this for at least one minute and repeat as needed.
Call your doctor: You should call your doctor immediately if you are experiencing chest pain, shortness of breath, severe abdominal pain or if you feel like you are going to pass out.
Withdrawal bleeding is not dangerous and does not cause an increased risk of cancer. Withdrawal bleeding only occurs when a woman is regularly using an IUD for birth control. Some women have also experienced spotting between periods when they first start using the IUD.
If you haven’t already, you should have a frank discussion with your doctor about how long you should use a back up method of birth control. This is especially true if you’ve had unprotected sexual activity with a new partner since your IUD was placed. You should also ask your doctor if you should be tested for STIs during your next visit.
The IUD (Intra Uterine Device) is a small ‘T’ shaped device that prevents pregnancy by stopping eggs from leaving the ovary or by preventing fertilized eggs from attaching to the uterus. The progestogen (a synthetic form of progesterone) in the IUD causes changes to the inside of the uterus, making it more hostile to implantation.
You should also call your doctor if you get a fever over 100 degrees Fahrenheit or have severe pain, heavy bleeding or more bleeding than a regular period.
*Progestin Only (mini-pill) regimen:
This type of birth control pill does not contain estrogen and can be a good option for some women. You should only use this pill if you have no history of blood clots, or liver or heart disease. You should also make sure your doctor is aware of all other medications you are taking, as this type of pill can interact with other medicines.
Yaz is a specific brand of birth control pill that contains the hormone drospirenone. This medication has recently come under fire due to the small increased risk of dangerous blood clots (known medically as venous thromboembolisms or VTE’s).
In some cases it can be difficult to tell the difference between normal period cramps and something that is more serious. Cramping is very common in the first one to two weeks after your period starts. If you have never experienced this type of pain before, it can be scary.
Information on this website is provided for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information on any product label or packaging. You should not use the information on this website for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should carefully read all product packaging and instructions prior to use.
What is the difference between normal period cramps and something more serious?
The cramping that some women experience when they first start their period is usually caused by menstrual cup slippage. A menstrual cup can slip lower in the vaginal canal, or even out of the vaginal canal completely. This can cause cramping, as well as a mess if the cup is empty and slips out of the vaginal opening.
Blood can also seep out of the vaginal opening, even in small amounts.
If you’ve just started your period, you may want to wear a pad until your period is at its heaviest, especially if it’s your first time using a menstrual cup.
This person should be ready to help you if something goes wrong. This person does not need to know the details about your abortion experience. They will take you into a room to ask you some questions about your medical history and to do a vaginal exam.
The health care provider will use an instrument called a speculum to hold the walls of the vaginal apart so that they can see the walls of your cervix.
A few minutes after the health care provider gives you the medication, you will begin to feel pain in your lower abdomen and lochia (vaginal discharge) will leak out of your vaginal opening.
Once back at home, rest and apply icepacks or take a warm bath to help with any swelling or pain. You can also take over the counter pain medication such as acetaminophen or ibuprofen to help with any discomfort.
In the unlikely event that you have any heavy bleeding or other concerns, call your health care provider when you return home.
If it’s been less than two hours since your health care provider gave you the misoprostol, you can still call them and they may be able to give you a prescription for a medication to stop the abortion from continuing.
You may feel pain in your lower abdomen and lochia (vaginal discharge) will leak out of your vaginal opening.
You can definitely feel when the abortion is working, as cramping increases and you will likely have to go to the bathroom several times to pass clots.
Go to a different location than where you had the first appointment.
The sounds of the contractions and your baby moving down will both fade as your baby is passed. You may feel the sensation of the baby moving from your vaginal opening to the toilet.
You can keep it in for up to 3 hours after taking the misoprostol, though you can pass larger clots for a few days after the procedure.
Fold a pad or small towel under your hips to catch any blood that leaks out.
It’s very important that you stay off your back after the procedure. Other than that, you can go about your normal daily activities.
Misoprostol works by causing the uterus to contract and push out the pregnancy, as well as cause the cervix to expand and soften to help with the bleeding.
After the cramping and bleeding have stopped, you will pass a large clot like tissue (a ‘reacted’ abortion). This usually happens within the first hour after using the misoprostol.
The blood from the passed pregnancy is what is known as lochia. This blood will be mixed with small amounts of fetal and placental tissue over the course of several hours or days.
The sound of your baby moving within you will fade away as your baby is passed from your body.
As the abortion happens, you will most likely experience cramping and bleeding as the pregnancy is passed from your body.
It is important to note that not all of these side effects will occur in everyone and they can vary in intensity.
The most common side effect is cramping during the abortion procedure. This can be controlled in most cases with medication.
Your health care provider should give you a vaginal suppository,instructions on when to take the misoprostol and a pain medication if needed.
Misoprostol is most effective when it is used in the first 12 weeks of pregnancy. If you are further along, your health care provider will likely give you a prescription for a drug called Mifepristone as well as Misoprostol.
While the name is quite a tongue-twister, the medication is not. All you have to do is swallow one pill of Mifepristone and 2 days later (48 hours) take 2 Misoprostol tablets – one in the morning and one in the evening.
RU-486 is a medication that can be taken in combination with Mifepristone or on its own. The pills are not available at a pharmacy, so you would need to see a doctor to get a prescription and then pick it up at the pharmacy.
It is important to note that while these methods may cause an abortion, they do not always work.
You will be given antibiotics at the health care center if your abortion results in a bacterial infection. You also have a greater risk of developing a yeast infection.
Tearing (abrasions) during the abortion is possible but happens in less than 1% of cases. There is also a risk of perforation of the uterus, which is when the uterus is punctured by a sharp item.
If you smoke, there is an increased risk of complications and incomplete abortion. You should stop smoking before the abortion and for at least a week after the procedure.
A medical abortion with Mifepristone and Misoprostol will not affect your fertility. It is safe to become pregnant again after the abortion.
While a follow-up appointment is not required, it is recommended to do a checkup 3-4 weeks after the procedure.
It is important that you do not have any sexual partners for 7 days before and after taking the medication. If you do, you can get them pregnant too!
Be sure to know the date of your last menstrual cycle so you know how long along you are. You can also use an online calculator to figure out how many weeks since the first day of your last period.
The date of your last period (LMP) is the day you become pregnant. If you do not know the date of your last period, a health care provider will figure it out during your medical history & physical.
Your health care provider will place the medication into your uterus. This procedure is called a vaginal insertion. It may feel similar to a Pap smear.
You will also be given pain medication to take with you after the procedure.
Your health care team will give you written instructions on how to take the medication and what to expect.
Once you have taken the pills, unless you experience side effects, the abortion should be completed within 4 hours.
Misoprostol can sometimes cause a serious bowel condition called Pancreatitis. This happens most often when the person who is taking the medication does not follow instructions (such as taking more than the recommended dose or taking it over a longer period of time than directed). The most common symptoms are indigestion and severe stomach/abdominal pain. Contact your health care provider if you experience these symptoms.
You can experience heavy bleeding for several hours or even days after taking the Misoprostol. You should wear a pad or a pair of underwear/pants with a heavy lining. You may need to change the pad/liners often. It is also normal to experience some light bleeding for up to 2 weeks after the procedure.
You may have nausea, diarrhea, fatigue, cramping, and/or feel faint. These symptoms usually last less than 24 hours.
You should avoid heavy lifting for 1 week after the medication is inserted. You should not work or do anything that could be dangerous if you are dizzy, faint, or have a stomach ache (like driving).
If you experience any of these symptoms, seek medical attention immediately: severe abdominal pain, fever, chills, persistent nausea and vomiting, severe diarrhea.
Other side effects include: headache, fatigue, back pain, muscle aches, tenderness in the lower abdomen.
There are some limitations and risks to consider too.
Risks include allergic reaction to Mifepristone or Misoprostol. In such cases, hospitalization may be needed. Your cervix is dilating so there is a small risk of uterine rupture during the procedure requiring immediate medical attention.
This is a list of things you should and should not do after the abortion. Your health care provider will give you full instructions when you see him or her for your post-abortion check-up.
After an abortion, some women experience depression and feelings of guilt. It is natural to be sad after the loss of a pregnancy, but if these feelings do not pass, it is important to seek support from friends and family or speak to a mental health professional.
If you feel you are having any of the following symptoms and they are affecting your everyday life, seek help from a healthcare professional:
Grief that you are experiencing may be eased by expressing yourself through writing or drawing. Sometimes finding an artistic way to express your feelings can make you feel better.
Many women after an abortion find themselves with concerns about the future. This is normal and can be prevented by taking steps to ensure that you do not become pregnant again until you are ready. Discuss with your doctor what forms of birth control are best for you.
It is also advised that if you are experiencing symptoms of depression or anxiety, you should seek help from a health professional in dealing with those issues.
Most women who have an abortion feel relief and are able to move forward with their lives after the procedure.
You are likely to experience many different emotions after your procedure. It is normal to feel a sense of loss or grief, and you may feel relieved or happy. You may also have strong feelings of anger or questions about what you have done. These are all natural reactions, but the most important thing is that you are able to come to terms with your decision.
Some women feel relief after an abortion. Relief that they made the right decision for them. Helping to alleviate any fears you may have about your decision, knowing you have made the right choice is one of the most important things a supportive partner can do. It is okay to help your partner through this process, although you should avoid saying anything that implies she did something shameful or wrong by getting an abortion.
Your local Planned Parenthood health center offers free post-abortion support services to any woman who has had an abortion. This service is confidential and you do not need to give your real name. If you would like to talk to someone, you can call 1-800-230-PLAN.
The support group is a place where women who have had abortions come together in a safe environment to share their feelings, discuss any concerns they may have, and get information about birth control methods which can prevent an unwanted pregnancy in the future. It also provides each woman with a caring and supportive listener who will validate her feelings and decisions.
An abortion support group is a place designed for women who have had an abortion to talk about how they feel.
Some women find that having the support of their friends, and family makes them feel much better about their decision. Holding off on telling people you are pregnant until you feel ready can sometimes help, especially if you know the news will be met with a negative response.
Tell Your Story
The first step you can take is to tell your story. Whether you had an abortion, decided not to have an abortion, or were faced with the difficult choice of whether or not to have your pregnancy terminated, we want to hear your story. We are collecting personal testimonies for an ongoing exhibit here at A is for Abortion .
You can submit your story to us in the box provided below.
Collecting testimonies about abortion stories for A is for Abortion exhibit
If you are a minor and would like to leave your name out of the exhibit, please write that in the above box.
If you do not want your email shared, please indicate that when submitting your story.
Please answer the following questions so we may put your story on our site:
Did you have a choice in deciding to get an abortion?
How did you feel before getting the abortion?
How did you feel during the abortion?
How do you feel now? If different from before or during, why do you think that is?
What would you like others to know about your abortion?
Anything else you would like to add?
If you are submitting a picture with your testimony, please use caution when posting pictures of your IDs or any other documents that could be used to identify you. We suggest taking the cover sheet off of the top of sheets of paper to blur out any sensitive information. If you would like to submit a photograph of before or after your abortion, please do not include identifying features in the photo.
We appreciate your participation in A is for Abortion!
If you want to submit an anonmyous story, leave the name and email boxes blank. Please be aware that we may edit your story for content and clarity.
Once you hit submit, it may take a moment for your story to show up below. Thanks for participating in A is for Abortion!
Name: Email: Testimony: The Abortion Gang
“I’m thankful my parents were so supportive that they drove me all the way to Mississippi for the procedure. I don’t know what I would’ve done without their help.
I was nervous about the procedure for obvious reasons. The doctor told me it would be over before I knew it. He wasn’t lying. It wasn’t painful at all.
Afterwards I felt relieved and thankful that it was all over. My parents and I went out to eat at a nice buffet on the way home.
I’ve found that some people have negative things to say about my decision, but I don’t let it get to me. Everyone is entitled to their own opinion.”
How was school?”
my mom would ask me every afternoon.
“Good,” I would say, and leave it at that.
I couldn’t tell her that the other kids wouldn’t stop teasing me about my pregnancy. They kept calling me a slore and a skank, and they even said that I deserved to be pregnant because I was dirty.
I wanted to beat the hell out of them, but I just kept quiet and counted down the days until I could leave for summer vacation.
When the last day of school finally came, I was ecstatic. I didn’t have to see those mean girls smirking at me in the hallways anymore.
I also didn’t have to put up with teachers giving me dirty looks every time I raised my hand to answer a question. Apparently, pregnant girls shouldn’t be able to answer biology questions.
My mom picked me up after school and we drove home in silence. I always felt so bad for bringing trouble to her doorstep, but I couldn’t help it. She was the only person that I could think to turn to when I needed help.
“We need to talk,” My mom said sternly as soon as we walked through the front door.
I gulped nervously and waited for her to yell at me. I didn’t know how much more of her disappointed stares I could take.
Shouldn’t you be taking care of this?”
she asked, holding out a pregnancy test that I hadn’t seen her holding before.
I snatched it from her hands and looked at it. Positive.
“I can’t believe this… You’re only fourteen!
What am I supposed to do now?
!” my mom yelled, on the verge of tears. “You’re not even able to take care of yourself, let alone a child!”
I didn’t even know what to say to her, I was in shock.
Give me something here! I’m supposed to be able to count on you to speak your mind!” my mom said before bursting into tears and running upstairs to her bedroom.
I laid down on the couch, still clutching the positive pregnancy test that would change everything.
A few days later, my mom dropped me off at the airport with a one way ticket to Mississippi.
Sources & references used in this article:
Compliance considerations with estrogen replacement: withdrawal bleeding and other factors by RG Hahn – American Journal of Obstetrics & Gynecology, 1989 – ajog.org
Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial by L Miller, JP Hughes – Obstetrics & Gynecology, 2003 – Elsevier
Is the timing of withdrawal bleeding a guide to endometrial safety during sequential oestrogen-progestagen replacement therapy? by DW Sturdee, DH Barlow, LG Ulrich, H Gydesen… – The Lancet, 1994 – Elsevier
Women’s opinion on withdrawal bleeding with hormone replacement therapy by R Barentsen, F Groeneveld, FP Bareman… – European Journal of …, 1993 – Elsevier
Signalling possible drug–drug interactions in a spontaneous reporting system: delay of withdrawal bleeding during concomitant use of oral contraceptives and … by EP Van Puijenbroek, ACG Egberts… – British journal of …, 1999 – Wiley Online Library
Relationship between sonographic endometrial thickness and progestin-induced withdrawal bleeding by S Nakamura, T Douchi, T Oki, H Ijuin, S Yamamoto… – Obstetrics & …, 1996 – Elsevier
Factors associated with withdrawal bleeding after administration of oral micronized progesterone in women with secondary amenorrhea by MM Shangold, TP Tomai, JD Cook, SL Jacobs… – Fertility and sterility, 1991 – Elsevier
Women’s attitudes to withdrawal bleeding and their knowledge and beliefs about the oral contraceptive pill by W Rutter, C Knight, J Vizzard, M Mira… – Medical Journal of …, 1988 – Wiley Online Library
Postponement of withdrawal bleeding in women using low-dose combined oral contraceptives by JVTH Hamerlynck, JA Vollebregt, CM Doornebos… – Contraception, 1987 – Elsevier