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When do menstrual periods restart after abortion or miscarriage.

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Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus.Abortions are low risk medical procedures that end pregnancies. It is normal to experience bleeding right after having an abortion, but a woman's first period will usually occur several weeks later.

Miscarriage is when an embryo or fetus dies before the 20th week of pregnancy. Everyone's experience of pregnancy loss is different. Many need time and support to recover before they try to conceive again. Others may wish to become pregnant as soon as possible.

The main aim of this article is to discuss how abortion and miscarriage affect the menstrual cycle.

What is post-abortion bleeding?

Many people experience some bleeding after having an abortion. Doctors call this post-abortion bleeding. It is a good idea to use pads after an abortion to track how much blood is resulting.

The two main types of abortion are medical and surgical. Here, we discuss these types of abortion and bleeding that women may experience afterward.

Bleeding after a medical abortion
A medical abortion is when the doctor gives a woman abortion pills to end her pregnancy. This type of abortion is available in the first 10 weeks of pregnancy.

During a medical abortion, the doctor gives a woman two pills:


  • mifepristone to stop the pregnancy developing
  • misoprostol to trigger the uterus to expel the pregnancy tissue

Misoprostol causes the uterus to contract, which forces the pregnancy tissue to pass out through the vagina. This treatment results in bleeding, which can be similar to having a heavy period. Some people experience heavier bleeding than others, and it may contain large blood clots.

A woman may then experience spotting or light bleeding for up to 2 weeks after the pregnancy tissue passes out.

Bleeding after a surgical abortion

Surgical abortions typically take place after week 10 of pregnancy. There are two types of surgical abortion:


  • vacuum aspiration, which involves removing the pregnancy by the use of suction
  • dilation and evacuation, which involves dilating the cervix with forceps and removing the pregnancy with suction

Doctors usually use vacuum aspiration up to around 14–16 weeks after a woman's last period. After a longer time, they will generally recommend dilation and evacuation.

Surgical abortions can also cause post-abortion bleeding, which may be similar to a normal period. Bleeding after a surgical abortion usually lasts around 1–2 weeks. Some women may experience spotting up until their next period.


How does abortion affect the menstrual cycle

A woman will usually have her next period 4–8 weeks after having an abortion. The abortion empties the uterus, so restarts the menstrual cycle.

The start date of a woman's next period will depend on whether she is using birth control and, if so, which type.

If a woman's periods do not start within 8 weeks of having an abortion, she should speak to her doctor.


Does abortion cause irregular periods?

Some birth control methods may affect the regularity of periods after an abortion. If a person typically has irregular periods, they may continue to experience these after an abortion.

Having an abortion can lead to emotional stress, which may also affect someone's menstrual cycle. Experiencing stress can change the regularity of periods.

If a woman has irregular periods after an abortion and did not previously, she should speak to her doctor.


How does miscarriage affect the menstrual cycle?


After a miscarriage, the menstrual cycle restarts, and many women will have their first period 4–6 weeks later. However, it can take several months for the menstrual cycle to return to how it was before pregnancy.

It is normal to experience some bleeding after pregnancy loss. The first day of bleeding is day 1 of the new menstrual cycle. Bleeding or spotting may continue for around a week after this.

Ovulation may occur around 2 weeks into this new cycle. Day 14 of the menstrual cycle is when ovulation typically occurs for women with regular periods.

Women are most fertile 3–5 days before ovulation till around 1–2 days after ovulation.

According to the American College of Obstetricians and Gynecologists (ACOG), women can ovulate as soon as 2 weeks after a miscarriage, if it occurs within the first 13 weeks of pregnancy.

If miscarriage occurs in the later stages of pregnancy, their cycle may take longer to adjust.

However, exactly when ovulation occurs will vary from person to person. For example, women who had irregular periods before pregnancy may find that their periods remain irregular.


Signs of ovulation

There are many signs of ovulation. Some are quite easy to look out for, but their reliability can vary. These signs can include:

vaginal discharge that appears clear, gloopy, and wetter than usual
breast tenderness
bloating and abdominal cramping
Other signs of ovulation require a little more effort to monitor. These can include measuring and recording basal body temperature and levels of luteinizing hormone (LH). We discuss both of these below:

Tracking basal body temperature

People can work out roughly when they are going to ovulate each month by tracking their daily basal body temperature. For most people, the temperature reading will be 0.5–1.0°F higher when ovulation occurs and will then return to normal 1­–2 days before their period starts.

To use this method, a person needs to measure and record their temperature each day using a basal body thermometer. It is best to take the reading at the same time every morning, ideally before getting out of bed in the morning.

Rectal thermometers are usually more reliable than oral thermometers. Because the change in temperature is typically very small, it is important to use a thermometer with an accurate and easy to read scale.

Basal body thermometers are available in pharmacies, and a person can also purchase them online.

There are also many smartphone apps that allow people to easily record their basal body temperature and track their fertility cycles. Some thermometers even come with their own apps.

Tracking basal body temperature over multiple cycles can help a person predict when ovulation is likely to occur.


Testing for LH

Another way to predict ovulation is by testing for levels of LH in the urine.

When LH levels rise, it causes the ovaries to release an egg. LH levels typically begin to surge around 36 hours before ovulation.

A person can purchase ovulation predictor kits from drug stores as well as online.

The kits normally comprise a number of test sticks and a sterile container. To use, urinate on one of the tests strips and then place it in the container.

A change in the color or appearance of the plus symbol indicates a positive result. A person may need to test LH for several days before they detect a surge.


What to expect for the first period after abortion

After a surgical abortion, a woman's first period may be shorter than usual. The abortion procedure fully empties the uterus, so there is less tissue to expel, which can result in a lighter period.

A women's first period may be longer than usual, following a medical abortion, because the treatment uses hormones that may impact her cycle length. This period can also be heavier as the body may have additional tissue to expel after the procedure.

Using pads during the first period after an abortion allows a woman to monitor the amount of blood she is losing.


What to expect for the second period after abortion

The second period after an abortion is likely to return to how an individual's periods were before.

That said, some women may find that it takes two or three cycles for their periods to return to normal. If this does not happen, they should speak to their doctor.


When can you start birth control after abortion?

Women can start using birth control straight after an abortion. If they want to use an intrauterine device (IUD), they can ask a healthcare professional to fit one during the same appointment as the abortion.
IUDs are an effective form of birth control. Both hormone-free copper IUDs and hormonal-plastic IUDs are available.

The advantage of copper IUDs is that they do not affect mood, but they may cause heavier periods.

Hormonal IUDs may lighten periods but, as with all hormonal contraception, they may affect mood.

Condoms offer a reliable hormone-free contraception method that does not require surgery.

Which contraception method to use is a personal choice, and different options work for different people.


When to see a doctor after abortion

If a woman experiences very heavy bleeding after an abortion or pain that is not manageable with over-the-counter pain medication, she should speak to her doctor.

Blood clots up to the size of a lemon are normal during post-abortion bleeding. Blood clots that are larger than this are something to discuss with a doctor.

Symptoms that may include dizziness, sweating, and nausea during or after an abortion are typical. However, women who feel very faint or have a high temperature should talk to their doctor.

If a woman experiences any symptoms that worry or alarm her, speaking to a doctor for reassurance is a good idea.


When is it safe to conceive again after a miscarriage?

When a woman tries to conceive again is a personal decision. Some people try again straight away, but others prefer to wait.

The World Health Organization (WHO) advise waiting at least 6 months to reduce the risk of low birth weight, maternal anemia, and preterm birth.

However, one 2017 systematic review suggested that conceiving again within 6 months of pregnancy loss may actually lower the risk of:


  • miscarriage
  • preterm birth

Also, the ACOG state that there is no medical reason to wait before trying to conceive again. However, they do explain that waiting until after a woman has her first period can make it easier to calculate the due date.


Are people more fertile after a miscarriage?

Scientists are not able to say with certainty exactly how miscarriages affect a person's fertility.

Every woman experiences a different level of fertility after a miscarriage, which makes it difficult to draw conclusions.

For example, a study from 2003 suggested that getting pregnant is easier than usual in the first cycle after an early miscarriage. However, another study from 2005 suggested that miscarriage may slightly reduce subsequent fertility.


How likely is another miscarriage?

Although it is possible to have more than one pregnancy loss, multiple miscarriages are rare. According to the ACOG, around 1% of women experience repeated miscarriages.

Around 60% of miscarriages occur randomly, and there is no medical reason for why. Less commonly, certain genetic problems and medical conditions can increase the risk of repeated miscarriages.

Women who have experienced a miscarriage should discuss the possible reasons with a doctor, who can test for any underlying causes.


Having more than one miscarriage does not mean that having a baby is unachievable. In fact, around 65% of women who experience multiple unexplained miscarriages go on to have healthy babies.


Summary

On Abortion.

Abortions lead to the menstrual cycle restarting. Most women get their period 4–8 weeks after an abortion.

The first periods after a medical abortion may be heavier and longer than before. The first period after a surgical abortion may be shorter and lighter.

If a woman's periods do not start 8 weeks after an abortion or return to normal after 3 months, she should see her doctor.


Post-abortion bleeding is normal. If this is very heavy, continues for more than 2 weeks, or contains blood clots larger than a lemon, a woman should speak to her doctor.


On Miscarriage.

Miscarriage restarts a woman's menstrual cycle, with the first day of bleeding being day 1 of the new cycle.

Ovulation tends to occur around day 14 of the menstrual cycle. However, the exact time of ovulation varies among women, and it may take several months for their cycle to return to normal after pregnancy loss.

Women who had irregular cycles before pregnancy may continue to experience irregular cycles after a miscarriage. Early miscarriage is less likely to impact the regularity of the menstrual cycle than miscarriages that occur later in pregnancy.

Signs that a woman is ovulating can include abdominal cramps, breast tenderness, and clear, gloopy vaginal discharge. However, testing for LH and tracking basal body temperature are more reliable ways to predict ovulation.


Knowing when ovulation is likely to occur can help people understand when in their cycle they are most fertile. This information is useful when trying to plan or avoid pregnancy.

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