Photo Credit: Valentina

The following is a summary of “Patients’ experiences with pain and bleeding in first-trimester abortion care,” published in the February 2025 issue of American Journal of Obstetrics & Gynecology by Mahoney et al. 

Although abortion care is safe and common, and while some pain and bleeding are expected, patient experiences with these symptoms can impact satisfaction, and research characterizing factors associated with severe pain and heavy bleeding with current methods remains limited.  

Researchers conducted a retrospective study to identify clinical predictors of patient-reported heavy bleeding and pain in individuals undergoing first-trimester abortion.  

They performed a secondary analysis of 644 individuals undergoing medication or procedural abortion up to 11 week. The primary outcome was self-reported severe post-abortion pain, while secondary outcomes included bleeding severity and discrepancies between expected and actual pain and bleeding. Logistic regression models were used to evaluate clinical factors linked to severe pain, heavy bleeding, greater-than-expected pain, and heavier-than-expected bleeding.  

The results showed that among 644 eligible individuals, 516 (80%) responded, including 347 (67%) had medication abortion and 169 (33%) had procedural abortion. Severe pain was reported by 25.0%, heavy bleeding by 35.0%, pain exceeding expectations by 31.6%, and heavier-than-expected bleeding by 33.5%. Factors most strongly linked to severe pain included medication abortion (OR=4.69 [95% CI: 2.56-8.58]), history of severe menstrual pain (OR=2.60 [95% CI: 1.38-4.89]), and positive depression screening at baseline (OR=2.13 [95% CI: 1.18-3.85]). Independent risk factors for pain exceeding expectations included first abortion experience (aOR=2.03 [95% CI: 1.18-3.48), nulliparity (aOR=2.21 [95% CI: 1.26-3.85]), prior cesarean delivery (aOR=2.06 [95% CI: 1.14-3.72]), and baseline depression (aOR=1.72 [95% CI: 1.05-2.82]), adjusting for gravidity, abortion method, and care location. Self-reported heavy bleeding was most strongly associated with medication abortion (aOR=9.19 [95% CI: 5.09-16.61]) and baseline depression (aOR=2.15 [95% CI: 1.28-3.61]). Abortion method and gestational length were the only significant predictors of discordance between expected and experienced bleeding.  

Investigators concluded that while most patients anticipated post-abortion pain and bleeding, incorporating risk factors for severe pain and heavy bleeding into anticipatory guidance could improve the patient experience. 

Source: ajog.org/article/S0002-9378(25)00111-5/abstract