Post-abortion infection affects roughly 2% of medical abortions and up to 5% of surgical abortions, making it uncommon but important to recognize early. The key warning signs are a fever over 100°F, foul-smelling vaginal discharge, and pelvic pain that gets worse over time rather than gradually improving. Knowing the difference between normal recovery and an infection can help you act quickly if something goes wrong.
What Normal Recovery Feels Like
Some cramping and bleeding after an abortion is expected, whether you had a medication or surgical procedure. Mild to moderate pelvic cramping typically lasts several hours after a surgical procedure and can come and go for days after a medication abortion. Bleeding similar to a heavy period is normal, and you may pass small clots. This bleeding gradually lightens over one to two weeks.
The important word is “gradually.” Normal recovery follows a pattern of steady improvement. Pain decreases day by day, bleeding slows, and you generally start feeling more like yourself. When that trajectory reverses, and symptoms get worse instead of better, that’s when infection becomes a concern.
The Main Signs of Infection
Infection after abortion typically shows up through a cluster of symptoms rather than a single sign. Watch for these:
- Fever over 100°F (37.8°C). A brief low-grade temperature spike can happen, especially after taking misoprostol during a medication abortion. But a fever lasting more than four hours, or one that develops in the days following the procedure, points toward infection.
- Foul-smelling vaginal discharge. Some discharge and bleeding are normal. A strong, unpleasant odor is not. This is one of the most reliable early indicators of bacterial infection in the uterus.
- Pain that escalates. Cramping that intensifies rather than easing, or new pain that develops after a few days of feeling better, suggests something is wrong. Continued severe pain after a surgical abortion is particularly unusual.
- Prolonged cramping. Cramps lasting beyond 48 hours after a medication abortion deserve attention, especially if they’re worsening.
You don’t need to have all of these at once. Even one or two of these symptoms in combination, especially fever plus foul-smelling discharge, is enough to warrant a call to your provider.
Infection vs. Retained Tissue
Sometimes what looks like an infection is actually caused by tissue from the pregnancy that wasn’t fully passed or removed. Retained tissue can cause many of the same symptoms: pelvic pain, vaginal bleeding, discharge, and sometimes fever. In fact, retained tissue often leads to infection if it isn’t addressed, because it creates an environment where bacteria thrive.
The symptoms overlap so much that you won’t be able to tell the difference on your own, and you don’t need to. What matters is recognizing that prolonged or worsening symptoms aren’t normal and getting evaluated. Your provider can use an ultrasound to check whether tissue remains in the uterus and determine the right treatment from there.
When Bleeding Becomes a Red Flag
Heavy bleeding alone doesn’t necessarily mean infection, but it can signal a serious complication. The general rule: if you’re soaking through two or more thick pads per hour for two consecutive hours, that level of bleeding needs immediate medical attention. Feeling dizzy, lightheaded, or faint alongside heavy bleeding makes it more urgent.
Infection-related bleeding tends to be persistent rather than a single heavy episode. If bleeding that had started to taper off suddenly picks back up days later, especially alongside pain or fever, infection or retained tissue are the most likely explanations.
Symptoms That Need Emergency Care
Most post-abortion infections are caught early and treated effectively. But in rare cases, infection can become severe. Get to an emergency room if you experience any of the following:
- Rapid heart rate with dizziness or feeling faint. These are signs your body is struggling to maintain blood pressure, either from blood loss or spreading infection.
- Abdominal rigidity or guarding. If your abdomen feels hard and tense, and pressing on it causes sharp pain, this can indicate the infection has spread beyond the uterus into the abdominal cavity.
- Abdominal swelling or distension. A visibly swollen belly alongside pain and fever is a serious warning sign.
- Sudden collapse or confusion. Sudden drops in blood pressure or mental clarity can indicate sepsis, which requires immediate treatment.
Medical vs. Surgical Abortion: Differences in Risk
Both types of abortion carry a low risk of infection, but the risk profile differs slightly. Surgical abortions involve instruments entering the uterus, which creates a direct pathway for bacteria. For this reason, you’ll typically receive preventive antibiotics before or after a surgical procedure. Research from one Swedish study found that surgical abortions had an infection rate of 4.9%, compared to 2.4% for medical abortions.
Medical abortions don’t usually require preventive antibiotics because the process involves passing tissue without instrumentation. However, the process takes longer and involves a window of time where the cervix is open, which still carries some risk. With medical abortion, watch especially for fever that starts in the days after taking misoprostol, since this medication itself can cause temporary chills and a brief temperature increase that shouldn’t be confused with infection.
What Happens When You Get Checked
If you go in with suspected infection symptoms, your provider will typically start with a physical exam, checking your vital signs, pressing on your abdomen for tenderness, and doing a pelvic exam. They’ll likely order blood work to look for elevated white blood cell counts and other markers of infection. An ultrasound is standard to check for retained tissue.
If infection is confirmed, treatment usually involves antibiotics. Most post-abortion infections respond well to antibiotics when caught early. If retained tissue is found, a procedure to remove it may be necessary. The vast majority of people recover fully with prompt treatment.
Timing: When Infections Typically Appear
Post-abortion infections don’t always show up right away. They most commonly develop within the first one to two weeks after the procedure, though symptoms can appear as early as 24 hours later. This is why the first two weeks of recovery are the most important time to pay attention to your body.
A pattern that should raise concern: you feel like you’re recovering normally for several days, then suddenly develop new pain, fever, or discharge. This delayed onset is a classic presentation of infection, and the fact that you were feeling better before doesn’t mean the new symptoms are harmless. Any new or worsening symptoms after an initial period of improvement deserve a call to your provider.