Measurement of medication abortion-related bleeding: A systematic scoping review

Bleeding is a key expected result of medication abortion (MA); however, people's expectations and experiences of bleeding can affect their abortion experiences. Our objective was to document the measurement approaches of MA-related bleeding in the literature to date from a patient perspective.

We conducted a systematic scoping review of English language, peer-reviewed studies identified through PubMed from January 2000 to March 2025. The authors screened abstracts and full text in Covidence based on pre-determined inclusion and exclusion criteria. We included quantitative, qualitative, and mixed methods studies from any geographic region. All authors extracted data on time to onset, duration, volume, expectations, and acceptability of bleeding.

The majority of the 111 included studies measured bleeding duration (89), followed by volume (65), time to onset (35), expectations (32), and acceptability (22). Studies used a variety of data collection approaches, including patient diaries/symptom logs, questionnaires, and in-depth interviews. Measurement of volume was most often in comparison to a menstrual period, and a variety of scales were also used. No studies mentioned using measurements that had been developed through a participatory process involving patients.

Volume and duration were the most commonly measured aspects of MA-related bleeding identified across studies, though they were rarely linked to patient expectations or acceptability of their abortion. This review provides clinicians, researchers, and advocates an overview of the measurement approaches to date regarding MA-related bleeding and the gaps for future measurement development.

To provide comprehensive, clear and appropriate information on MA care, more and better ways of measuring and understanding people's MA bleeding experiences are still needed. Learnings from other fields, including menstrual health, can guide the development of future patient-reported outcome measures that reflect a broader range of patient experiences with MA-related bleeding.