Objective To investigate the effect of immediate administration of compound norethisterone enanthate injection after medical abortion in early pregnancy on uterine recovery-related outcomes. Methods A dual-center，prospective cohort study design was adopted，enrolling 139 patients who underwent early-pregnancy medical abortion at the Obstetrics and Gynecology Hospital of Fudan University and Xuzhou Maternal and Child Health Hospital between January 2025 and January 2026 and met the inclusion and exclusion criteria. The observation group（n=69）received 2 mL of compound norethisterone enanthate injection immediately after medical abortion；the control group（n=70）did not use any hormonal contraception after abortion. The duration of vaginal bleeding after medical abortion，time to first menstruation，residual uterine tissue at 2 weeks after medical abortion，and curettage rate were compared between the two groups. Subgroup analysis was performed on patients with residual tissue of average diameter ≤3 cm at 2 weeks after-abortion，and multivariate logistic regression was used to assess the relevant factors for their outcome. Results There were no statistically significant differences in baseline characteristics between the two groups. The first menstrual period returned significantly earlier in the observation group than in the control group [（25.51±6.77）days vs.（33.80±7.71）days，P<0.001]. The proportion of vaginal bleeding lasting ≤2 weeks was higher in the observation group than in the control group（97.1% vs. 84.3%，P=0.021）. At the 2-week follow-up after medical abortion，the proportion of no retained products of conception was higher in the observation group than in the control group（44.9% vs. 27.1%，P=0.038），and the retained product volume was smaller. At the post-menstrual follow-up，the rate of no retained products of conception was significantly higher in the observation group than in the control group（76.8% vs. 55.7%，P=0.011）. The curettage rate was lower in the observation group than in the control group（1.4% vs. 7.1%），but the difference was not statistically significant. In patients with residual tissue of average diameter ≤3 cm at two weeks after medical abortion，the negative conversion rate was statistically significant in both the observation and control groups upon follow-up（P<0.05）. At the end of follow-up，the proportion of patients with normal uterine cavity recovery was higher in the observation group than in the control group（59.5% vs. 43.5%）. Multivariate analysis showed that vaginal bleeding duration >2 weeks was associated with a decreased probability of negative conversion of residual tissue of average diameter ≤3 cm（aOR 0.08，95%CI 0.01-0.68，P=0.021）. Conclusions Immediate administration of compound norethisterone enanthate injection in early pregnancy after medical abortion results in shorter duration of vaginal bleeding，faster menstrual recovery，smaller residual tissue，and a higher proportion of normal uterine cavity recovery after menstruation. This regimen may provide additional benefits to uterine cavity recovery after medical abortion in addition to implementing post-abortion contraception.