What you can expect

By Mayo Clinic Staff

Medical abortion doesn't require surgery or anesthesia. The procedure can be started in a medical office or clinic. A medical abortion can often be completed at home, but you'll still need to visit your doctor to assess the effectiveness of the treatment and identify potential complications.

During the procedure

Medical abortion can be done using the following medications:

  • Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). This is the most common type of medical abortion. These medications are usually taken within seven weeks of the first day of your last period.

    Mifepristone (mif-uh-PRIS-tone) blocks the hormone progesterone, causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Misoprostol (my-so-PROS-tol) causes the uterus to contract and expel the embryo through the vagina.

    If you choose this type of medical abortion, you'll likely take the mifepristone in your doctor's office or clinic, then take the misoprostol hours or days later, most likely at home. You'll need to visit your doctor again about a week later to make sure the abortion is complete. This regimen is approved by the U.S. Food and Drug Administration (FDA).

  • Oral mifepristone and vaginal, buccal or sublingual misoprostol. This type of medical abortion uses the same drugs as the previous method, but with a slowly dissolving misoprostol tablet placed in your vagina (vaginal route), or in your mouth between your teeth and cheek (buccal route) or under your tongue (sublingual route).

    The vaginal, buccal or sublingual approach lessens side effects and may be more effective. These medications must be taken within nine weeks of the first day of your last period.

  • Methotrexate and vaginal misoprostol. Methotrexate is rarely used for elective, unwanted pregnancies, although it's still used for pregnancies outside of the uterus (ectopic pregnancies). This type of medical abortion must be done within seven weeks of the first day of your last period. Methotrexate is given as a shot or vaginally and the misoprostol is later used at home.

    It can take almost a month for methotrexate to complete the abortion. If the pregnancy continues, another dose of misoprostol will be given. Methotrexate isn't approved by the FDA for medical abortion.

  • Vaginal misoprostol alone. Vaginal misoprostol alone can be effective in promoting the completion of a miscarriage — a spontaneous abortion where the embryo has died. For uses other than this, vaginal misoprostol alone is less effective than other types of medical abortion.

The medications used in a medical abortion cause vaginal bleeding and abdominal cramping. They may also cause:

  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Diarrhea
  • Headache

You may be given medications to manage pain during and after the medical abortion. You may also be given antibiotics, although infection after medical abortion is rare.

Your health care provider will explain how much pain and bleeding to expect, depending on the number of weeks of your pregnancy. You might not be able to go about your normal daily routine during this time, but it's unlikely you'll need bed rest. Make sure you have plenty of absorbent sanitary pads.

If you have a medical abortion at home, you'll need access to a health care provider who can answer questions by phone and access to emergency services. You'll also need to be able to identify complications.

After the procedure

Signs and symptoms that may require medical attention after a medical abortion include:

  • Heavy bleeding — soaking two or more pads an hour for two hours
  • Severe abdominal or back pain
  • Fever higher than 100.4 F (38 C) or any fever lasting more than 24 hours
  • Foul-smelling vaginal discharge

If vaginal bleeding doesn't begin within 48 hours after treatment, you may have had an incomplete abortion or still be pregnant. In these cases, a surgical abortion may be needed.

After a medical abortion, you'll need a follow-up visit with your health care provider to make sure you're healing properly and to evaluate your uterine size, bleeding and any signs of infection. To reduce the risk of infection, don't have vaginal intercourse or use tampons for two weeks after the abortion.

Your health care provider will likely ask if you still feel pregnant, if you saw the expulsion of the gestational sac or fetus, how much bleeding you had, and whether you're still bleeding. If your doctor suspects an incomplete abortion or ongoing pregnancy, you may need an ultrasound and possible follow-up treatment.

After a medical abortion, you'll likely experience a range of emotions — such as relief, loss, sadness and guilt. These feelings are normal. It might help to talk to a counselor about them.

Preventing pregnancy

Normal ovulation usually occurs about three weeks after a medical abortion, and another pregnancy is possible even before your period begins. So — before the abortion — talk to your doctor about contraception that you can start as soon as the procedure is over.

April 01, 2015