Medical abortion doesn't require surgery or anesthesia. The procedure can be started in a health care provider's office or clinic. Sometimes a medical abortion can be done at home, but you'll still need to make several visits to your health care provider 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 and oral misoprostol. This is the most common type of medical abortion, likely due to the ease of oral rather than vaginal dosing. These medications must be taken within seven weeks of the first day of your last period. Mifepristone (mif-uh-PRIS-tone) — also known as RU-486 — blocks the action of 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 must visit your health care provider twice to take the medications and then afterward to make sure the abortion is complete. Medical abortion is not a Food and Drug Administration-approved use of misoprostol.
- Oral mifepristone and vaginal, buccal or sublingual misoprostol. This type of medical abortion uses the same drugs as the previous method, but a slowly dissolving misoprostol tablet is 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 approach lessens side effects and may fail less often, but may increase your risk of infection. These medications must be taken within nine weeks of the first day of your last period.
- Methotrexate injection and vaginal misoprostol. This type of medical abortion must be done within seven weeks of the first day of your last period. Methotrexate (meth-o-TREK-sayt) is given as a shot by your health care provider and the misoprostol is later used at home. You must visit your health care provider within a week of getting a methotrexate shot for an ultrasound to confirm if the abortion is complete. If the pregnancy continues, another dose of misoprostol will be given. It may take up to a month to complete the abortion. Medical abortion is not a Food and Drug Administration-approved use of methotrexate.
- Vaginal misoprostol alone. This method may be used over a broader range of gestational ages, but requires scheduling multiple doses of the medication. 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:
You may be given medications to manage pain during and after the medical abortion. You may also be given antibiotics.
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 in a health care provider's office or clinic, you'll have a pelvic exam before you're given additional doses of misoprostol to see if the fetus has been expelled. The frequency and strength of your uterine contractions also will be monitored. While the most discomfort may last one to two hours, spotting before and bleeding after could last two weeks.
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 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 health care provider 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 loss, sadness and anger. These feelings are normal. Consider talking to a counselor about your feelings.
Normal menstruation usually starts four to six weeks after a medical abortion. Keep in mind that pregnancy is possible shortly after an abortion, even before your period begins. So — before the abortion — talk to your health care provider about contraception that you can start as soon as the procedure is over. Termination of pregnancy is not an appropriate form of ongoing birth control.
May. 31, 2012
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 67: Medical management of abortion. Obstetrics and Gynecology. 2005;106:871. Reaffirmed 2011.
- Pregnancy choices: Raising the baby, adoption, and abortion. American College of Obstetricians and Gynecologists. http://www.acog.org/Search?Keyword=abortion. Accessed Feb. 27, 2012.
- Induced abortion. American College of Obstetricians and Gynecologists. http://www.acog.org/Search?Keyword=abortion. Accessed Feb. 27, 2012.
- Clark W, et al. Misoprostol as a single agent for medical termination of pregnancy. http://www.uptodate.com/home/index. Accessed Feb. 27, 2012.
- Spitz IM. Mifepristone for the medical termination of pregnancy. http://www.uptodate.com/home/index. Accessed Feb. 27, 2012.
- Methotrexate. Micromedex Healthcare Series. http://www.micromedex.com. Accessed April 24, 2012.
- Shulman LP, et al. Overview of pregnancy termination. http://www.uptodate.com/home/index.html. Accessed Feb. 27, 2012.
- Misoprostol. Micromedex 2.0. Thomson Reuters. http://www.thomsonhc.com/micromedex2/librarian. Accessed March 23, 2012.
- Templeton A, et al. A request for abortion. The New England Journal of Medicine. 2011:365:2198.
- Gallenberg MM (expert opinion). Mayo Clinic Rochester, Minn. March 26, 2012.
- Harms RW (expert opinion). Mayo Clinic Rochester, Minn. April 12, 2012.