Medical abortion is a procedure that uses medication to end a pregnancy. A medical abortion is started either in a medical office or at home with follow-up visits to your doctor. It doesn't require surgery or anesthesia. It's safer and most effective during the first trimester of pregnancy.
Having a medical abortion is a major decision with emotional and psychological consequences. If you're considering this procedure, make sure you understand what it entails, side effects, possible risks, complications and alternatives.
Why it's done
A woman's reasons for having a medical abortion are highly personal. You can choose medical abortion to complete an early miscarriage or end an unwanted pregnancy. You may have mixed feelings about being pregnant. You may have major financial problems or you may not be capable of parenting due to mental health problems or other issues.
You can also choose to have a medical abortion if you have a medical condition that makes continuing a pregnancy life-threatening.
Potential risks of medical abortion include:
- Incomplete abortion, which may need to be followed by surgical abortion
- An ongoing unwanted pregnancy if the procedure doesn't work
- Heavy and prolonged bleeding
- Gastrointestinal discomfort
You must be certain about your decision before beginning a medical abortion. If you decide to continue the pregnancy after taking medications used in medical abortion, your baby will be at risk of significant birth defects.
Medical abortion hasn't been shown to affect future pregnancies unless complications develop.
Medical abortion isn't an option if you:
- Are too far along in your pregnancy. You shouldn't attempt a medical abortion if you've been pregnant for more than nine weeks (after the start of your last period). Some types of medical abortion aren't done after seven weeks of pregnancy.
- Have an intrauterine device (IUD).
- Have a suspected pregnancy outside of the uterus (ectopic pregnancy).
- Have certain medical conditions. These include bleeding disorders; certain heart or blood vessel diseases; severe liver, kidney or lung disease; or an uncontrolled seizure disorder.
- Take a blood thinner or certain steroid medications.
- Can't make follow-up visits to your doctor or don't have access to emergency care.
- Have an allergy to the medications used.
Surgical abortion may be an option for women who want to end a pregnancy but can't have a medical abortion.
How you prepare
If you're considering a medical abortion, meet with your doctor to discuss the procedure. If your doctor is willing to perform an abortion, he or she will likely:
- Evaluate your medical history and overall health
- Confirm your pregnancy with a physical exam
- Do an ultrasound exam to date the pregnancy and confirm it's not outside the uterus (ectopic pregnancy) and not a tumor that developed in the uterus (molar pregnancy)
- Do blood and urine tests
- Explain how the procedure works, the side effects, possible risks and complications
Having a medical abortion is a serious decision. If possible, talk with your partner, family or friends. Talk with your doctor, spiritual adviser or a counselor to get answers to your questions, help you weigh alternatives and consider the impact the procedure may have on your future.
Keep in mind that no doctor is required to perform an abortion and that in some states there are certain legal requirements and waiting periods you must follow before having an elective abortion.
What you can expect
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:
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.
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.
Jan. 10, 2018