Abortion procedures - medication

What is medication abortion?#

Medication abortion is a low-risk, non-invasive way to end a pregnancy without surgery. It can be carried out in the early weeks of pregnancy, generally up to 9 weeks. It is around 99% effective, and about 2 to 5% of people who have a medication abortion will need some follow-up treatment to complete it.

Instead of surgery, it uses a combination of two medications, mifepristone and misoprostol. A pregnancy needs high levels of the hormone progesterone to continue. Mifepristone (previously known as RU486) blocks the action of progesterone so the pregnancy stops developing. Misoprostol, taken afterwards, softens the cervix and contracts the uterus to expel the pregnancy.

Exactly when medication abortion is available, and up to how many weeks of pregnancy, depends on the laws and services where you live. Where it is available, it can usually be done from the time a pregnancy can be seen on an ultrasound.

What to expect at your appointments#

The number of appointments varies depending on the clinic and whether tests such as an ultrasound are available on site or need separate visits. Some clinics can offer the necessary tests and the medication in a single initial appointment. If you have an intrauterine device (IUD) in place, it will need to be removed before you take the first medication.

You will usually be seen by a doctor, and often a nurse, who will:

• Check the stage of your pregnancy, arranging an ultrasound, and urine or blood tests. Some clinics may also offer testing for sexually transmissible infections (STIs).
• Carry out a confidential medical assessment, which may include questions about your medical history and your sexual and reproductive health.
• Give you information about the types of abortion, what to expect, the steps involved, and pre- and post-abortion care.
• Give you the chance to ask questions so you can make an informed decision.
• Ask you to sign a consent form if you decide to go ahead.
• Discuss pain relief and any other medication you may need to reduce side effects.
• Give you a prescription for the abortion medicines to take to a pharmacy.
• Discuss your contraception choices, if you wish.

The procedure step by step#

A medication abortion usually involves the following steps:

• Take a tablet of mifepristone first. You can go about your usual activities afterwards.
• Take a tablet of misoprostol 36 to 48 hours later. This softens the cervix and helps the uterus push out the pregnancy.
• Stay at home for the next 6 to 10 hours. Make arrangements for anyone in your care, such as school pick-ups, and have a responsible adult stay with you who can take you to a clinic or hospital if you need extra care.
• The abortion is usually completed some hours later, although it can take longer.
• Plan for a day or two of rest or reduced activity. Keep in contact with the clinic, or seek other expert support, if you have questions or concerns.

What happens after taking the medication#

After the second tablet you may experience nausea, vomiting, diarrhoea, dizziness, headache and fever. Pain from uterine cramping usually begins within about half an hour and is generally much stronger than period pain. Bleeding tends to start one to four hours later, is heavier than a period, and there may be large clots. After two to six hours the bleeding usually settles to the level of a normal period, and bleeding similar to a normal period may continue for another three to seven days.

The timing of pain and bleeding is unpredictable. It occasionally starts before the second medication but can take up to 24 hours to begin. Unpredictable, irregular or prolonged bleeding can last for up to four weeks.

It is important to attend a follow-up appointment to make sure the procedure is complete and the pregnancy has ended. Many doctors arrange a blood test to check that the pregnancy hormone level has dropped, and a review is often scheduled about two weeks later. Medication abortion does not work in around 1% of cases. About 2 to 5% of people have some pregnancy tissue remaining in the uterus and need further treatment, such as additional tablets or a small surgical procedure, to complete the abortion. Your doctor will discuss this with you.

Self-care at home#

The doctor or nurse will advise how to look after yourself in the days after the abortion. Self-care may include:

• using over-the-counter anti-inflammatory medication to manage cramps (your doctor can prescribe something stronger if needed)
• using hot packs for pain relief
• gently massaging the painful area

To reduce the risk of infection in the week after the procedure, it is recommended that you do not:

• go swimming or have a bath (you can shower)
• insert anything into your vagina, including tampons
• have vaginal sex
• do any strenuous activity, including sport or heavy physical work, until the bleeding stops

If you have any concerns, it can help to talk them through with someone you trust, such as a partner, friend, family member, teacher, counsellor or health professional.

Advantages and disadvantages#

Advantages of medication abortion include:

• It is effective for around 95 to 98% of pregnancies up to 9 weeks, with no further treatment needed.
• It does not need to take place in a hospital or day surgery, so it does not require a surgeon or anaesthetist. This can make it suitable for people in remote areas, as long as they have access to emergency care.
• It is a less clinical, non-surgical procedure that happens in a home environment, which some people prefer and feel is more natural.
• You usually have more choice about the timing.

Disadvantages include:

• It tends to be more time consuming than a surgical abortion, with potentially more visits and tests.
• There is pain after the second medication.
• You need to stay within one to two hours of emergency services for two weeks after starting the tablets.
• A separate appointment is needed if you would like an IUD inserted after your abortion.

Who medication abortion may not suit#

Medication abortion is not suitable for everyone. It may not be recommended if you:

• have had an allergic reaction to the medication
• have certain medical conditions, such as bleeding problems, adrenal failure or high blood pressure
• take long-term steroid or blood-thinning medication

Your doctor will tell you about the side effects and the risk of complications, and what to do if they occur.

Side effects and possible risks#

Typical side effects of medication abortion include pain from uterine cramping and irregular or prolonged bleeding. Contact your doctor if any side effects are worrying or you need advice. You will usually also be given a 24-hour contact number for out-of-hours concerns.

Serious complications are uncommon. They can include:

• Haemorrhage (very heavy bleeding). If you are filling more than two large pads an hour for more than two hours, passing clots the size of a small lemon, feel you are bleeding heavily, or feel weak or faint, seek immediate medical attention. Rarely, very heavy bleeding may require a blood transfusion.
• Retained products. Pieces of tissue may remain in the womb and cause ongoing bleeding. These usually pass with time, but you might need repeat tablets or a small surgical procedure to remove them.
• Continued pregnancy. In around 1% of cases the medication does not work and the pregnancy continues. The tablets can be repeated if the pregnancy is no more than 9 weeks; otherwise a surgical abortion may be required.
• Infection needing antibiotic treatment, which happens in around 1% of people. Infection may cause pain, abnormal vaginal discharge or fever, and sometimes more general symptoms such as tiredness, diarrhoea and vomiting.

If you are concerned about symptoms, seek medical help by contacting the clinic where the abortion took place, a doctor, the 24-hour number you were given, your nearest hospital emergency department, or your local emergency number for an ambulance.

If you think you are still pregnant after a week, or you are not bleeding at all 24 hours after taking misoprostol, seek medical help straight away. If the abortion does not occur and you remain pregnant, it is recommended that you do not continue the pregnancy, because the medications taken may cause malformation of the developing fetus.

Managing emotions afterwards#

After an abortion, most people feel relief, particularly if they had support and were able to make a free and informed decision. If the decision was difficult, you may feel sadness or other difficult emotions, especially in the short term. If you feel you need emotional support, speak to your abortion provider or doctor. If your pregnancy is unplanned and you are finding it difficult to weigh up your options, emotional support is available.

Key points#

• Medication abortion is a low-risk, non-invasive way to end a pregnancy.
• Around 2 to 5% of people who have a medication abortion will need some follow-up treatment to complete it.
• It is important to have a follow-up appointment to make sure the procedure is complete and the pregnancy has ended.
• Your doctor will let you know about side effects and risks and what to do if they occur.
• If you have any concerns, it is important to discuss them with someone you can trust.

Where to get help#