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By Mayo Clinic staffMedical abortion doesn't require surgery or anesthesia. The procedure can be done 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 multiple 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 — 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, a prostaglandin, 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 misoprostol. This type of medical abortion uses the same drugs as the previous method but in different doses. Also, instead of taking a misoprostol pill, the medication is placed in your vagina. These medications must be taken within nine weeks of the first day of your last period. This method can be done at home. It's faster, more effective, less expensive and has fewer side effects than other types of medical abortion.
- 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 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.
- Vaginal misoprostol alone. This method may be used over a broader range of gestational ages. This method is less effective than are other types of medical abortion and may cause more significant side effects.
The medications used in a medical abortion cause vaginal bleeding and abdominal cramping. They may also cause:
- Nausea
- Vomiting
- Fever
- Chills
- Diarrhea
You may be given medications to manage pain after the medical abortion. You may also be given antibiotics. A 2009 study showed a significant drop in the rate of serious infection after a medical abortion when women took misoprostol orally — instead of vaginally — along with antibiotics.
Your health care provider will explain how much pain, bleeding and passing tissue to expect depending on the length of your pregnancy. You may not be able to go about your normal daily routine during this time but it's unlikely that you'll need bed rest. Make sure you have plenty of absorbent sanitary pads.
Signs that may require medical attention after a medical abortion include:
- Heavy bleeding — soaking two pads an hour for two hours and still bleeding
- Severe abdominal or back pain
- Fever higher than 100.4 F (38 C) or lasting more than 24 hours
- Foul-smelling vaginal discharge
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 subsequent 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 undergo a medical abortion at home, you'll need to have access to a health care provider who can answer questions by phone. You'll also need to be able to identify complications.
After the procedure
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 have a follow-up visit with your health care provider to make sure you're healing properly. Your health care provider will evaluate your uterine size, bleeding and any signs of infection. You'll likely be asked if you still feel pregnant, if you saw the expulsion of the gestational sac or fetus, how much bleeding you experienced, 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.
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 menstruation begins. To reduce the risk of infection, don't have vaginal intercourse or use tampons for two weeks following a medical abortion.
After a medical abortion, you'll likely experience a range of emotions — such as relief, loss, sadness and anger. These feelings are normal. Consider talking to a counselor about your feelings.
- Fjerstad M, et al. Rates of serious infection after changes in regimens for medical abortion. New England Journal of Medicine. 2009;361:145.
- Pregnancy choices: Raising the baby, adoption, and abortion. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp168.cfm. Accessed Aug. 12, 2009.
- Induced abortion. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp043.cfm. Accessed Aug. 12, 2009.
- Clark W, et al. Misoprostol as a single agent for medical termination of pregnancy. http://www.uptodate.com/home/index.html. Accessed Aug. 12, 2009.
- Spitz IM. Mifepristone for the medical termination of pregnancy. http://www.uptodate.com/home/index.html. Accessed Aug. 12, 2009.
- Kulier R, et al. Medical methods for first trimester abortion. (Review). Cochrane Database of Systematic Reviews. 2004:CD002855.
- Shulman LP, et al. Overview of pregnancy termination. http://www.uptodate.com/home/index.html. Accessed Aug. 13, 2009.
- Cytotec misoprostol tablets. Pfizer. http://media.pfizer.com/files/products/uspi_cytotec.pdf. Accessed Aug. 17, 2009.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 27, 2009.
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