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Medical abortionBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/medical-abortion/MY00819
Medical abortion is a procedure that uses various medications to end a pregnancy. A medical abortion is started either in a doctor's office or at home with visits to your health care provider. Medical abortion doesn't require anesthesia or surgery, but it can only be done early in pregnancy.
Pursuing a medical abortion is a major decision with emotional and psychological consequences. If you're considering medical abortion, make sure you understand what the procedure entails, the side effects, and possible risks and complications.
Why it's done
A woman's reasons for pursuing medical abortion are highly personal. 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. For most of these circumstances there are alternatives, such as adoption. Sometimes a woman may have a serious medical problem that poses a life-threatening risk to her during pregnancy.
Some women prefer medical abortion over other types of abortion because some methods of medical abortion may be done at home, providing privacy and some degree of control.
Potential risks of medical abortion include:
- Incomplete abortion, which may need to be followed by surgical abortion
- Heavy bleeding
- Damage to the uterus
You must be certain about your decision before taking any medication to begin a medical abortion. If you decide to continue the pregnancy after beginning to take the 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 may not be an option if you:
- Are too far along in your pregnancy — you should not 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 are not done after seven weeks
- Have a high risk of uterine rupture — for example, if you have several surgical scars that could rupture — or if you have an intrauterine device (IUD) in place
- Have certain medical conditions, such as uncontrolled high blood pressure, diabetes, 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 attend follow-up visits with your health care provider or don't have access to emergency care
- Have an allergy to the medications used
Women who want to end a pregnancy but can't have a medical abortion may want to consider surgical abortion instead.
How you prepare
If you're considering medical abortion, meet with your health care provider to discuss the procedure. Your health care provider 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) or 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
Proceeding with a medical abortion is always a very serious decision and in most cases should not be done without discussions with people you need to support you in such a major step. Talking with your partner, family or friends may help. Talk with your health care provider, 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 health care provider is required to perform an abortion and that in some states there are certain legal requirements and waiting periods you must follow before proceeding with an abortion.
What you can expect
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.
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