You are in the first trimester of your pregnancy and sure about your decision to terminate it. You may consider invasive methods or a non-invasive method with pills. Both methods are safe, but pills are easy to use and more convenient than invasive methods. Can everyone use medication abortion as a first choice? In this article, we will explore conditions and warning signs which should be considered before opting for pills as an abortion method.
Abortion pills are considered a safe and efficient method in selected cases.
Women with bleeding disorders, anemia, and chronic adrenal insufficiency are not suitable for medication abortion.
Women with an IUD in place, or those who use a blood-thinning drug or long-term corticosteroids should also be evaluated by health care providers before choosing a medical abortion method.
Ectopic pregnancies cannot be terminated with a medication abortion, and women with risk factors should get medical assistance to confirm intrauterine implantation.
How do abortion pills work?
Medical or medication abortion is the termination of pregnancy with the use of oral drugs, commonly referred to as abortion pills.
Two medications are commonly used for abortion; mifepristone, and misoprostol. They could be used in combination for a better result. However, if mifepristone is unavailable, misoprostol will also be effective as a single agent.
Progesterone is the main hormone in pregnancy; it prepares the womb for successful implantation, prevents the immune rejection of the embryo as a foreign body, and suppresses uterine contractions. Mifepristone antagonizes these effects of progesterone and disrupts the healthy progress of the pregnancy.
Misoprostol acts as a prostaglandin, a substance protecting the inner layer of the stomach from acid. Initially, it was used as a protector from ulcers when drugs like aspirin (NSAIDs) were used. Later, it was observed that misoprostol causes uterine contractions and softens the cervix. This led to its off-label use for pregnancy termination.
Abortion pills – when are they suitable?
Medication abortion is a recommended method in the first trimester of pregnancy. The upper limit is 10 to 12 gestational weeks. According to the U.S. Food and Drug Administration (FDA) approval, it is safe to use pills up to 10 weeks (70 days) from the first day of the last menstruation. World Health Organization (WHO) defines this limit as 12 weeks.
When is abortion with pills not an option?
Despite high safety and efficacy, abortion with pills may have severe complications if risk factors are not assessed carefully.
- Bleeding disorders. Women with conditions leading to decreased blood clotting have a risk of heavy bleeding during and after abortion and should not use abortion pills. These conditions might be genetically inherited, such as Hemophilia A and B, von Willebrand disease, or could be induced by blood thinning drugs. Additionally, women with anemia should also consider potential heavy bleeding with abortion pill use.
- Current intrauterine device (IUD) use. Women with IUDs in place should not use abortion pills to terminate the pregnancy. Abortion pills are advised only after the removal of the IUD.
- Drug allergies or interactions. Any known allergy to mifepristone or misoprostol makes abortion pills an unsuitable choice for abortion.
- Medical conditions. Conditions such as porphyria, chronic adrenal failure, or long-term corticosteroid use are also contraindications for abortion pills.
- Ectopic pregnancies. Although ectopic pregnancies are not common, they might be associated with life-threatening complications, including death, if missed or managed incorrectly.
What if I have an ectopic pregnancy? How to understand?
Ectopic pregnancy is the condition when the embryo implants anywhere outside the womb cavity. In abortion with pills, the pregnancy material needs to be evacuated from the body, and locations outside the uterine cavity wouldn't directly connect to the outside environment. Thus, disrupted or missed ectopic pregnancies may lead to organ rupture and internal bleeding.
But how to understand whether your pregnancy is ectopic or not? Should everyone be screened for ectopic pregnancy before using abortion pills?
Serial measurements of human chorionic gonadotropin (HCG) levels in the blood may assist with the diagnosis. Ultrasonographic imaging of the embryo inside the uterine cavity is another way to verify the intrauterine location.
While these examinations are not absolute requirements prior to abortion pills, risk factors for ectopic pregnancy should be kept in mind, and women with increased risk should consider preabortion evaluation by healthcare providers.
Some risk factors for ectopic pregnancy are listed below:
- Any pathology or surgical procedure in the uterine tubes (an organ connecting the uterus with ovaries).
- History of a previous ectopic pregnancy.
- Use of abortion pills in the past.
- Implementation of assisted reproductive technology, such as in vitro fertilization (IVF).
- Use of intrauterine contraceptive devices in the past or with the current pregnancy.
- Age above 40 years.
In summary, medication abortion is a safe and efficient method to terminate first-trimester pregnancies in selected cases. Getting counseling and disclosing all possible warning signs is highly recommended, which will help you choose the most medically suitable option for your case.
Is there any time limit for the safe use of abortion pills?
Yes, according to the leading international health organizations, abortion pills are safe until 10 to 12 gestational weeks.
What are warning signs to consider before an abortion with pills?
If you carry a risk for ectopic pregnancy, it is highly recommended to confirm the intrauterine localization of the embryo prior to initiating the abortion. Moreover, if you have any known blood clotting disorder, anemia, porphyria, chronic adrenal insufficiency, or use blood thinning drugs, long-term corticosteroids, or IUD, abortion is not a recommended method for you.
Do I have to get an in-clinic examination or laboratory assessment to take abortion pills?
Although it is not an absolute requirement, detailed counseling with a healthcare provider is always recommended to avoid undesired complications. Moreover, it is highly advised to have a healthcare contact for possible complications in self-managed abortion cases.
- The American College of Obstetricians and Gynecologists. Medication Abortion Up to 70 Days of Gestation.
- UpToDate. First-trimester pregnancy termination: Medication abortion.
- Obstetrics and Gynecology. Uses of Misoprostol in Obstetrics and Gynecology.
- BMC Pregnancy and Childbirth. Risk factors for ectopic pregnancy: a multi-center case-control study.
- Obstetrics and Gynecology. Significant adverse events and outcomes after medical abortion.