Medication abortion is the use of medication to induce the ending or termination of a pregnancy, similar to a miscarriage. This is also known as a medical abortion. Medication abortions are an alternative to surgical abortion or other procedures in which the embryo is removed from the uterus manually. Avoiding surgery and anesthesia makes this option a safer alternative. Medication abortion is only done in the first trimester or the first 70 days of pregnancy.
Why is a medical abortion done?
Choosing to have a medication abortion is a very personal and significant decision. When making this decision, ensure you should understand what is involved emotionally, physically, and medically.
Medication abortion is to:
- Complete a miscarriage.
- End and unwanted pregnancy.
- Eliminate a pregnancy that would be life-threatening.
- Prevent the risk of the baby having a congenital or inherited disease.
What are the risks?
Like all medical procedures, there can be side effects and risks. Be sure you know and understand the risks before deciding to proceed with medication abortion. Risks include:
- Incomplete abortion, which requires surgery.
- Continued pregnancy, if not effective.
- Heavy or extended bleeding.
- Diarrhea, cramping, or abdominal pain.
- Allergic reaction to the medications.
Risks are also involved if you stop taking the medicines after starting them. Stopping the medications could cause serious complications should you continue the pregnancy. You must be clear on your decision before you begin taking the drugs.
Who should not have a medication abortion?
Medication abortion should not be considered by those who:
- Are too far alongs in the pregnancy.
- Have a bleeding or clotting disorder.
- Have a pregnancy outside of the uterus, known as ectopic pregnancy.
- Have an intrauterine device (IUD) for birth control.
- Have a known allergy to the medication.
- Cannot return for a follow-up visit.
- Take certain medications: Blood thinners or steroids.
- Have specific health conditions: Heart or blood vessel disease; liver, kidney, or lung disease; uncontrolled seizure disorder.
What to expect during a medication abortion
Your healthcare provider will prescribe the appropriate medications for you and explain how to use them. Be aware that this may not be something you will receive from your family physician, gynecologist, or local hospital. You may need to locate a specialty practice to seek treatment.
The provider will complete a physical examination and review your medical history during your appointment. They will confirm you are pregnant, determine how long you’ve been pregnant, and do an ultrasound to ensure the pregnancy is not ectopic. The provider will explain how the procedure works and review the side effects, risks, and what to expect as you take the medications.
After the examination, you will receive the prescription to complete the medication abortion at home. You will take the medications as directed and then return to see the provider for a follow-up to make sure there were no complications. If complications occur, the provider will instruct you to contact them or go to your closest emergency department.
The most common medications include:
- Mifepristone and misoprostol (both oral): The most common option is taken within seven weeks of the first day of your last period. You will receive the mifepristone at the provider's office and then take the misoprostol 24 to 48 hours later at home.
- Mifepristone (oral) and misoprostol (vaginal, buccal, or sublingual): This is the same as above, except the misoprostol is taken vaginally or dissolved in the cheek or under the tongue 24 to 48 hours later.
- The abortion occurs by combining the two medications. Mifepristone blocks the hormone progesterone in the uterus. Without progesterone, the embryo cannot stay attached to the uterus. The uterine wall thins and begins bleeding. The misoprostol causes the uterus to contract and pass the embryo out.
- You may also receive medication for pain or antibiotics to take during this time. Infections are rare, but the risk is preventable. Avoid using tampons for two weeks after the abortion to reduce the risk of infection. Only use sanitary pads during bleeding. Also, avoid sexual intercourse for two to three weeks following the abortion or until your provider tells you enough time has passed.
Symptoms of medication abortion
Signs and symptoms of a medical abortion do occur as a natural part of the process:
- Bleeding and cramping one to four hours after taking the second pill.
- Heavy bleeding with clots.
- Cramping for several hours.
Side effects can also occur:
- Hot flashes or chills.
You may also have quite a few emotions after experiencing a medication abortion. Women often feel sadness, loss, guilt, relief, or other intense feelings. Any or all of these feelings are normal. Consider speaking with your provider or a counselor if the emotions are overwhelming or go on for an extended period.
If you experience complications
While the signs and symptoms above are common, if the side effects are persistent or you experience the following symptoms, contact your provider or seek emergency care.
- Excessive bleeding - soaking two or more pads per hour for two hours.
- Severe abdominal or back pain.
- Fever lasting more that 24 hours.
- Foul-smelling vaginal discharge.
Following up with your provider
At your follow-up appointment, your provider will evaluate your bleeding and any signs of infection. If appropriate, they will measure the size of your uterus. They will ask if you saw the embryo when it passed and how much bleeding you had. Your provider will want to ensure you had a complete abortion and that further intervention is unnecessary.
Medication abortion can be an alternative for someone who does not want surgery.
Medication abortion can be done in the first trimester or the first 70 days of pregnancy and is considered a safer alternative.
Regardless, it is still a difficult decision that can come with potential risks, many emotions, and a lot to understand.
Mayo Clinic. Medical abortion.
Cleveland Clinic. Medical Abortion.
The American College of Obstetricians and Gynecologists. Medication Abortion Up to 70 Days of Gestation.