Medical Abortion

 

There are several abortion methods and they each have their advantages and drawbacks. Let’s take a closer look at medical abortion – what it is, how long it takes, and the risks associated with this abortion procedure.

What is a Medical Abortion?

A medical abortion has many names, a couple of which include non-surgical abortion and the abortion pill. As you may have guessed from these names, medical abortion is when medication is used to terminate a pregnancy as opposed to a surgical abortion procedure. The medication is taken orally or may also be introduced either vaginally or via an injection. A medical abortion is achieved with the help of a combination of medications, the first of which will cause the pregnancy to end and the second of which will cause the uterine lining to expel thus getting rid of the embryo from the body.

Medical abortion is one of the safest ways to terminate a pregnancy in the earliest stages of pregnancy, up to nine weeks. It cannot be used effectively after this point as the embryo then grows to a stage that the medication cannot affect. Although medical abortion is sometimes done even after nine weeks, the success rate of the abortion diminishes considerably. If done in the first eight weeks of pregnancy, medical abortion has a 98% success rate. This progressively declines as the pregnancy develops. Let’s now take a look at what the medical abortion procedure entails.

Medical Abortion Procedure

A medical abortion can be performed at home or at a clinic. Most women choose to do this at home, and this is preferred by doctors too since the complications arising out of medical abortion are very rare. Rest assured that a medical abortion is safe enough to do on your own as long as you have a doctor who is on call 24/7 to respond to an emergency. In fact, in countries where medical abortion is illegal, pro-choice groups will send the medication required for a medical abortion by post to women from those countries who write to them, along with instructions on how to administer the medication and aftercare. So you can imagine how safe medical abortion is if a doctor is willing to allow someone they have never met to do it on their own. Of course, these are extreme circumstances where there are no other options available for the women wanting to terminate their pregnancies and it does not have to be the case for you. You must see a doctor who can evaluate your pregnancy and your medical history first and who is on call at all times, even if the medical abortion is going as smooth as can be. Some doctors will insist that you come to the clinic at least for the administration of the medication for the medical abortion. This may be necessary if you have to take an injection.

More than one drug is used in a medical abortion. The main ones are called mifepristone (also known as RU-486, Mifeprex, Mifegyn) and misoprostol (brand names Misotrol, Cyctotec, Oxaprost, Cyprostol). Other over-the-counter drugs may be given for the pain such as ibuprofen. Aspirin is not recommended since this is a blood thinner and may cause more bleeding than is safe or normal. If you are not sure of the brand name of a pain medication that is safe to take during a medical abortion, ask your doctor.

There are three main ways in which a medical abortion is achieved. It can be a combination of  

1. mifepristone and misoprostol both administered orally
2. mifepristone administered orally but misoprostol vaginally
3. and lastly, a methotrexate injection followed by vaginal administration of misoprostol

There is another method of medical abortion as well where only misorpostol is administered vaginally to induce uterine contractions in the hope that this will terminate the pregnancy. But this is not very widely used because it is a rather ineffective method of medical abortion, not to mention that the side effects of this abortion method are daunting to say the least.

The first option listed above – mifepristone and misoprostol both administered orally – is the most common method of medical abortion the world over. It is the simplest and safest way to achieve a medical abortion. Generally, the mifepristone is administered at the doctor’s office and then you are sent home to wait out the abortion with regular updates to your doctor by phone. But it is getting more and more common to allow the patient to take the mifepristone in the privacy of her home. If this is something you are more comfortable with and you have no existing medical conditions that need monitoring, ask your doctor if it is OK for you.

The mifepristone inhibits the function of the pregnancy hormone progesterone which is needed to sustain a pregnancy. Without the progesterone, the embryo does not remain implanted in the uterine wall, plus the uterine lining itself starts to thin out. Eventually the lining break away from the wall along with the embryo, of course, and the pregnancy is terminated. Bleeding will occur as an indication. But this is not the end of the medical abortion. The lining and embryo still have to be expelled from the body. And this is not going to happen on its own. The next medication – misoprostol – needs to be taken to get the uterus to expel them through the vagina. Misoprostol is a prostaglandin that induces uterine contractions and once the body expels the uterine lining and embryo the abortion is considered to be complete.

Medical abortion by the other two methods follows approximately the same procedure, except that the methods of administering the medication are different.

So how long does a medical abortion take? Well, the first part of the medical abortion where the action of the mifepristone terminates the pregnancy can take just four to five hours. After taking the misoprostol, it may be another day or two before the uterine lining and embryo are expelled and the medical abortion is complete. But it can take longer – sometimes as much as two whole weeks or even a month before the pregnancy is passed out of the body. There is no way of determining how long it will take for you as this differs from woman to woman and the factors that decide the outcome have yet to be identified. You will need to visit your doctor within a week of administering the misoprostol; an ultrasound will be conducted to determine whether or not the pregnancy has been successfully terminated.

Side Effects of Medical Abortion

All abortion methods have side effects. You may not experience any at all or you might have some really bad abortion side effects. Again, there is no way to determine who will and who will not suffer from side effects. Following are the most common side effects of a medical abortion i.e. what you will most likely experience after taking the medication.

• Some bleeding is likely to occur as the pregnancy is being terminated.

• Period like cramping is a normal side effect of medical abortions. The intensity of the pain will differ from woman to woman. The cramping can last for a couple of days or for up to a couple of weeks or more after the abortion too. Medication is usually prescribed to manage the pain.

• Nausea and/or vomiting are also commonly experienced by women undergoing medical abortion.

• Fever, dizziness and chills can be expected, but not always. This normally goes away in a few hours even if it does occur.

• And finally, diarrhea may occur as a result of the medical abortion.

There may be a general feeling of discomfort as you are undergoing the medical abortion, which is why it would be best if you take it easy for at least the first two to three days after taking the mifepristone. The side effects are always less severe if you are more relaxed.

When to Contact your Doctor

Now since you know what the medical abortion side effects are, you are more likely to not panic when or if they start to occur. However, there are times when medical intervention is necessary. Since you are at home while the medical abortion is underway, it is crucial that you are vigilant about the extreme medical abortion side effects so that you can call your doctor or clinic or hospital for help when the following warning signs manifest.

• A smelly vaginal discharge is reason enough to call the doctor supervising your medical abortion.

• Very heavy bleeding also needs medical aid. But since we all interpret ‘heavy’ in different ways, here is a standard parameter – if you have been bleeding for two hours and have soaked two pads to the point of saturation and yet you continue to bleed, this may be considered as heavy bleeding and you should call the emergency 24-hour number given to you by your doctor or family planning clinic.

• If you have a fever that is higher than 100 degrees Fahrenheit or if you experience a lower-temperature fever for over 24 hours, it may be a sign of an infection. Call your doctor straight away.

• Very intense pain in the abdomen or back could also indicate a problem with the medical abortion. 

Advantages of Medical Abortion

• The most obvious advantage of a medical abortion is that there is no surgery involved. You would be surprised at how much this cuts your risk for infection and complications. Firstly, any surgery is a bit of a shock to the body, even if it is not an invasive one. Your body needs to use valuable resources to heal itself after a surgery, and even your mind needs to come to terms with it. With a medical abortion, it is still quite a shock, but considerably less stressful on the body than a surgical abortion. Plus, there are fewer complications with a medical abortion as compared to surgical abortion methods.

• Since no anesthesia is used for a medical abortion, there is no chance of allergic reaction, heart attack or death from a violent reaction to the anesthesia – a more common phenomenon than you think.

• And finally, since there are no cutting or surgical instruments involved, there is little likelihood of a rupture or damage to the cervix, uterus or other nearby organs.

• A medical abortion can be done in the privacy of your home.

• Medical abortion methods are generally cheaper than surgical abortion methods.

Risks, Drawbacks and Complications of Medical Abortion

• One of the main complaints about a medical abortion is that it takes too long – sometimes as much as two weeks – and you cannot be sure that the abortion is completed till you go back to the doctor for a follow-up and get some tests done. At least with a surgical abortion it all happens within a few hours and you can put the experience behind you. But with a medical abortion, you have to wait and wait and wait and that can be quite nerve-wracking.

• A medical abortion may not be successful, in which case you may have to undergo a surgical abortion. That means added expenses, extra recovery time, and anxiety at the delay.

• Even if the pregnancy is successfully terminated, the contents of the pregnancy may not have been expelled from the body. This can be highly toxic and can cause death. Again, surgery will be needed to remove what was left inside you.

• There is always the possibility of an infection with all abortion methods. It is no different with a medical abortion.

• There is a chance that your body reacts badly to the medical abortion and you suffer very heavy bleeding as a consequence. Heavy bleeding due to a hemorrhage may call for a blood transfusion and can lead to death. Since you are at home when you are having the medical abortion, this can be very scary especially if you live far away from the family planning clinic or a hospital. If this is something that you are at high risk for, your doctor will suggest that you undergo the medical abortion at the clinic itself.

• Like all other abortion methods, even a medical abortion can cause damage to the uterus in some way. This can lead to problems with conception or problems in future pregnancies.

 

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