Medical abortion

Overview

Medical abortion is a procedure that uses medicine to end a pregnancy. The procedure doesn't require surgery or medicines that prevent pain, called anesthetics. A medical abortion is safest and works best during the first trimester of pregnancy.

The procedure can be started in a medical office or at home. If it works as it should, follow-up visits at your healthcare professional's office or a clinic aren't necessary. But for safety, be sure you can reach a healthcare professional by phone or online. That way you can get help in case the procedure leads to medical problems called complications.

If you're thinking about getting a medical abortion, learn all you can about the procedure. Understand what it involves and what types of medicine can be used. Be aware of the possible side effects and risks too.

Why it's done

The reasons for having a medical abortion are highly personal. You can choose to have a medical abortion to complete an early miscarriage or end an accidental pregnancy. You also can choose a medical abortion if you have a health condition that makes continuing a pregnancy life-threatening.

Risks

In general, medical abortion is safe and effective. But it does come with risks, including:

• The body not releasing all pregnancy tissue in the uterus, also called an incomplete abortion. This may require surgical abortion.
• An ongoing pregnancy if the procedure doesn't work.
• Heavy and prolonged bleeding.
• Infection.
• Fever.
• Digestive symptoms such as upset stomach.

It's also risky to change your mind and choose to continue a pregnancy after taking medicine used in medical abortion. This raises the chances of having serious complications with the pregnancy.

In general, medical abortion hasn't been shown to affect future pregnancies unless there are complications.

But some people should not get a medical abortion. The procedure isn't an option if you:

• Are too far along in your pregnancy. You shouldn't attempt a medical abortion if you've been pregnant for more than 11 weeks. A pregnancy is dated from the first day of your last menstrual period.
• Have an intrauterine device (IUD) currently in place.
• Have a suspected pregnancy outside of the uterus. This is called ectopic pregnancy.
• Have certain medical conditions. These include anemia; some bleeding disorders; chronic adrenal failure; certain heart or blood vessel diseases; severe liver, kidney or lung disease; or an uncontrolled seizure disorder.
• Take a blood thinner or certain steroid medicines.
• Can't reach a healthcare professional by phone or online, or don't have access to emergency care.
• Have an allergy to the medicine used in a medical abortion.

A surgical procedure called a dilation and curettage may be an option if you can't have a medical abortion.

How you prepare

Before a medical abortion, your healthcare professional reviews your medical history. The healthcare professional also talks with you about how the procedure works, the side effects, and the risks and possible complications. These steps take place whether you have an in-person healthcare appointment or meet with a healthcare professional online.

If you have an in-person appointment, your healthcare professional confirms your pregnancy. You might receive a physical exam. You also might receive an ultrasound exam. This imaging test can date the pregnancy and confirm that it's not outside the uterus. An ultrasound also can check for a complication called a molar pregnancy. This involves an unusual growth of cells in the uterus. Blood and urine tests also may be done.

As you weigh your options, think about getting support from your partner, a family member or a friend. Talk with your healthcare professional to get answers to your questions. Your healthcare professional also can talk with you about medical and surgical abortion options and help you consider the impact the procedure may have on your future.

An abortion requested for reasons other than to treat a health condition is called an elective abortion. In some places, an elective abortion may not be legal. Or there may be certain legal requirements and waiting periods to follow before having an elective abortion. Some people who have miscarriages need medical abortions to pass pregnancy tissue out of the body. If you're having an abortion procedure for a miscarriage, there are no special legal requirements or waiting periods.

What you can expect

Medical abortion doesn't require surgery or medicines that prevent pain, called anesthetics. The procedure can be started in a medical office or clinic. A medical abortion also can be done at home. If you do the procedure at home, you may need to see a healthcare professional if you have complications.

During the procedure

Medical abortion can be done using these medicines:

• Oral mifepristone (Mifeprex, Korlym) and oral misoprostol (Cytotec). This combination is the most common type of medical abortion. These medicines can be taken within 11 weeks of since the first day of your last period. Mifepristone (mif-uh-PRIS-tone) is taken first. Misoprostol (my-so-PROS-tol) is taken 24 to 48 hours later. Some people take mifepristone at a healthcare professional's office or clinic, but it also can be taken at home. Misoprostol usually is taken at home.

  Mifepristone blocks the hormone progesterone. This causes the lining of the uterus to thin. It prevents the embryo from staying attached to the uterine wall and growing. Misoprostol causes the uterus to contract and expel the embryo through the vagina.

  You can choose to visit your healthcare professional a week later to make sure the abortion is complete. Or you could follow up with a healthcare professional online or by phone. You also can choose to assess your symptoms at home and then take an at-home pregnancy test.

• Oral mifepristone and other forms of misoprostol. With this type of medical abortion, you take a mifepristone tablet by mouth. The next step is to use slowly dissolving misoprostol tablets placed in the vagina, in the mouth between the teeth and cheek, or under the tongue.

  These ways of taking misoprostol lessen side effects. They also may work better than swallowing oral misoprostol. These medicines may work best if you take them within nine weeks since the first day or your last period.

• Misoprostol alone. This can be an option if mifepristone isn't affordable or available. Misoprostol alone can be used in the vagina, in the mouth between the teeth and cheek, or under the tongue. Up to three doses are taken hours apart to boost how well the medicine works. Misoprostol alone may not be as effective after the first nine weeks since the first day of your last period. And misoprostol alone doesn't work as well as does the combination of mifepristone and misoprostol.

The medicines used in a medical abortion cause vaginal bleeding and cramping in the stomach area. They also may also cause:

• Upset stomach.
• Vomiting.
• Fever.
• Chills.
• Diarrhea.
• Headache.

You may be given medicine to manage pain during and after the medical abortion. Infections after medical abortion are rare, so antibiotics usually aren't needed.

Your healthcare professional lets you know how much pain and bleeding to expect. You might not be able to go about your usual daily routine during this time, but you're not likely to need bed rest. Make sure you have plenty of absorbent sanitary pads.

If you have a medical abortion at home, make sure you have access to a healthcare professional who can answer questions by phone or online. Also be sure you can get emergency care in case you have health problems called complications.

After the procedure

Call a healthcare professional right away if you have any of the following symptoms after a medical abortion:

• Heavy bleeding — soaking two or more pads an hour for two hours in a row.
• Bad pain in the stomach area or pelvis.
• Chills or body aches.
• Fast heart rate.
• Fever that lasts more than four hours or that starts in the days after you take misoprostol.
• Foul-smelling vaginal discharge.

After a medical abortion, you can have a follow-up visit with your healthcare professional by phone, online or in person. A follow-up online or by phone usually happens 1 to 2 weeks after the medical abortion. Your healthcare professional asks you about your symptoms. You work together to decide whether the pregnancy tissue likely has passed from your body. Around four weeks after the medical abortion, you take an at-home pregnancy test of your urine to confirm whether the process worked.

If you get a follow-up visit at a doctor's office, your healthcare professional makes sure you're healing properly. You may be asked questions such as:

• Do you still feel pregnant?
• Did you see the pregnancy material pass from your body?
• How much bleeding did you have? Do you still have any bleeding?

If your healthcare professional thinks you had an incomplete abortion or have an ongoing pregnancy, you may need an ultrasound. You also may need a surgical abortion.

After a medical abortion, you may have a mix of emotions, such as relief, loss, sadness or guilt. If these feelings bother you, it might help to talk to a counselor about them.

Preventing pregnancy

The ovaries may release an egg as soon as eight days after a medical abortion. Another pregnancy is possible even before your period starts. Before the abortion, talk with a healthcare professional about your birth control options. You can start birth control as soon as the procedure is over.