Definition of Medical Abortion
A medical abortion is one that is brought about by taking medications that will end a pregnancy by inducing a "miscarriage". The alternative is surgical abortion, which ends a pregnancy by emptying the uterus (or "womb") with special instruments and a vacuum device.
A medical abortion is done without entering the uterus.
Mifeprex, a medication approved by the Food and Drug Administration (FDA) for pregnancy termination, can be used for a medical abortion. Mifeprex, a non-invasive early option pill is taken orally and allows you to avoid anesthesia and surgery in most cases. This medication, taken together with another medication, Misoprostol, will end a pregnancy in a high percentage of instances. Termination is accomplished in 95% of the patients who are 7 weeks or less from their last menstrual period.
Determination of Length of Pregnancy
Before any abortion can be done, a medical professional must confirm that a woman is indeed pregnant and determine the length of the pregnancy. The length of a pregnancy is usually measured by the number of days that have passed since the first day of the woman's last menstrual period (abbreviated as LMP) using ultrasound. Medical abortions can be performed as early as a pregnancy can be confirmed. In fact, the shorter the time that a woman has been pregnant, the better the medications will work. Because they do not work as well later in pregnancy, medical abortion is not usually an option after seven weeks (or 49 days) LMP. After that, surgical abortion is the safest and best option.
How the Medications Work
| • | Mifeprex: taken orally blocks a hormone needed to maintain pregnancy. When followed by Misoprostol, Mifeprex ends pregnancy. |
| • | Misoprostol: 2 days after taking
Mifeprex , a second drug, Misoprostol is taken orally. The Misoprostol
causes the uterus to contract and empty its contents. This ends the
pregnancy. This step is repeated on day 4. |
How Long Do
Medical Abortions Take?
Medical abortion can take anywhere from 3 to 4 days but bleeding and spotting
usually last about 9-16 days. Medical Abortion requires two visits to
the office. An initial visit and a return visit are required. It is very
important since there is no other way to be sure that the abortion has
been completed. With the Mifeprex / Misoprostol combination, 95 % of women
will abort within 4 days. A small number of women who try medical abortion
will need to have a surgical abortion because of heavy bleeding or because
the medication does not work for her.
Step 1
A clinician or counselor will explain the process to you and answer all
your questions. After reviewing your medical history an ultrasound, blood
work, pregnancy test and and a physical exam will be completed. You will
read and sign an informed consent. After that the doctor will give you
the medication to be taken orally. You may have some initial bleeding
after this first medication. Very few women will have a complete termination
of their pregnancy before using the second medication.
Step 2
Two days later at home, you will take 4 tablets. Within a few hours you
will probably start to have cramping and bleeding. You may pass some blood
clots. Pain medication and a heating pad can help with the cramps. You
may also have nausea, vomiting, fever, chills, a feeling of being tired
of rarely diarrhea. These symptoms usually last a short time and stop
on their own. If you soak more than two maxi pads per hour for two hours
in a row, you should call us.
Step 3
One day later you will take another 4 Misoprostol tablets.
Step 4
It is very important to come back to the office in two weeks to make sure
that the abortion is complete. At that time you will have another pregnancy
test and an ultrasound. A small number of women, even if they have had
bleeding, may need to use more Misoprostol or wait several more days or
rarely, a few weeks for the abortion to be complete. If the pregnancy
is continuing, a surgical abortion is required because the medicine can
cause birth defects. The doctor or counselor will talk to you about birth
control methods to use once your abortion is complete Misoprostol, the
medication taken after the Mifeprex, causes the most common side effects
of medical abortion. The side effects may include: cramps similar to those
with a heavy menstrual period, headache, nausea, vomiting, diarrhea, and
heavy bleeding.
The amount of bleeding that a woman has will be greater with medical abortion
than with surgical abortion. Most women have cramps for several hours,
and many pass blood clots as they are aborting. In some cases, the blood
clots will be larger than the embryo and other tissue from the pregnancy
that will also be passed. The embryo will probably not be seen among the
blood clots. For example, at 49 days LMP, the size of the embryo will
be about one-fifth of an inch. In an earlier pregnancy, it might be much
smaller than that. Cramps and bleeding usually begin to ease after the
embryonic tissue has been passed, but bleeding may last for a week or
more after medical abortion.
Women report that their first regular menstrual period usually occurs
4 to 6 weeks after a medical abortion and may be heavier, or longer, or
in some other way different than normal for them. By the second period
after the medical abortion, their cycles should be back to normal.
Possible Complications
Medical abortion is irreversible once the Mifeprex has been taken. If
the pregnancy is not expelled after using these medications, a suction
procedure (surgical abortion) must be done to empty the uterus and complete
the abortion. The most common immediate complication of a medical abortion
is heavy bleeding. For this reason, a woman must have access to a telephone
and transportation in case emergency treatment is needed. In rare cases,
a woman will need an emergency D&C (evacuation of the uterus) or a
blood transfusion to stop the bleeding. These complications are rare.
There does not appear to be any long-term complication associated with
the use of these drugs to induce a medical abortion.
Follow-up Care
Because there is no way to know for sure that the abortion is complete
without an examination by a health care professional, keeping appointments
with the office for follow-up care is very important! In addition, a woman
must report any problems she has during the medical abortion to a health
care professional.
