Medical abortion

Women of all ages and backgrounds can have unplanned pregnancies, Some women choose to give birth to their baby, while other women choose to terminate their pregnancy through abortion.

A medical abortion, also known as a medication abortion, is a procedure utilized to terminate a pregnancy during its early stages. It involves the use of prescription pills rather than surgical intervention. The most common regimen comprises two pills: mifepristone and misoprostol. Mifepristone works by blocking progesterone, the hormone necessary for supporting a pregnancy, while misoprostol induces cramping and bleeding to empty the uterus.

This method is typically employed for pregnancies within the first trimester. If a pregnancy has progressed beyond this stage, other procedure options such as in-clinic abortion, aspiration abortion, or dilation and curettage (D&C) abortion may be discussed with the healthcare provider.

It’s a secure medical procedure designed to end a pregnancy, also known as ‘termination’ or ‘pregnancy termination. Statistics suggest that around one-third of unintended pregnancies undergo termination. If the fetus dies in the womb before the 20th week of pregnancy, it is termed a spontaneous abortion, also known as a miscarriage. Terminating a Child in a woman depends on the stage of her pregnancy

Why undergo a medical abortion

The decision to undergo a medical abortion is deeply personal and influenced by individual circumstances. Some individuals may opt for this procedure due to concerns about passing on a genetic disease, while others may choose to terminate an unwanted pregnancy. Medical abortion pills may also be used to manage a miscarriage that has not yet occurred naturally, referred to as a missed abortion or completing a miscarriage. Additionally, a medical abortion may be considered if continuing the pregnancy poses a threat to the individual’s life.

Given the uniqueness of each situation, seeking guidance from a healthcare provider who understands one’s medical history and healthcare needs is crucial in making informed decisions about the most suitable option.

Reasons for Terminating pregnancy

hormonal imbalance.
Immunity or blood clotting problems.
Problems like thyroid or diabetes.
Any kind of problem in the womb or uterus.
smoking too much

It is a personal choice. It may be difficult to decide. There are many reasons for choosing to Terminate a Pregnancy. Whatever the reason, if you want to terminate your pregnancy it is your choice.

When Can You Have a Medical Abortion?

The FDA has authorized the use of mifepristone and misoprostol for medical abortion as a safe and effective method up to 10 weeks of pregnancy. However, there’s evidence suggesting its safety and effectiveness beyond this timeframe. FDA regulations permit certified medical professionals and pharmacies to provide these medications for medical abortion in healthcare settings and through mail delivery. This mail access facilitates individuals receiving telehealth care to obtain their medications.

Abortion laws vary from state to state. Each state determines the legality of medical abortions within its borders. In states where medical abortions are legal, state laws dictate:

Who can prescribe or administer the medication (some states mandate physicians only).
The requirements for the visit (some states stipulate one or more in-person visits or restrict the use of telemedicine for abortion).
Procedures during the visit (such as requiring a pregnancy ultrasound).

Who Should Not Undergo a Medical Abortion?

Before opting for any procedure, it’s essential to discuss your medical history with your healthcare provider to ensure safety. A medical abortion might not be suitable if you:

Are in the advanced stages of pregnancy.
Have allergies to the medications used.
Are experiencing an ectopic pregnancy (pregnancy outside the uterus).
Regularly use long-term corticosteroids.
Have an intrauterine device (although it’s an option if removed).
Suffer from blood clotting disorders, significant anemia, or chronic adrenal failure.
Lack access to emergency medical care.

Prevalence of medical abortion

Medical abortions are quite common in the United States, accounting for over half of all abortions performed. This indicates that a majority of individuals who opt for abortion choose to do so in the early stages of pregnancy.

Types of abortion

There are different types of abortion but the medical and surgical abortion methods are safe and effective.

1. Missed abortion

In this the pregnancy terminates on its own. During this period, neither bleeding nor any kind of symptoms are observedIn some cases, even after terminating the pregnancy, the fetus remains in the womb and this becomes known when the development of the fetus stops in the womb. It is detected through ultrasound.

2. Incomplete abortion

In this the woman experiences heavy bleeding and severe pain in the lower abdomen. Only a small part of the embryo can come out. This is why it is called incomplete abortion. Diagnosis is by ultrasound.

3. Complete abortion

Severe abdominal pain and heavy bleeding can be symptoms of complete abortion. In this, the fetus comes out completely from the uterus.

4. Inevitable miscarriage

Bleeding continues and the cervix opens, allowing the fetus to come out. During this period the woman continues to have stomach cramps.

5. Septic abortion

Infection in the womb leads to the termination of the pregnancy

6. Medical abortion

This means that you have to take medicine to have an Terminate the pregnancy. This option is available up to nine weeks of pregnancy. If you undergo a medical abortion, you may experience severe cramps for several hours, but the pain should subside after the termination is complete.. Your doctor can prescribe very effective painkillers to help you in this situation. You should be able to manage this at home.

7. Surgical abortion

If you are more than nine weeks pregnant, or you do not want to have a medical abortion, you can choose to have a surgical abortion instead.
Normally, it is performed as a one-day procedure. If you have a this type of Pregnancy termination under a general anaesthetic (while you are asleep), you will not experience any pain. But later you may have cramps for a few days. If you have a surgical abortion under local anaesthetic, you are likely to feel mild to severe levels of cramping during theTermination. It is also normal to have cramps and pain similar to a menstrual cycle during the next few days. To get relief from pain, you can use heat packs, painkillers and rest. If you still have severe pain, talk to your doctor.

Benefits of medical abortion

A medical abortion offers several benefits, making it a safe and effective option for ending an early pregnancy:

Early termination: A medical abortion allows you to end a pregnancy as soon as you confirm it or learn of an early miscarriage, providing timely resolution.
Natural process: Passing the pregnancy tissue may feel more natural compared to undergoing a surgical procedure, offering a sense of control and familiarity.
Comfort of home: You can undergo the process in the comfort and privacy of your own home or another safe and familiar environment, minimizing stress and discomfort.
Personal support: Having the freedom to choose your support system allows you to have trusted individuals with you during the process, providing emotional and physical support as needed.

Risks of medical abortion

Despite its overall safety, it’s crucial to adhere to prescribed medication instructions to minimize potential risks. Some risks associated with medical abortion include:

Incomplete abortion: There is a slight risk of failure to fully end the pregnancy or retained pregnancy tissue, which may require additional intervention such as a dilation and curettage (D&C) procedure.
Heavy bleeding: In rare cases, heavy bleeding may occur and persist, necessitating medical attention to prevent complications.
Gastrointestinal discomfort: Diarrhea and digestive pain are possible side effects of the medications used in a medical abortion.
Allergic reaction: Although rare, allergic reactions to the medications may occur, requiring prompt medical evaluation and treatment.
Infection: Infection is a potential risk, indicated by symptoms such as an unpleasant vaginal odor and fever lasting more than 24 to 48 hours. Prompt medical attention is necessary if signs of infection develop.

Effectiveness of Medical abortion

A medical abortion, using the combination of mifepristone and misoprostol, is highly effective, with a success rate of about 98%. It is considered a safe and reliable method for ending a pregnancy.

What Occurs During a Medical Abortion?

A medical abortion involves the oral or vaginal intake of pills. Initially, you’ll take mifepristone to terminate the pregnancy, followed by misoprostol to empty the uterus. Adhere strictly to the provided instructions.

Mifepristone, also known as Mifeprex® or RU-486, functions by blocking progesterone, a hormone necessary for maintaining pregnancy. By thinning the uterine lining and preventing attachment, the pregnancy ceases. This pill is taken orally.

Misoprostol (Cytotec®) induces uterine contractions, leading to bleeding and expulsion of the pregnancy. It’s available in pill form for buccal administration (dissolving in the cheeks) or vaginal insertion. Oral misoprostol should be taken within 24 to 48 hours after mifepristone, while vaginal administration can occur 0 to 48 hours after mifepristone.

After taking the second pill (misoprostol), most individuals experience:

Bleeding and cramping beginning one to four hours later.
Intense cramping and bleeding with blood clots over the subsequent hours.
A mild fever or chills lasting approximately a day. Some may also feel tired, nauseated, dizzy, or experience diarrhea.

How Long Does a Medical Abortion Last?

A medical abortion typically takes about two to six hours following the intake of the second pill, although durations may vary. It’s advisable to rest during this period. Having someone you trust nearby can offer care and comfort during the process.

Types of Abortion Procedures

Several procedures are used to induce abortion in clinics or hospitals. A medical abortion, also known as RU-486 or mifepristone, involves taking a prescription pill and can be done at home during the early stages of pregnancy. The choice of abortion procedure depends largely on the stage of pregnancy.

First Trimester: Vacuum aspiration is typically performed.
Second Trimester: Dilation and evacuation (D&E) are commonly used (after 13 weeks).
Later Stages: Dilation and extraction (D&X) may be necessary for more advanced pregnancies.

Does a Medical Abortion Pain Resemble Labor Pain?

The pain experienced during a medical abortion is akin to strong period cramps. However, the intensity of cramping and pain varies among individuals. To alleviate discomfort, you can utilize a heating pad and take over-the-counter (OTC) pain relievers, such as NSAIDs like ibuprofen.

Consult your healthcare provider regarding which pain medications to use and when to take them. For instance, it might be advisable to take a pain reliever half an hour before consuming misoprostol.

What to Expect After a Medical Abortion

The primary side effects post-medical abortion are vaginal bleeding and cramping. While the most intense bleeding typically occurs several hours after the second pill intake, period-like bleeding may persist for several days afterward. Additionally, light to moderate bleeding may continue for several weeks.

Expect a follow-up visit or call with your healthcare provider to confirm the completion of the abortion process.

Procedure Details

Most abortion procedures are outpatient, meaning patients do not need to stay overnight at the clinic or hospital.

Before the Procedure:

Your healthcare provider will provide instructions over the phone when scheduling the appointment.
Fasting may be required from midnight the night before the procedure due to its surgical nature.
Upon arrival at the clinic, you’ll complete paperwork and discuss your medical history.
A pre-abortion workup includes a physical examination, pregnancy test, blood test, and screening for sexually transmitted infections. Additional tests, including ultrasound, may be conducted to determine the stage of pregnancy and check for abnormalities.

Counseling Session:

During a counseling session, your doctor will review all information gathered to determine the most suitable procedure for you. This includes discussing the risks, benefits, and implications of each option.

Pain Management:

Your healthcare provider will discuss pain management options available during the abortion procedure. For in-clinic abortions, local anesthesia is typically provided, numbing the cervix while you remain awake. Additionally, oral medication or sedation may be offered to help you relax. If you prefer heavy sedation, IV sedatives can be administered to keep you lightly asleep throughout the procedure.

Abortion procedures

Vacuum Aspiration (Suction Abortion):

Common for pregnancies up to 12-13 weeks, vacuum aspiration, also known as a “suction abortion,” is performed. Minimal preparation of the cervix is needed for early-stage procedures. However, for later pregnancies, cervical dilation may be required using sterilized seaweed sticks called laminaria. During the procedure, a speculum is inserted into the vagina, and the cervix is numbed before a suction tube removes uterine contents. The process typically takes several minutes, followed by a brief observation period.

Second Trimester: Dilation and Evacuation (D&E):

For pregnancies beyond 12 weeks, a D&E procedure is common. Preparations include cervical dilation, potentially using laminaria sticks or medication. The cervix is numbed, and tools are used to remove uterine contents, including forceps and a curette. Ultrasound may guide the procedure, and medications may be administered to stop fetal heartbeat and reduce bleeding afterward. The process lasts 10 to 20 minutes, followed by a period of rest under observation.

Late-Term Abortion: Dilation and Extraction (D&X):

For later pregnancies, specialized providers may perform a D&X procedure, reserved for serious fetal or maternal complications. Preparations and post-procedure steps are similar to D&E. General IV anesthesia may be offered for sedation, especially if the procedure is conducted in a hospital setting.

Other Options:

Other abortion methods, such as labor induction, hysterotomy, and hysterectomy, are riskier and typically reserved for medical necessity.

Post-Procedure Care

After the procedure, you’ll spend about 30 minutes resting under supervision at the clinic. Then, you can relax in a recovery area until you feel ready to go home. If you received sedation, you’ll need someone to drive you. Additionally, you’ll be given a prescription for an antibiotic.

Expect some cramping for a few days and light bleeding for up to 2 weeks. Over-the-counter or prescription pain relievers like acetaminophen, ibuprofen, or codeine are effective for managing most pain and cramping.

Plan to rest on the procedure day, and you might need a few extra days if you had a D&E or D&X. Avoid lifting heavy objects for a few days. Your doctor will advise you on when it’s safe to resume sexual activity or use tampons, which could be up to a month after the procedure.

If you experience severe pain, a fever exceeding 100°F, or soak through more than two pads per hour, contact your provider or the emergency contact they provided immediately.

Most providers will schedule a follow-up appointment within 1 to 4 weeks to ensure your physical recovery and confirm the termination of pregnancy.

Duration of Bleeding After a Medical Abortion

The duration and intensity of bleeding following a medical abortion vary from person to person and depend on the stage of pregnancy. Generally, anticipate heavier bleeding for one to two days, followed by a gradual decrease over two to three weeks. It’s advisable to use sanitary pads during this time to monitor clotting and blood loss, enabling you to provide valuable information to your healthcare provider.

What Happens During the Follow-Up Appointment After a Medical Abortion?

Your healthcare provider will schedule a follow-up appointment within two to five weeks post-abortion. During this visit, your provider may conduct several assessments to ensure the effectiveness of the medication and confirm the termination of the pregnancy. This may include a home urine pregnancy test, laboratory work, or ultrasound examination.

When can you do normal activities again?

If you feel well physically and emotionally, you can resume normal activities the day after the termination. But for the next one to two weeks, you should try not to do these things:

heavy lifting, physical work, and strenuous activities
having sex, using tampons, and inserting anything into your vagina
swimming

How Effective is a Medical Abortion?

When you combine mifepristone and misoprostol, the effectiveness of medical abortion reaches about 98%. It’s a reliable and secure method for ending a pregnancy.

Recovery Time After a Medical Abortion

The recovery period varies for each individual. Most people start feeling better the day following their last pill. You might resume normal activities within one or two days. Listen to your body and take it easy if needed. Avoid any activities that cause discomfort.

Recovery isn’t only physical; it involves emotional aspects too. It’s normal to experience a mix of feelings like relief, sadness, stress, or guilt. If you find it challenging to cope, consider talking to a mental health professional such as a therapist. Your healthcare provider can offer recommendations for mental health support.

When Can You Resume Sexual Activity After a Medical Abortion?

It’s advisable to wait at least two to three weeks before engaging in sexual intercourse post-medical abortion. This is to lower the risk of vaginal infections. Avoid inserting anything into your vagina during this period, including tampons.

Getting Pregnant Again After a Medical Abortion

You can conceive again within two weeks after the abortion. Typically, your regular menstrual cycle should return within four to six weeks post-medical abortion. However, the first period might be slightly irregular due to hormonal changes related to the procedure.

Unless complications arise, a medical abortion generally doesn’t impact future pregnancies.

Common emotional symptoms include:

mood swings
not being able to remember things
Restlessness.

When to See a doctor

It’s crucial to maintain close communication with your healthcare provider throughout your medical abortion journey. Don’t hesitate to ask any questions you have to ensure you fully comprehend the procedure and what to expect afterward.

Here are the situations in which you should contact your healthcare provider:

No Bleeding 24 Hours After Taking Misoprostol: If you haven’t experienced any bleeding within 24 hours after taking misoprostol.
Severe Bleeding: If you’re soaking more than two thick pads within an hour due to heavy bleeding.
Signs of Infection: If you notice signs of infection such as a fever lasting more than 24 hours accompanied by foul-smelling vaginal discharge.
Severe Abdominal or Back Pain: If you’re experiencing intense abdominal or back pain.
Absence of Period After Two Months: If you haven’t had your period return after two months post-abortion.
Symptoms of Pregnancy: If you’re experiencing symptoms of pregnancy after the abortion.

What is the fee for an Abortion?

The fees depend on:

type of Termination
What stage of pregnancy are you in?
Where you get the procedure (eg, in a government or private clinic)

If you are eligible for Medicare or have private health insurance, you won’t have to pay anything. Some clinics or public hospitals may have lower fees. Your doctor can give you more information.

Does getting a Pregnancy Termination require a referral?

In countries where it is required by law, you need a referral from your doctor to book a Pregnancy Termination.

Do you need counseling before having Terminating A child?

You don’t need counselling, but if you want to talk to someone or find out more, it’s available.

Sources

American College of Obstetrics & Gynecologists. Medication abortion up to 70 Days of Gestation. Practice Bulletin Number 225
Baraitser P, Free C, Norman WV, et al. Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review
Planned Parenthood
Medscape
National Abortion Federation
Guttmacher Institute
American College of Obstetricians and Gynecologists
Pregnancy Center of the Coastal Bend: “Abortion Information Texas.”
Life Choices Memphis: “The Abortion Pill.”
Bateson D, McNamee K, Harvey C. Medical abortion in primary care
Mazza D, Burton G, Wilson S, Boulton E, Fairweather J, Black KI. Medical abortion
U.S. Food and Drug Administration. Information about Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation

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