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MEDICAL ABORTION

A medical abortion is brought about by taking medications that will end a pregnancy. The alternative is a surgical abortion, which ends a pregnancy emptying by the uterus (womb) with special instruments. A medical abortion is done without entering the uterus, therefore, it can be safer. Either of two medications, methotrexate or mifepristone, can be used for medical abortion. Each of these medications is taken together with another medication, misoprostol, and either regimen will end a pregnancy. Medical abortion is 90-96% effective, but can be more unpredictable than a surgical abortion. The process may be complete in a day or two or take a full 6 weeks. Many women will not want to wait and request a surgical abortion if the process is not complete in 6 weeks.

Determining the Length of Pregnancy

Before any abortion can be done, a medical professional must confirm pregnancy and determine the exact length of the pregnancy. The length of pregnancy is measured by the number of days that have passed since the first day of the last menstrual period (abbreviated as LMP). Medical abortions can be performed as early as a pregnancy can be confirmed. In fact, the shorter 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 9 weeks LMP. After that, surgical abortion is the safest and best option.

How The Medications Work

Methotrexate: Methotrexate has been used in the U.S. since 1953 when it was approved by the Food and Drug Administration (FDA) to treat certain types of cancer. Since that time, medical researchers have discovered other important uses for the drug. One of these uses is to end unintended pregnancies. Although the FDA did not consider methotrexate for this specific purpose, clinicians may prescribe (and are not prescribing it) methotrexate for early abortion. Methotrexate is given to a pregnant woman in the form of an injection (shot). It stops embryonic or fetal cells from dividing. Once these cells can no longer divide, the pregnancy stops growing. This medicine has been used to safely end ectopic pregnancies since the 1980s.

Mifepristone: Another medication that might be used is mifepristone. Mifepristone (RU-486) is a newer medication developed and tested specifically as an abortion-inducing agent. Over 100,000 women have used it worldwide, and medical abortions with this medicine have been approved in France, England, and China for many years. Mifepristone is taken in the form of a pill. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy. Without this hormone, the lining of the uterus breaks down, the cervix (opening of the uterus or womb) softens, and bleeding begins. This medication is not generally available to all physicians, but we, like other medical abortion providers, have specific purchase arrangements with the company since we are also capable of providing surgical abortions.
Misoprostol: A few days after taking methotrexate or mifepristone, a second drug, misoprostol, which comes in the form of a pill or suppository, is inserted into the vagina or taken by mouth. The misoprostol causes the uterus to contract and empty. This ends the pregnancy.

You should not have a medical abortion if you:

• Have adrenal disease or severe liver, kidney, or pulmonary disease.
• Use corticosteroids.
• Have cardiovascular disease.
• Have inflammatory bowel disease.
• Have abnormal blood profile and/or severe anemia.
• Have an ectopic pregnancy.
• Are breastfeeding.
• Have folate deficiency.
• Have known intolerance to either methotrexate or misoprostol.
• Cannot commit to returning to clinic for all recommended follow-up visits.
• Are unwilling to have a surgical abortion even if the provider advises you to.
• Have no telephone.
• Have no transportation.
• Live more than two (2) hours away from emergency medical care.

Medical Abortion Procedure Schedule with RU-486 (Mifepristone) and Misoprostol

This is most similar to the FDA-approved regimen.

Day 1: Medical evaluation, consent process, physical examination, and an oral dose of the Mifepristone (RU-486). This consent process takes about one hour.

Day 2 or 3: The misoprostol will be provided to you with medication instructions that carefully explain the timing and route of administration. About half of all patients will pass the pregnancy within 4 hours of this dose, and you will want to alert your support person of this. A few women will pass the tissue in the next couple of days so it is not unusual for this process to be longer than 4 hours. Most of the heaviest bleeding and cramping will only last 2-4 hours whatever day it begins. It is recommended that women use the pain medication they were prescribed before concluding the pain is not manageable.

Although women are specifically checked for a tubal (ectopic) pregnancy before being given the medical abortion if there is unusual pain or bleeding you must seek medical attention immediately. Over a million women have used these medicines safely but there have been cases of infection and sepsis. If you have pelvic pain or a fever over 100.4 F that lasts at least 4 hours you should seek immediate medical attention.

Call us at any time if you have a concern. We offer 24-hour services because we feel it is very important that you be able to contact us at any time, and think this is an especially important reason for you to select Women's Health Practice for a medical abortion.

We have staff standing by to offer after hours care, on a limited basis, and welcome the opportunity to care for you.

Day 7-20: Return for an ultrasound to assure abortion completeness.

Medical Abortion Procedure Schedule with Methotrexate

Day 1: Consent process, medical evaluation, injection of Methotrexate.

Day 5-7: You will insert pills misoprostol in your vagina while at home. Repeat twenty-four (24) hours later if little or no bleeding. (Optional: May be requested to return on Day 8 for ultrasound).

Day 15: Return for office ultrasound

If pregnancy still growing:
1. You should have surgical abortion; it is unlikely additional medication will work.
2. Return in three (3) weeks for follow-up visit.

If abortion has not happened and pregnancy is not growing:
1. Return in three (3) weeks; we may select to give you additional medication.
2. Three (3) week visit for ultrasound.
3. If the abortion has not occurred, you should have a surgical abortion.
4. Return in three (3) weeks for follow-up visit.

If ultrasound is clear:
1. Abortion is complete.
2. Return in two (2) to three (3) weeks for negative pregnancy test.