(Back to Abortion)
1. What is a medical abortion?
Pregnancy termination by taking medication that causes you to begin to contract, bleed, and then pass the pregnancy as if you miscarry. The alternative is surgical abortion using instruments and suction curettage.
2. What are the medications and how do they work?
Mifepristone (RU-486) is an antiprogesterone. This causes the pregnancy to detach from the uterus. Misoprostol is a prostaglandin that causes softening of the cervix, uterine contractions, and leads to expulsion of the pregnancy spontaneously. Some medical abortions begin with methotrexate; a drug that causes rapidly dividing cells to stop dividing and die. The RU-486 method is more effective and more predictable.
3. Is this method safe?
Medical abortions are very safe and avoid the chance of inadvertent rupture damage to the uterus that can be caused by sharp instruments used in surgical abortions. Both medical and surgical abortions have a less than 1% infection rate and less than 1-2% rate of serious bleeding. Patients rarely need repeat surgical abortions for an incompletely terminated pregnancy. For very early pregnancies, this may occur 4-5% of the time; for later pregnancies, it is much more rare.
4. Will this affect my future ability to have children?
Surgical abortions are much safer than carrying a pregnancy to term. Long-term health or psychological consequences are rare. Possible complications include damage or scarring to the uterus, injury to the cervix, pelvic infection, bleeding, or pain. Rare cases of a blood clot or other complications have been reported but the rate of death from an abortion is < 1/100,000 (check statistics). The medications for medical abortion can produce harmful birth defects if the abortion process is not completed successfully. Long-term effects of these medications are not known. Misoprostol has been used as a gastric ulcer treatment for years. Methotrexate has been used to treat arthritis, and RU-486 has been used in other countries for the treatment of fibroids and endometriosis.
5. What will the embryo (baby) look like?
Surgical abortion patients do not see their tissue. Medical abortion patients may or may not notice the pregnancy tissue as it passes from their body. The embryonic tissue is usually small, irregularly shaped, and white, and sometimes inside a blood clot. Even if you see it close up, it does not look like a baby because it is much too soon to have any real shape. If you do not see it, there is no need to worry since it is easy to miss. A pregnancy embryo of 49 days is 1/5 of an inch. By 63 days, the pregnancy could be as large as 1 ½". An early pregnancy would be even smaller.
6. How will I know when the abortion is complete?
The only way to be certain that the abortion is complete is to come back to Women's Health Practice for follow up visits. At this time an ultrasound will determine abortion completeness. You cannot be sure you aborted even if you bleed very heavily.
7. What should I expect on my first visit?
During the first visit is when most of the work will be done, including:
- Taking your medical history and patient information.
- Performing the pelvic exam and ultrasound.
- Doing necessary laboratory work/tests.
- Obtaining written consent.
- Counseling on the procedure and what to expect. Explaining the "do's and don'ts" until your follow up visit.
- Instructing you how to self administer the misoprostol at home
- Giving you the RU-486 tablet.
8. How effective is this method?
If used within 63 days after the first day LMP, the combination drugs have reported being 90-96% effective. About 5% of these abortions occur before the administration of the misoprostol medication, and 70-80% of the women abort within six (6) hours after it is administered. The procedure may take up to 6 weeks to complete, but that is unusual.
9. What are the side effects of the medications?
Most patients to not experience significant side effects or if they do they are mild and do not last long. Nausea, vomiting, diarrhea, headaches, dizziness, and warm/hot flashes are lessened if you use your medication vaginally instead of taking orally. With the misoprostol, side effects include nausea, vomiting, diarrhea, and fever/chills.
10. Will this method be painful?
Pain is variable and we do provide pain medication prescriptions. The initial cramping is mild. The cramps when you actually pass the pregnancy are dramatically stronger over 2-3 hours. The bleeding may or may not coincide with the pain. Women with strong menstrual cramps and women who have not previously had a baby may experience worse cramps. The strongest cramps usually occur 1-3 hours after the misoprostol (the second medication).
11. What amount of bleeding can I expect?
The amount of bleeding varies for each individual. Most likely it will be heavier than a period, so have a good supply of maxi pads. The bleeding will most likely begin with two (2) to four (4) hours after the cramping begins, but can start as soon as ½ hour, or as long as ten (10) hours later. Heavy bleeding will most likely last up to four (4) hours. Heavy bleeding is expected, but if you soak more than four (4) maxi pads per hour for more than two (2) hours in a row, contact Women's Health Practice.
12. May I choose to have a surgical abortion after starting the medical abortion?
You can change your mind and choose to have a surgical abortion at any point for any reason. Women who have begun a medical abortion then opted for a surgical abortion often cite the uncertain timetable as the biggest obstacle. Perhaps they need the abortion to be over quickly, don't feel comfortable with a lot of blood, have no one to watch the children, etc. If you are medically stable, the surgical abortion will be scheduled during our regular office hours.
13. What restrictions will I have during the medical abortion?
Individual instructions will be given, and methotrexate patients will be asked to avoid foods with folic acid. Avoid alcohol, aspirin, ibuprofen, and related medications and other nonprescription drugs. Abstain from sexual intercourse until the abortion and recovery period are over, which may take as long as four (4) weeks. Breastfeeding needs to stop for a period of time after taking the medications.
14. What if the medication does not work?
There is a 90-96% chance the medications will be successful in inducing an abortion. But, in the rare event the drugs do not work for you, the embryo can be severely damaged, and you will need to have a surgical abortion.
15. What if I continued the pregnancy after taking the medication?
Studies reveal severe birth defects (i.e., frontal and/or temporal defects in the skull and limb defiencies). You must be certain of your decision to have an abortion and be willing to have a surgical abortion.
16. When will I receive contraceptive to prevent future pregnancies?
Once the abortion is complete, Women's Health Practice physicians, counselors, or nursing staff will discuss contraceptive choices. You may receive a Depo injection immediately or start your oral contraceptives as soon as you know the abortion is complete.