Definition and Overview

Medication abortion, also called medical or non-surgical abortion, is a method of terminating pregnancy that uses medications instead of surgery. This type of abortion is only allowed for women who are five to seven weeks pregnant and is done under the supervision of a medical professional. It is one of the safe and legal methods of abortion, other than surgical abortion.

Who Should Undergo and Expected Results

Medication abortion is available for women who are five weeks pregnant, when counting from the conception date, or not more than seven weeks pregnant, when counting from the first day of their last menstrual period. Before undergoing the procedure, patients are advised to first discuss and study their existing options, as this is an irreversible procedure.

Some patients, however, may not be allowed to undergo a medical abortion despite meeting the pregnancy timeframe requirements due to the following reasons:

  • Patients with physical conditions or existing diseases, such as severe anemia
  • Patients using an IUD
  • Women who seek a faster way to terminate the pregnancy
  • Women who cannot return to the doctor’s clinic for a follow-up check
  • Women who cannot carry out the instructions for taking misoprostol unsupervised, either due to language and comprehension issues
  • Women who have strong allergies to some medications, especially to prostaglandins (which may include the drugs used for the procedure)
  • Women having an ectopic pregnancy, in which case medication abortion will be unsuccessful

How the Procedure Works

There are certain medications that can be used to facilitate a medication abortion. Some of them are:

  • Mifepristone – Often dubbed as the abortion pill, and also identified as RU 486, it is one of two medications used for in-clinic abortions. It works by blocking the production and effects of the hormone progesterone, which is responsible for stabilizing the lining of the uterus. Once progesterone is inhibited, the uterus lining breaks down and the womb will be unable to support the pregnancy.

  • Methotrexate – This is a drug that has been used in cancer treatment for many years now and has been used for medical abortion as early as the 1900s. It works by preventing effective egg implantation. In some countries, this is the drug equivalent of mifepristone.

  • Misoprostol – This drug is more commonly known by its brand names, such as Misotrol, Cytotec, and Cyprostol, among others. The purpose of this secondary drug is to empty the uterus completely by stimulating contractions. Studies show that in about 90% of cases, using misoprostol alone can successfully end a pregnancy. The procedure prescribed and conducted through safe and legal abortion services with doctor’s supervision, however, is still the dual-medication process.

The procedure usually begins with an ultrasound scan to determine the actual stage of the pregnancy. Once it is determined that the pregnancy is within the allowed period, the medications may then be administered, either orally or intravenously, by a doctor in a clinic or office. Usually, the above medications are used in combination, with methotrexate given initially followed by misoprostol a few days later. The doctor supervising the abortion will give patients full instructions on how to take misoprostol. The length of time it takes for a successful abortion differs from one woman to the next; in some, abortion may become successful just hours after misoprostol is taken, whereas for some, it may take a few days.

After taking methotrexate, the patient may expect to have some bleeding, but this does not indicate the end of the procedure. Over the next few days, the patient has to take misoprostol at given times and exactly as instructed. Since the drug will start emptying the uterus, some symptoms similar to those felt during menstrual periods may be expected. These include:

  • Strong abdominal cramping – These can be relieved with the help of warm compresses or mild pain medications such as ibuprofen or paracetamol
  • Bleeding similar to a heavy period – The bleeding may last up to three weeks after the abortion, generally similar to the amount of bleeding experienced by women who have just given birth. This period differs from woman to woman. However, bleeding that soaks two pads in one hour for two consecutive hours should be reported to the doctor.
  • Nausea
  • Feeling tired

Some other symptoms may also be experienced including:

  • Fever
  • Chills
  • Nausea
  • Vomiting

Once the allotted time for taking misoprostol has passed and the medication has been taken as advised, the patient needs to return to the doctor’s office for a follow-up check. The purpose of this visit is to ensure that the abortion has been completed. This is done by doing a pelvic exam and an ultrasound scan.

Possible Risks and Complications

Medication abortion is generally safe, as long as it is done only on pregnancies that are within the allowed timeframe and as long as both of the medications are administered correctly. Possible complications, although rare, may include:

  • An unsuccessful abortion – There is a risk that the abortion will not be successful, but this applies only to an estimated 1 to 2 percent of all women. In case of a failed medical abortion, the only other option the patient has is a surgical termination of the pregnancy. This is because once the medical procedure has been conducted, there is no longer any chance of continuing the pregnancy as the medications may have already compromised fetal development and may cause birth defects such as limb deformities and nerve problems.

  • Delayed reaction to the medication – In around 4 to 5 percent of women, there may be a delay in the body’s reaction to the drugs used in medical abortion. This does not render the procedure unsuccessful, but the patient will be asked to wait for the process to be completed. Patients who prefer not to wait may follow it up by a surgical abortion.

  • Infection

  • Bleeding excessively
  • Blood clots

The risk of infection and serious bleeding affects only less than 1 percent of women who undergo medical abortion. This risk increases the farther along the pregnancy is when it is terminated.

Also, alcohol and other drugs should be avoided at all costs during the entire procedure.

A medication abortion has no lasting effects on the body and will not keep a woman from getting pregnant again in the future. It also does not pose any major effects on a woman’s general health.

References:

  • Jensen J, Michell DR. Family Planning. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 13.

  • Lesnewski R, Prine L. Pregnancy Termination. In: Pfenninger JL, Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap. 128.

  • Oppegaard KS, Qvigstad E, Fiala C, Heikinheimo O, Benson L, Gemzell-Danielsson K. Clinical follow-up compared with self-assessment of outcome after medical abortion: a multicentre, non-inferiority, randomised, controlled trial. Lancet. 2015 Feb 21;385(9969):698-704. PMID: 25468164. http://www.ncbi.nlm.nih.gov/pubmed/25468164.

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