Medical abortion

 

from 5 to 9 weeks

 

What is a medical abortion?

Medical abortion is a procedure that uses medications to terminate a pregnancy from between 5 weeks to 9 weeks (63 days) from the first day of your last period. Medical abortions have been safely provided to women in the USA, Canada, Europe, UK and New Zealand for the last two decades and have recently been made available in Australia. Medical abortion is not considered a safer option than surgical abortion as both options are considered to be extremely low risk, but it provides women with an additional choice.

The medical abortion process occurs in at least three stages over a 2 to 3 week period. During the initial visit to the clinic, the pregnancy must be confirmed with an ultrasound scan and the first medication is taken which halts the growth of the pregnancy and causes it to detach from the uterine wall. The second stage occurs in your home, 36 to 48 hours later, where you take a second medication which will cause your uterus to contract and encourage the pregnancy tissue to pass over the following 12 to 24 hours. This stage can be painful and the bleeding will be heavy but can usually be made tolerable with pain relief medications. You should plan to be in a quiet, private place, with easy access to a bathroom, for at least 6 hours, and possibly as long as 24 hours.

The third stage requires a follow-up visit to the clinic after 14 to 21 days where we will confirm that the medical abortion has been completed successfully.

Is medical abortion suitable for me?

Many women will choose to have a medical abortion because they may prefer to avoid undergoing a procedure with IV sedation. In some cases women may have conditions which make a surgical abortion difficult to perform. Or you may prefer this option because it allows the process to take place at home.

While medical abortion has been safely offered to women around the world for many years, it is not suitable for all women. It may not be suitable for you if you have a bleeding or clotting disorder, liver or kidney disorder, are diabetic, have severe chronic disease, severe anaemia, known allergies to any of the medicatons used, if you currently have an IUD in place or if there is a risk of an ectopic pregnancy.

If the medical abortion is not successful (approx 5%), you must be prepared to undergo a procedure to complete the process.

You must be within 1 hour of a 24 hour hospital emergency department to allow for the possibility that urgent treatment may be required if bleeding becomes too heavy or other complications develop.

If you are unsure of your gestational age but have had a positive pregnancy test, it is important to understand that a medical abortion can only be performed after 5 weeks and before 9 weeks (63 days) counting from the start of your last period. Even if you’ve had a positive home pregnancy test, it is possible that you may still be too early to have a medical abortion. If you are in doubt, call the Private Clinic for advice.

How does it work?

The two medications have the generic name mifepristone and misoprostol.

Mifepristone is an anti-progesterone, which blocks the action of progesterone, a hormone essential for the establishment and development of a pregnancy. It also changes the uterine lining, causing the pregnancy to detach. This is taken during the initial visit to the clinic, after the doctor has confirmed the age and location of the pregnancy with an ultrasound scan.

The second medication is called Misoprostol and is taken at home, 36 – 48 hours after taking mifepristone. This is a synthetic prostaglandin, a hormone-like drug which causes your uterus to contract and encourages the pregnancy tissue to be expelled.

What happens during my initial appointment?

Your initial visit will commence the abortion process and will usually take around 1 hour.

Upon arrival you will be asked to complete several forms, to collect your personal details, including information about your medical history, a counselling questionnaire and you will be provided with the consent form which provides details about the known possible risks.

The consultation with the doctor will include a discussion about your medical, obstetric and gynaecological history. The doctor will also discuss contraception and we will also discuss your personal situation with you, as required for a lawful abortion in NSW.  The process will be explained, including the known risks and side effects, how to take the medications at home, what to expect, and the need for follow-up in two weeks.

We will perform a pregnancy test and an ultrasound scan will be carried out to verify that the pregnancy is located within your uterus and that you are between 5 to 9 weeks. (63 days). If you are 6 weeks or over, an abdominal (external) scan is usually only required. If this external scan does not clearly show a pregnancy or if you are very early, (5 to 6 weeks), an internal scan will be required.

If our ultrasound scan does not identify a small pregnancy, your pregnancy hormone levels must be checked with a series of blood tests and this will help to indicate whether you may have an ectopic pregnancy.

We will also need to take a small blood sample to test your blood group. If you have a rhesus negative blood group, you will be given an injection of Anti-D to protect future pregnancies.

The doctor will then give you the first medication (Mifepristone). The effects of Mifepristone are usually mild and do not last long. You may experience nausea or mild cramping. Some bleeding or spotting is also common, but it is rare for the pregnancy to abort after the Mifepristone alone.

We will  provide you with detailed instructions about the second stage of the process which will take place 36 to 48 hours later.

What should I expect during the abortion process at home?

You will need to allow at least 12 hours where you can rest comfortably in a quiet location with easy access to a bathroom.  You must have the support of a responsible adult who you can call upon to assist you if required and you must be within 1 hour of a public hospital.

Misoprostol causes cramping pain and bleeding, usually within one to six hours of using the tablets. Pain can range from mild, period-like pain to severe, disabling pain. For most women the pain can usually be made tolerable with pain relievers such as paracetamol and ibuprofen.

It is important to commence taking pain relief tablets shortly before taking the Misoprostol and at regular intervals for it to have the best effect. A heat pack, or abdominal or back massage, can also help to ease the pain.

The Misoprostol causes your uterus to contract and this will encourage the pregnancy tissue to be expelled. This stage will cause cramping and heavy bleeding lasting for up to 12 hours, or sometimes up to 24 hours.

Intermittent bleeding may continue for up to 3 to 4 weeks and a follow-up visit to the clinic in 14 days is essential to verify that the medical medical abortion is complete.

Comparison of medical and surgical abortion

 Surgical abortionMedical abortion
When can it be done?From 5 to 15 weeks (at the Private Clinic).From 5 to 9 weeks

(less than 63 days from the start of your last period)
Time required to completeThe procedure takes 10 minutes and you will be at the clinic for approximately 3 hours. At least 2 visits to the clinic are required 2 - 3 weeks apart.

You must allow at least 12 hours at home in a quiet location.
Risk of continuing pregnancyVery rare. Less than 0.1% and more likely with very early pregnancies (approx 5 weeks)Uncommon. Less than 1%.
Risk of incomplete abortion requiring additional treatmentLess than 1 in 200

Risk is minimised with use of ultrasound during procedure
Approx 1 in 20
Risk of haemorrhage requiring transfusionExtremely rare. Approx 1 in 500
Risk of infectionVery lowVery low
Risk of complications affecting future fertilityExtremely rare.Extremely rare.
Typical painThe procedure is performed with sedation so no pain will be felt during the procedure. Some women may experience period-like cramps after 3-4 days. Severe pain is rare. Ibuprofen can be taken to relieve any cramps.Pain can range from mild, period-like pain to severe, disabling pain. For most women the pain can usually be made tolerable with pain relievers such as paracetamol and ibuprofen
Typical bleedingBleeding is typically light for few days after the procedure but bleeding similar to a moderate period may occur as a part of the normal recovery process at around 3 days post-op and this may last for a few days. Spotting may sometimes occur until your next period.During the 12 - 24 hours after taking the misoprostol, heavy bleeding is normal but should begin to reduce within the following days. In some cases, moderate bleeding and spotting may continue for 3 - 4 weeks.
Patient satisfaction rates. (would choose this method again)94%68%
AdvantagesOnly 1 visit usually required and most women return to work / study the following day.

Pain and bleeding are much less

Much lower risk of complications caused by remaining pregnancy tissue

Completely managed by doctors

Lower out-of-pocket cost.

An IUD may be inserted at the same time.
Anaesthesia is not required.

A surgical procedure is not usually required

Fasting not required prior to appointment

May be better option for women with a known uterine condition which might make a surgical abortion difficult. eg. fibroids