Medical abortion offers an alternative to surgical abortion for women in the early weeks of pregnancy. Medication abortion uses a combination of two medications, mifepristone and misoprostol, to end a pregnancy up to nine weeks. Mifepristone was previously known as RU486 and is sometimes called the ‘abortion pill’.
Medical abortion is a low-risk, non-invasive way to terminate (end) a pregnancy. It is around 99 per cent effective at ending a pregnancy. Around two to five per cent of women who have a medication abortion will need some follow up treatment to complete the abortion.
An increasing number of GPs in Renah provide medication abortions. The telehealthinvolves a consultation with a doctor by phone, and tests that are organised locally.
Medication abortion procedure
Medical abortion involves using the medications mifepristone and misoprostol instead of surgery to end a pregnancy. It can be done as soon as a pregnancy can be seen in an ultrasound. In Australia, a medication abortion is performed up to nine weeks of pregnancy.
A pregnancy needs high levels of the hormone progesterone to continue. Mifepristone works by blocking the action of progesterone to cause the pregnancy to stop progressing. Misoprostol causes the cervix to soften and the uterus to contract to allow the pregnancy to be expelled from the uterus.
The process and number of appointments for having a medication abortion varies depending on the type of clinic setting you attend, and whether certain tests you need (such as ultrasound and blood tests) are available on site or require separate appointments. A number of clinics are able to offer necessary tests and medication abortion in a single initial appointment.
The process of having a medical abortion generally involves the following steps:
- You will have a medical consultation with a doctor and often a nurse as well, which involves a clinical assessment of medical and other relevant information, and arrangements for you to have an ultrasound and blood tests.
- You will be given information about the methods of abortion to help you to make an informed decision about the best method for you.
- If you decide to have a medical abortion, you will be asked to sign a consent form and will be given all the relevant information about what to expect, the steps you will need to take, and about pre- and post-abortion care.
- You will discuss what sort of pain relief, and any other appropriate medication you may require, and how to obtain it, in preparation for the abortion.
- If you have an intrauterine device, it will need to be removed before you take the first medication (mifepristone).
- You will take a tablet of mifepristone either at the clinic or at home and obtain the other appropriate medications.
- You will take a tablet of misoprostol 24 to 48 hours later. This softens the cervix and helps the uterus push out the pregnancy. This stage nearly always occurs at home. (If you need to travel after taking misopristol and before the abortion is complete, it is recommended that you have a responsible adult who can drive you.)
- The abortion is usually completed some hours later, although it may take longer. You will usually need a day or two of rest or reduced activity.
- You will be encouraged to have telephone contact with the clinic you attended or another source of expert support in case you have any questions or concerns at any time during and after the procedure.
What to expect during and after a medical abortion
After taking the second medication abortion tablet at home, you may experience the following:
- nausea, vomiting, diarrhoea, dizziness, headache and fever
- pain – usually within half an hour and generally much stronger than period pain
- bleeding one to four hours later – heavier than a period and there may be large clots
- after two to six hours the bleeding usually settles to the level of your normal period
- bleeding is usually similar to a normal period for another three to seven days
- unpredictable, irregular or prolonged bleeding can last for up to four weeks after a medication abortion.
Note: The timing of the pain and bleeding is unpredictable. It occasionally starts before taking the second medical, but may take up to 24 hours to start.
Follow-up after a medical abortion
It is important to have a follow-up appointment to make sure the procedure is complete and the pregnancy has ended. Many doctors order a blood test to check that the pregnancy hormone level has dropped. You will be given an appointment for review in two weeks’ time.
Medical abortion does not work in around one percent of cases. Around two to five per cent of women will have some pregnancy tissue remaining in the uterus (womb) and will need further treatment such as additional tablets or a small surgical procedure to complete the abortion. Your doctor will discuss this with you.
Self-care at home after a medical abortion
The doctor or nurse will advise you on taking care of yourself in the days following the abortion. This can include using over-the-counter anti-inflammatory medication to help manage the cramps (your doctor can prescribe stronger medication if needed). Hot packs and massaging the painful area can be helpful.
To reduce the risk of infection during the week after having the procedure, it is recommended that you do not:
- insert anything into your vagina, including tampons (do not use tampons until your next period)
- have vaginal sex
- perform any strenuous activity, including sport or heavy physical work, until the bleeding stops
- go swimming or have a bath (you can shower).
Your doctor will have informed you about the risks and symptoms of possible complications and what to do if they occur, such as where to obtain assistance at any time.