A medical abortion can only be performed very early in pregnancy—no
later than 7 weeks since the start of your last menstrual period.
A medical abortion requires a minimum of 3 visits to your doctor
or abortion provider.
The initial visit involves confirmation of your pregnancy and an ultrasound
to determine the date you conceived. Remember, you can undergo a medical
abortion very early in pregnancy. This visit may also include a
Pap test, screening for
sexually transmitted infections, and
time for you to discuss the procedure and address your feelings and
Following this initial visit, you'll be asked to think about your decision
for at least 24 hours. You may change your mind and no longer want an abortion.
You may decide that a medical abortion is undesirable and you may opt for a
surgical abortion instead. It's normal to come away from your first visit
feeling apprehensive about the process, uncertain about your decision, and
relieved that you've taken the first step.
If you're convinced abortion is for you, your initial visit will reaffirm
your decision and make you feel even more relieved. This is because the
process has actually started. If, on the other hand, you're unsure whether
to have an abortion, this initial visit may change your mind completely.
If you do not change your mind, you can expect to feel a broad range of
emotions: anger, fear, confusion, exhilaration, sadness, relief.
If you're very unsure, discuss this with your doctor or abortion provider
at your next visit. You may be advised to wait, in which case you will likely
undergo a surgical abortion if you ultimately decide abortion is for you.
If you do decide that a medical abortion is for you, there are a few things
you should know. During your second visit to the doctor or abortion provider,
you'll be given drugs to empty the contents of the uterus. There are two drug
combinations used to cause abortions:
- Methotrexate and misoprostol
- Mifepristone (RU 486) and misoprostol (this option is not approved for
use in North America)
Used to treat psoriasis and cancer, methotrexate also halts the growth of a
fetus when given to a woman very early in pregnancy. Used to treat stomach
ulcers, misoprostol causes uterine muscles to contract, thereby pushing out
the contents of the uterus.
Typically, methotrexate is given by injection during your second visit.
It can also be taken by mouth, usually in a fruit beverage or glass of juice.
If given methotrexate by injection, you may have pain, swelling, and discomfort
at the injection site.
It's very important to understand that once you receive methotrexate, you
have effectively terminated your pregnancy. Changing your mind at this stage
is not recommended: the fetus is dead and the cells are waiting to be expelled
from your body.
Misoprostol tablets are placed in the vagina 5 to 7 days after the
methotrexate injection. These medications will be given to you and you
will administer them yourself. It's necessary to take these medications in
order to complete the abortion: misoprostol is the drug that will begin the
contractions to expel the pregnancy from your body.
Within 1 to 12 hours, you will likely begin to feel cramping. Cramps can
be mild to severe, depending how far along you are in your pregnancy.
Generally, the earlier you are in your pregnancy, the less severe the cramps.
The severity of the cramping will also depend on your emotional state and on
the severity of your normal menstrual cramps.
At this stage, you may feel nauseated and feverish from pain and/or as a
side effect of the misoprostol pills. If you were given anti-nausea and/or
pain medication, you may elect to take some at this time.
Cramping is soon followed by bleeding. This is usually heavier than a
normal menstrual period and lasts between 3 and 5 hours. If you bleed
excessively, contact your doctor or report to the nearest hospital right away.
In most cases, the uterus will be emptied within 24 hours. In about 35
percent of cases, however, it can take several days or weeks. Because
pregnancy tissue exiting the uterus can cause painful cramps, pain medication
Once the contents of the uterus have been emptied, cramping and bleeding
usually subside. You will likely experience light and irregular bleeding
for 7 to 21 days. Your next menstrual period should begin within 4 to 6
weeks after receiving methotrexate. Because you can still become pregnant
during this time, you should consider the various methods of
birth control available to you
and your partner.
One or two weeks following the methotrexate injection, a third visit
is necessary. This is a follow-up exam done to ensure the abortion has
happened. An ultrasound will be performed. If the abortion is unsuccessful,
you will either be given another cycle of misoprostol tablets or the option
of a surgical abortion. You must be prepared to undergo a surgical abortion.
This is because the drugs used to induce medical abortions cause severe
What are the advantages of a medical abortion?
- Because it avoids surgery and possible risk to the uterus from surgical
instruments, it may seem less invasive and less risky.
- It can be performed early, before signs of pregnancy appear.
- Because most of the procedure can be done at home, it may seem more
- Some women feel this is more like a naturally occurring miscarriage and
therefore find it less emotionally stressful.
What are the disadvantages?
- It takes place over a week or more—it can sometimes
take up to 21 days from start to finish—and involves several
visits to the doctor.
- There is a 10 percent risk the abortion will be incomplete or unsuccessful;
if this occurs, a surgical abortion is necessary.
- It can cause heavy bleeding.
- Some abortion drugs can cause side effects such as nausea, headache, fever,
fatigue, diarrhea, hot flashes, vomiting, and abdominal cramping or pain.
What can I expect afterwards?
Some women find it very emotionally difficulty to cope with having had
an abortion. In fact, between 5 and 30 percent report feelings of anxiety,
guilt or mild depression. It's normal to experience a broad range of
emotions after an abortion—from relief and happiness to sadness, shame,
regret, guilt, grief and loss. There are as many reactions as there are women
and each woman is unique.
Most women, however, feel they have made the right decision; it's rare for
them to become clinically depressed following an abortion. However, if your
feelings are overwhelming and persistent, or if you have a previous history of
depression, you should consult a professional
therapist. (Refer to Finding
and Evaluating a Therapist for more information.) Depression is a very
Consider counseling even if you feel "OK"—abortion is a
weighty issue and there is no "right" or "normal" way to feel
about it: every woman is different.
Understanding your emotions and taking care of yourself are important: doing
so can help you let go of pain and start to heal. Talk to your partner, friends,
or family to let them know what you're feeling. You may also want to consider
professional counseling. If you're not sure where to go for counseling, talk
to your abortion provider: most providers can refer you to counseling services to assist
you in dealing with your feelings.