Abortion

Medical abortion

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 apprehension.

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 is prescribed.

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 birth defects.

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 private.
• 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 serious illness.

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.