Medical Abortion


What is it?

A medical abortion uses drugs to empty the contents of the uterus in stead of surgery. A Medical involves two medications taken by mouth (swallowed) to end a pregnancy.

The drugs that induce medical abortions cause birth defects. A woman who takes these drugs must be prepared to have a surgical abortion if the medical abortion is unsuccessful. A follow-up exam is done one or two weeks after to make sure that the abortion has happened.

How does it work?

The first medication weakens the attachment of the pregnancy to the womb. The second medication is taken two days later causing contractions of the uterus (womb) and bleeding and the pregnancy is expelled.

How soon can a woman have a medical abortion?

A woman can choose to have a medical abortion as soon as she knows she is pregnant and the pregnancy is confirmed to be in the early stages. In South Africa, it is done if a woman is less than 8 weeks pregnant (up to 56 days from the first day of her last menstrual period).

Who can have a medical abortion?

A woman may be a good candidate for a medical abortion if:

  • She has a confirmed pregnancy
  • The first day of her period was up to 56 days ago
  • She is willing to have a surgical abortion if the medical abortion does not work.
  • She is willing to return to the clinic 10 – 14 days later for a follow - up visit.

Are there any contra-indications to having a medical abortion?

Yes. There are a few circumstances when medical abortion should not be used. The doctor / nurse will advise you if there is a reason why you cannot choose this option.

A woman should not have a medical abortion if:

  • She has an Ectopic pregnancy (a pregnancy which lies outside the uterus)
  • Her adrenal glands do not function normally
  • She is on long - term corticosteriods (eg. for the long – term treatment of asthma) or she is taking blood thinning medication, or has a history of a bleeding disorder.
  • She is allergic to any of the components of the medication.
  • She has severe uncontrolled asthma.
  • She has a disease called porphyria
  • She has a intra – uterine contraceptive device (IUCD) in her uterus
  • She has serious cardiovascular problems or severe high blood pressure
  • She cannot return for a follow – up visit to the clinic 14 days after the medical abortion has taken place
  • She cannot get to an emergency medical clinic / hospital during the treatment (in case of emergency)

How safe is a Medical Abortion?

Medical abortion is extremely safe. The medicines used in medical abortions have been widely studied and have been used by millions of women in other countries for the past ten years. The South African Medicines Control Council also approves them. Of every 100 women who have a medical abortion, 1 woman will have very heavy bleeding that does not stop and requires a surgical abortion.

Is a medical abortion always effective?

Medical abortion is successful in about 95% of cases. This means that out of every 100 women taking both of the medicines for a medical abortion, about 5 women will not have a complete abortion. In this case, a surgical abortion will need to be done to complete the process. Surgical abortion usually involves removing the pregnancy by suction. Once a medical abortion has started, it needs to be completed because of the damage to the foetus.

What happens during a medical abortion?

Step 1: At the clinic

When a woman comes to the clinic, the doctor / nurse will explain the process and answer questions. After the woman’s medical history has been reviewed and she has been examined, a pregnancy test and a sonar performed, she will be given the first medicine to be swallowed at the clinic. The woman may experience some cramps and bleeding in the days after taking the first medicine, but very few women will have a complete abortion before taking the second medicine.

Step 2: 2 days later, at home

Unless the doctor / nurse says that the abortion is complete, the woman will swallow 2 tablets of the second medicine at home two days later. Within a few hours, she will probably start to have strong cramps and bleeding, which can be heavier than an ordinary period.
The woman should expect to bleed or spot for about 2 weeks after taking the tablets and she may see blood clots and tissue coming from the uterus.

This is an expected part of ending the pregnancy. The heaviest bleeding will happen while the abortion occurs, usually within the first 6 hours after taking the second medicine.

Step 3: 10 - 14 days later, follow-up visit to the clinic

The medicine cause bleeding and cramping and these symptoms mean that the treatment is working. Sometimes women can get cramping and bleeding and still be pregnant. This is why it is very important to return to the clinic 10 – 14 days after taking the first medicine to make sure that the pregnancy has ended. If a woman is still pregnant after taking the medicine, she will have a surgical procedure to end the process.

What are the possible side effects of a medical abortion?

  • Bleeding and cramping are a normal part of the process and show that the medicines are working. Cramps generally last a few days. Bleeding is heavier at first but some bleeding or spotting may continue for as long as 12 days.
  • A woman may also have some nausea, vomiting and diarrhoea on the days that she takes the medicines.
  • Occasionally women will also have headaches, dizziness, chills or fever. These symptoms usually last a short time and can be reduced by taking pain medicines or anti-nausea medicines.

Could I go back to work after taking the medicine?

Yes, after the intake of the medicine, the patient can return to work but she must bring along pads for bleeding that could occur 24 hours after the intake of the tablets.

Are the pains quite strong?

No, the abdominal pains are usually moderate. They only require a prescription for painkillers in 16% of the cases. But it is better to relieve the pains allowing the patient to remain relaxed and thus avoiding the delay for expulsion. The pains, consecutive to the contractions of the uterus, are of the same intensity as painful periods.

Can the bleeding be abundant with this method?

The uterine bleeding could be abundant, exceptionally. A uterine examination is necessary in less than 1,5% of cases. The telephone number of the clinic together with the emergency number are given to the patient and it is suggested that she does not hesitate to contact one of these numbers in cases of emergency.

How will I know that I have actually expulsed?

The patient must be reassured on the expulsion. It usually occurs within 24 hours after the intake of the 2nd medication and does not result in significant haemorrhage. The patient should be informed that she could notice the egg but there is no need to worry due to its smallness and its appearance. It measures approximately 2cm and it is covered with villosities. An appointment for check-up is systematically given within the next two weeks in order to examine the uterine vacuity.

What happens after the abortion?

As far as we know, having a medical abortion will not affect a woman’s chances of having a baby in the future and will have no long-term effects on a woman’s health. A woman can become pregnant again right after the current pregnancy has ended. If the women does not want to become pregnant again, she will need to start using a contraceptive method as soon as the pregnancy ends, or before she starts having sexual intercourse again.

What is the best method for termination of pregnancy?

There is no best method. Each has it’s limitations. The choice is according to the personality of the patient, her story as well as the opinion of the physician.

Advantages

  • avoids surgery and the risk of damage to the uterus with surgical instruments
  • can be done early before signs of pregnancy occur
  • may feel less invasive than surgery
  • may seem more private to some women since much of the procedure can occur at home

Disadvantages

  • takes place over a week or more and involves several visits to the doctor
  • ten percent risk that the procedure will be incomplete and a surgical abortion will need to be done
  • sometimes causes heavy bleeding
  • the drugs may have unpleasant side effects including nausea, diarrhoea, abdominal cramping or pain, vomiting, hot flashes

 

 

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