When a woman is pregnant, she has the option to continue the pregnancy or to have an abortion. A woman’s decision may depend on many factors such as her health, her finances, or her relationships. Once she has made the decision to have an abortion, she has the option to have a medical abortion (one that is achieved via use of medication), or a surgical abortion. A woman can choose to have a medical abortion until 70 days (or 10 weeks) into a pregnancy. A surgical abortion can be done at any point in the pregnancy within the legal limits of the state (or province/country) in which a woman lives. Despite the fact that there are many laws and restrictions surrounding abortion, it is safe; the rate of complications from abortion is extremely low, and abortion is twenty times safer than childbirth.
Before the Abortion
Before having an abortion, an ultrasound examination is necessary to confirm that the pregnancy is inside the uterus and not an ectopic pregnancy, a pregnancy that develops outside the uterus and that can be life-threatening. Early in the pregnancy an ultrasound probe placed into the vagina may need to be used to measure the pregnancy. The woman will then have a consultation with a healthcare provider. This consultation can be done in-person at a clinic, or via video consultation, or telemedicine where those options are available. She will be counseled about how to take the medications and what to expect from the abortion process.
Medications
In the US and in some countries where abortion is legal, two different medications are used in a medical abortion. Mifepristone, or RU-486, is a pill that works by stopping the pregnancy from continuing to develop. After taking mifepristone, some women may notice a small amount of bleeding or light cramping, but the majority of women do not experience any symptoms. Within 48 hours after taking the mifepristone, women will take misoprostol, a medication that causes the uterus to cramp and expel the pregnancy tissue. Misoprostol pills can be placed into the vagina or between the cheeks and gums to dissolve. This combination of mifepristone and misoprostol is very effective. In geographic areas where mifepristone is not available misoprostol can be used alone, although this method is slightly less effective.
The Process
Within a few hours after taking the misoprostol pills, a woman will have heavy bleeding and cramps. The bleeding may be as much as two sanitary pads an hour for 1-2 hours, and may include clots as large as a golf ball or a lemon. A heating pad and pain medication such as ibuprofen can be used to relieve the cramps. The pregnancy at 10 weeks or less is very small and typically cannot be seen during the medical abortion process. After the pregnancy has passed, a woman will continue to have some bleeding and cramping for a few days, and may have bleeding for up to 4 weeks. After a medical abortion it is important to confirm that the abortion is complete by doing an ultrasound or having blood tests.
Advantages
A medical abortion can be done in the privacy of a woman’s home and at a time that is convenient for her. Some women may also have difficulty with pelvic exams or procedures, and neither of these is necessary for a medical abortion.
Risks
Medical abortion is safe and effective. As with any medication or procedure, there are some risks. During the process of passing the pregnancy, a small number of women may not pass all of the pregnancy tissue and may continue to bleed heavily. Women who do experience continued heavy bleeding are encouraged to seek medical attention immediately. Despite taking the medication, a small number of women may have a pregnancy that continues to develop. For this reason, following up to confirm that the abortion is completed is extremely important.
Having a medical abortion does not affect a woman’s ability to become pregnant in the future. If a woman does not want to be pregnant after an abortion she should start a birth control method as soon as possible as it is possible to become pregnant again as early as one week after an abortion.