Everything You Need to Know About Medical Abortion

The word “abortion” is usually brought up in a controversial way, even though abortion is a procedure vital to the livelihood, health care, and rights of women, especially those that are underprivileged and marginalized. However, there is a lot of untrue and false information regarding abortion floating around. For abortion to be practiced effectively, it needs to be SAFE. And safe abortion occurs when people are well informed with accurate information.
To put it simply, there are two types of abortion – medical abortion and surgical abortion. Today we’ll learn about an abortion procedure known as a medical abortion.

What Is a Medical Abortion? Definition and Overview, Difference Between Medical and Surgical Abortion

So, what exactly is a medical abortion? A medical abortion is a way to end a pregnancy, usually during the first trimester, by taking pills, either vaginally, buccally (between your cheeks and gums), or sublingually (under the tongue). The term “medical abortion” is usually ascribed to an abortion during the first trimester; there is another method of medical abortion that is done in the second trimester, called a labor induction abortion. However, this is a lesser-known method and is only generally done for diagnostic purposes on the fetus (1).

From this point onwards, when we’re referring to medical abortion, we are denoting the procedure that is done in the first trimester, which is primarily an outpatient procedure. This typically involves a two-step process using Mifepristone and Misoprostol. You can also have a medical abortion using only Misoprostol, although this practice is undertaken when there are limited resources and/or when the patient is allergic to Mifepristone – research suggests the combined method yields higher effectiveness (2).

It is also beneficial to understand medical abortion in comparison to surgical abortion and how these two methods may differ in terms of procedure and effectiveness. Surgical abortion in this case will be referred to as manual vacuum aspiration (MVA) as this is the most commonly done surgical abortion procedure.

Comparison between medical abortion and MVA adapted from UCLA Health (3)

Appointments

• MVA: Typically requires one to two visits, depending on whether you choose to be awake or asleep during the procedure.
• Medical Abortion: Although a pregnancy confirmation is recommended for those seeking an abortion, clinic visits are often not required for a pregnancy under 13 weeks. Self-management of abortion can be done at home after confirming a positive pregnancy and following available safe abortion guidelines properly.

When is it done?

• MVA: For manual vacuum aspiration, the gestational age of pregnant people that can undergo this procedure varies. Usually, it’s done at 14 weeks’ gestational age or less. If more than 14 weeks, a D&E (dilatation and evacuation) is performed.
• Medical Abortion: Up to 13 weeks by a physician or through a self-managed abortion according to our safe2choose protocol.

How is it done?

• MVA: Gentle suction is used to remove all of the pregnancy tissue.
• Medical Abortion: You will take medications that enable you to pass the pregnancy at home.

Preparation pre-procedure

• MVA: No fasting is required.
• Medical Abortion: No fasting is required.

Procedure time

• MVA: For pregnancies between 6 to 12 weeks, the appointment lasts about three to four hours. The procedure lasts around 10 minutes. Later abortions often require longer or multiple visits.
• Medical Abortion: Face-to-face consultations are typically one to three hours. The process of taking the pills lasts two to three days if using the combined method or around eight hours if using the Misoprostol-only method.

Effectiveness

• MVA: 98%
• Medical Abortion: 95-97%

Bleeding

• MVA: Light bleeding at home for up to two weeks.
• Medical Abortion: Heavy bleeding for several hours and period-like bleeding for about two weeks after starting the process. You can find out more about what to expect during an abortion through safe2choose resources here.

How Medical Abortion Works – Step-by-Step Process, Expected Timeline, and Results

Step-by-Step Process (4)(7)

• Initial Consultation:
  • Confirm pregnancy and gestational age (must be less than 13 weeks).
  • Discuss the procedure, options, and any potential risks or side effects. You can contact the safe2choose counselors for support.
• First Medication: Mifepristone
  • Dosage: 200 mg orally.
  • Purpose: Blocks the hormone progesterone, which is necessary for pregnancy to continue.
  • Timing: Administered during the initial visit.
• Second Medication: Misoprostol
  • Dosage: 800 μg.
  • Administration: Can be taken vaginally, sublingually, or buccally.
  • Timing: One to two days after taking Mifepristone, with a minimum interval of 24 hours.
• Alternative Regimen: Misoprostol Alone
  • Dosage: 12 Misoprostol pills of 200 μg each, taken in doses of four pills every three hours.
  • Administration: Buccally, sublingually, or vaginally.
• Alternative Regimen: Letrozole and Misoprostol (New evidence from WHO guideline)
  • Letrozole: 10 mg orally each day for three days.
  • Misoprostol: 800 μg sublingually on the fourth day.

Expected Results

• Bleeding: Heavy bleeding for several hours, followed by period-like bleeding for about two weeks.
• Effectiveness: The combination of Mifepristone and Misoprostol is more effective than Misoprostol alone.
• Follow-Up: A follow-up visit, often via telehealth, can be scheduled to confirm whether the abortion was successful or to answer any questions you may have about post-abortion care.

All routes of Misoprostol administration (vaginal, sublingual, buccal) are included to accommodate abortion seekers’ and providers’ preferences. Repeat doses of Misoprostol can be considered, if needed, to ensure the abortion process is successful.

Eligibility and Considerations: Who Can Opt for Medical Abortion? Important Medical Precautions

It’s recommended that you confirm your pregnancy and calculate the weeks of gestation before having an abortion. If you have an IUD in place, it’s important to check that you do not have an ectopic pregnancy. An ectopic pregnancy can also occur without an IUD and can be confirmed with an ultrasound. If you have an IUD in place, removing it before starting the procedure is the best option. A medical abortion can be performed safely at home by yourself under 13 weeks of pregnancy if you follow our safe2choose protocol closely.

Most abortion seekers at 13 weeks of gestation or less are eligible for a medication abortion, which may be preferable for those with certain medical conditions, such as significant uterine fibroids, congenital uterine anomalies, or introital scarring.

Abortion seekers with asthma can have a medication abortion since Misoprostol acts as a weak bronchodilator.

Multiple gestations, including twin pregnancies, are not a contraindication and can be treated with the same regimen as single pregnancies. However, a medication abortion is not recommended for those with a confirmed or suspected ectopic pregnancy, an intrauterine device in place, chronic adrenal failure, known coagulopathy, inherited porphyria, intolerance to Mmifepristone or Misoprostol, or those using current long-term systemic corticosteroid therapy or anticoagulant therapy.

Abortion seekers with significant comorbidities may still undergo a medication abortion but require additional monitoring. The safety of a medication abortion for abortion seekers with anemia is uncertain due to the exclusion of anemic abortion seekers from studies (5). If you’re unsure about what abortion methods are available and need support, contact our safe abortion counselors for guidance or visit our FAQ page for more information.