After the Supreme Court overturned Roe v Wade the laws regarding abortion were left to the states. Due to increased restrictions in some states, interest in abortions induced by medication has increased. This post only addresses medical information and takes no side regarding any other consideration about abortion.
Medication abortion has been available in the US for about 20 years. It is almost always safe and effective. It has the advantage of being done in the privacy of the woman’s home and feels more natural than having a procedure done. This is largely because the physiology is very similar to what happens during a spontaneous miscarriage.
Medication abortion is an option during the first trimester (specifically, before 11 weeks of pregnancy). There are contraindications. Because the abortion does cause some bleeding from the vagina, women with significant anemia, are on a blood thinner, or who have a bleeding disorder are generally not a candidate for a medication-induced abortion.
Other relative contraindications include allergy to one or both medications, disorders of the adrenal gland, taking steroid medications, or having an ectopic pregnancy (anywhere outside of the womb such as in an ovarian tube).
Typically, medication-induced abortion requires taking two medication at separate times; the second medication is taken up to 24-48 hours after the first one.
The first pill is mifepristone (trade names are Korlym and Mifeprex). It causes the embryo to detach from the wall of the uterus. The second pill is misoprostol (trade name is Cytotec). It causes the cervix to soften, enlarges the opening, and causes uterine contractions. This is what happens naturally during a miscarriage.
This treatment is 98% effective when done before 7 weeks and 95% when done up to 11 weeks. It is important to know how long the woman has been pregnant. This can be determined with good reliability in women with regular periods, and she is confident of the date of onset of her last period. Otherwise, a uterine ultrasound is usually performed before considering a medication-induced pregnancy.
An additional reason to perform an ultrasound is if the woman is at increased risk of a pregnancy outside of the womb (ectopic). The risk is increased if she has an IUD, had a tubal ligation, had an infection involving one or both uterine tubes, or the woman is experiencing lower abdominal pain and/or vaginal bleeding.
The experience of having a medication-induced abortion varies from woman to woman. However, most women have few side effects, mainly nausea (less often vomiting) and vaginal spotting due to the mifepristone. Following the second pill (misoprostol) she will typically experience more spotting and cramps similar to menstrual cramps; passing blood clots may also occur and sometimes a small amount of light tissue may be seen. Cramps usually subside in two days; light bleeding may persist for a few weeks.
While complications are unusual, they can occur. Beyond the vaginal bleeding, there can be retained products of conception, gastrointestinal symptoms, infection, and, sometimes, the medications don’t work (uncommon).
Medication-induced abortion does not increase risks for future pregnancies, does not cause blood clots in veins, and does not increase the risk of any form of cancer.
Some women omit the second medication, either because they think they don’t need it or they forget to take it. About half the time the pregnancy ends anyway. There may be only a partial detachment, and excessive bleeding may occur. Excessive bleeding is recognized if the woman soaks two maxi pads in one hour at least two times. She should see a physician promptly.
After a medication-induced abortion, fertility rapidly returns. If the woman wants to avoid getting pregnant, birth control should be made available. This could be birth control pills, an IUD, injectable birth control, or a tubal ligation (if no future pregnancies are desired).
Women should see a physician if they are considering medication-induced abortion. The doctor can determine if the approach is safe for that woman, can provide information about the correct way to take the medication (e.g., misoprostol can be taken vaginally, under the tongue, or between the tongue and the teeth), provide education, examine the woman if needed, and answer questions.
If a woman is experiencing any untoward symptoms during or after taking the medications, such as heavy bleeding, she should contact her doctor.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
