Your One-Stop Guide to Medication Abortion

In the course of our discussions about abortion, or elective termination of pregnancy, here on The Pulse, we have referred to medication abortion numerous times. Additionally, you may be hearing about medication abortion a lot in the news. Given all of this, it makes sense to have a post devoted solely to the topic of medication abortion, so that’s the topic for today. Currently, medication abortion is the preferred approach to elective abortion, for doctors, other abortion providers (nurse practitioners, specially trained midwives), and for abortion recipients. Medication abortion is an abortion in which the process of terminating pregnancy is achieved with the use of medications alone. No instruments or other procedural elements are needed. Medication abortion is not always the best option for everyone, for reasons that we’ll discuss, but if you are candidate for it, you can have a medication abortion up to the 77th day of pregnancy, the end of the 11th week, meaning 77 days, counting from the first day of bleeding of the last menstrual period as day 1.

Medication abortion relies on two different medications, both of which you must take as directed. Since neither drug needs to be administered intravenously, you can have a medication abortion in the privacy of your own home after consulting with a healthcare professional via telemedicine and receiving the medications in the mail. The fact that you can have it at home is a major reason why many women who undergo abortions choose the medication route. The two medications are called mifepristone and misoprostol and you don’t take them both at the same time.

The first medication that you take is mifepristone and there are different routes of delivery, depending on which type you get. Some preparations are oral, some are vaginal, some are sublingual (you let it sit under your tongue and it is absorbed through the buccal mucosa, and there are rectal preparations too. Once you take the mifepristone, you wait a day or two and then take the other medication, which also is available with different routes of administration. One common regimen consists of 200 mg mifepristone 200 mg orally, followed one to two days later by 600 mcg misoprostol sublingually, or 800mcg misoprostol vaginally, and then 400mcg misoprostol sublingually or vaginally, every three hours, until the products of conception are expelled.

Mifepristone works by blocking the effects of the hormone progesterone. Technically, it’s called a progesterone antagonist. What this does is to cause the placenta to detach from the uterus, making the pregnancy non-viable, since the placenta is the lifeline for the embryo, then later the fetus. But this is not enough to assure a safe end to the pregnancy, and that’s where misoprostol comes in. Misoprostol is what doctors call a prostaglandin E1 analog. What this does is to stimulate uterine contractions to expel the products of conception. If you are wondering what would happen were you to take only the mifepristone not the second drug, it’s actually an issue that hasn’t been studied adequately yet, but doing such a thing would put a woman in a certain amount of danger. Once you start the process of taking the first drug, you need to be committed to taking the second drug, but don’t worry about forgetting. The healthcare team that is managing your procedure will be in contact with you and will check up with you. When the regimen is taken correctly, the success rate is very high. It’s roughly 98 percent effective very early in pregnancy and about 95 percent effective for those close to the 77 day limit.

What you will experience in the course of a medication abortion is heavy bleeding at first and then cramping, especially after you take the second drug, misoprostol. In some cases, it may be advisable to have an ultrasound exam a few days after the medication abortion, namely when you are experiencing symptoms longer than you should. That’s because such symptoms, such as continued cramping, or worse, fever, could be the result of products of conception remaining. For those without continued symptoms, medication abortion is considered safe enough for follow-ups to be in the form of phone calls or telemedicine sessions with providers, to ask you about your symptoms.

While medication abortion is possible up to 77 days of pregnancy, of course it is not permitted in US states that have enacted prohibitions against abortion, either throughout pregnancy, or beyond a certain point. If you are in one of the states that has a complete abortion ban, or a ban on abortion beginning at 6 weeks gestation, or at the first ‘heartbeat’, such a state would not permit even a medication abortion during the part of pregnancy when abortion is illegal. However, given all of the legal confusion, it’s currently fairly easy to obtain the needed medications via mail, from a healthcare provider working from a state with legal abortion. Medically, the abortion that you would experience as a result of the medication will be  indistinguishable from a spontaneous abortion (miscarriage). This means that if you receive abortion medications and take them in the privacy of your home in a state where abortion is not legal, and if you then arrive at a clinic or an emergency department, on account of symptoms, such as bleeding, cramping, fever, or anything else, you will not be in any kind of trouble, as long as you do not declare that your abortion was self-induced. In come cases, a thoughtful doctor or nurse may warn you that you are not required to reveal anything about what led to the abortion, but not in all cases. If you are in a situation in which you cannot travel to a pro-choice state, if you undergo a medication abortion with help from someone in another state, and then you feel that you need medical help, simply act as if you are suffering a spontaneous abortion. Say that you are having a miscarriage. You will be checked with ultrasound to make sure that the products of conception have all come out, and if not you make undergo a procedure to remove them, such as a dilation and curettage (D&C), or dilation and suction.

As for why medication abortion is not the best option for everybody, in some cases it is situational. You may not want to wait through a process that takes a few days. You might just want the abortion performed in one sitting, in which you walk into the clinic, have the procedure, and you are finished. There also can be medical issues. If you have a bleeding disorder for instance, or if you are anemic, medication abortion is not a good option, because of the heavy bleeding that you will experience. In contrast, a procedural abortion can avoid large amounts of bleeding, or at least such bleeding can be controlled at the health care facility. There also are extremely rare allergies that some may have for the medications. Apart from medical issues, there also are cases of women who do not have a safe place at home to experience her abortion. If you are living with people who oppose abortion and will make trouble for you, you may be better off getting a procedural abortion at a facility. The same is true if you have problems with a domestic partner.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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