How medical abortion is performed and why it is dangerous

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

This procedure can have serious side effects.

What is medical abortion

Medical Abortion Medical Management of First ‑ Trimester Abortion - ACOG is one way to terminate early pregnancy. It is considered the least traumatic. In the physical sense, of course.

If a conventional surgical or vacuum abortion implies an operation under anesthesia, then with medication, a woman takes a couple of pills - and then the process of abortion starts by itself.

But like any medical intervention, this procedure has its own nuances that you need to be aware of.

How is a medical abortion done?

In no case do not take any medications without the appointment of a gynecologist. Medical abortion should be performed under the strict supervision of a physician.

So, you suspect you are pregnant and firmly decided that you want to get rid of it.

First you need to visit a gynecologist. The doctor will conduct an examination, find out when you had your period (this is important, since a medical abortion can be done if less than 7 weeks have passed since the start of the last menstrual period) and without fail send it to an ultrasound scan - to confirm the fact of pregnancy and exclude its ectopic variant …

If everything is in order, you will receive two tablets (mind you, you will not be able to buy them at the pharmacy on your own - these are strictly prescription drugs) along with detailed instructions on how to take them.

The first contains mifepristone. It blocks the production of progesterone, a hormone that is responsible for the development of the lining of the uterus (endometrium). The endometrium becomes thinner, the ovum cannot stay in it and begins to exfoliate. In addition, mifepristone causes the uterus to contract more actively, pushing the egg out, and softens the cervix to make it easier for it to pass out.

The second drug is misoprostol. It is taken 24–48 hours after mifepristone, when the effect of the first active ingredient is gaining strength. Misoprostol further stimulates the uterus, and the ovum, along with the dead endometrium, is pushed out.

This process is similar to menstruation. Only more abundant: the uterus does not get rid of a tiny egg, but from the ovum that has developed for several weeks.

Since both drugs affect hormones and can cause severe bleeding, the tablets should only be taken under medical supervision. You may be asked to stay at the clinic for a couple of hours after each pill, and then, if everything goes well, they will let you go home.

Then you will need to return to the hospital in 7-10 days to have a second ultrasound and make sure that the abortion is complete.

Where do you get medical abortion and how much does it cost?

Medical abortion can be done in almost any clinic where there is a gynecologist who has the appropriate qualifications and experience in carrying out such procedures. Whether it is a public hospital or a commercial one, it makes no difference.

In most regions of the Russian Federation, drug abortion is not included in the compulsory health insurance system, so the patient will have to pay for it. The cost of the service varies from 6 to 12 thousand rubles.

What you need to know before deciding on a medical abortion

This is not a harmless procedure.

1. It is desirable to have an abortion before 6-7 weeks

The maximum Medical Management of First ‑ Trimester Abortion - ACOG period until which a medical abortion can be performed is 9 weeks from the first day of the last menstrual period. The key word here is maximum.

The longer the gestation period, the larger the size of the ovum and the endometrium in which it is immersed. This means that "menstruation" can be much more abundant and painful than usual. In addition, the effectiveness of the procedure depends on the period:

• if less than 42 days have passed since the first day of the last menstruation, the probability of a successful abortion is 96–98%;
• from 43 to 49 days - 91–95%;
• over 49 days - less than 85%.

An additional factor: with a gestational age of more than 49 days, the risk of complications increases (about them below). Therefore, most clinics prefer to work with patients whose last menstrual period has passed less than 7 weeks.

2. Medical abortion is not performed for less than 4 weeks

This is due to the need to confirm the pregnancy with an ultrasound scan and find out if it is ectopic.

Even the most sensitive transvaginal examination, in which the probe is inserted directly into the vagina, can detect the ovum in the uterus only after it reaches a size of about 2 mm. This corresponds approximately to a period of 4 weeks.

Until an ultrasound scan is carried out and its results are received, a self-respecting clinic will refuse to carry out an abortion.

3. The procedure is not carried out on the day of treatment

Based on the two points above, it is clear that time is limited. A woman has only 2-3 weeks to establish a pregnancy, decide on an abortion and have it. And in this period, one more nuance must be laid: medical abortion, as a rule, is not done on the day of treatment.

A good gynecologist will send you to think for a few days. It will give a chance to cope with emotions and, possibly, still preserve the pregnancy.

4. Medical abortion takes longer than vacuum or surgical

The classic instrumental abortion has its drawbacks, such as the need for anesthesia. But there are also advantages.

If you come for a surgical or vacuum abortion, you know exactly when it will start and end. As a rule, the procedure takes no more than one and a half hours, including all the necessary preparation and time to recover from anesthesia. In most cases, patients do not feel pain, do not suffer from heavy bleeding, do not experience health problems and can try to forget about the abortion the very next day.

The drug option is different. You will constantly remember about it for at least several days - the interval between taking the pills and the entire period of subsequent bleeding until the second ultrasound. There can be problems with well-being too.

5. Be prepared for side effects

Taking mifepristone often comes with unpleasant side effects:

• nausea and vomiting;
• abdominal cramps;
• diarrhea;
• dizziness and headache;
• weakness;
• an increase in temperature.

This means that your energy, efficiency, concentration will decrease. Or you may not want to leave the house at all. Consider this fact when planning your time.

6. Medical abortion can be painful

Bleeding with this type of abortion, although it resembles menstrual bleeding, is more difficult to tolerate. It is often accompanied by severe cramps in the lower abdomen.

Sometimes this pain can be relieved by taking an over-the-counter pain reliever such as ibuprofen. But more powerful prescription drugs may be required. Be sure to discuss this with your doctor.

7. Serious complications are possible

First of all - in the form of excessive uterine bleeding. This can be defined, for example, like this: you have to change two or more maxi-gaskets per hour for 2 hours in a row. If this is your case, seek advice from a gynecologist. Or, if bleeding scares you profusely, call an ambulance right away.

It is also necessary to seek help from a doctor if profuse bleeding does not reduce its intensity for 2-3 days.

Fortunately, such complications are quite rare: as statistics show, they occur in less than 1% of women.

8. You may still have to go through a surgical abortion

Medicines do not give a 100% guarantee of termination of pregnancy.

It may happen that the fertilized egg does not come out and the pregnancy continues to develop. This situation is called incomplete abortion. In this case, the remains of the ovum and the dead endometrium will have to be removed surgically.

9. Medical abortion has contraindications

A good clinic will refuse the procedure if the patient:

• pregnancy over 70 days (10 weeks);
• ectopic pregnancy;
• inflammatory or infectious diseases of the genital organs;
• uterine fibroids;
• hepatic or renal failure;
• diabetes;
• an intrauterine device is installed;
• has any diagnosis in which she regularly takes corticosteroids;
• pregnancy arose against the background of the use of hormonal contraceptives.

The doctor will tell you more about contraindications.

10. You will have to actively protect yourself

There is data from Conception rates after abortion with methotrexate and misoprostol that those who have undergone medical abortion have more pregnancies in the next year than other women on average. This happens even if the woman does not plan to become a mother.

Scientists warn of the increased risk of repeated unwanted pregnancies after medical abortion and ask to use contraception more actively.

If you nevertheless decide to have a baby, done a month or two before the onset of a new pregnancy, medical abortion will not be an obstacle: it does not in any way affect the health of the unborn baby.