Medical Abortion

If any of the following apply, a medical abortion may not be suitable for you:

• Your doctor determines that your pregnancy is too advanced to proceed (over 9 weeks for medical abortion, over 8 weeks for tele-abortion)
• You have a known or suspected ectopic pregnancy (a pregnancy growing outside the uterus)
• You have a known or suspected hypo-coagulation disease (a bleeding disorder)
• You are taking anticoagulants (drugs that prevent or treat blood clots), have a known or suspected hypocoagulation disease (a bleeding disorder)
• You suffer from severe disease where it is necessary to take corticosteroids (medicines such as prednisolone and cortisone)
• You have adrenal failure
• You have an allergy to either mifepristone and/or misoprostol or prostaglandins
• You have an IUD in place (this must be removed before the abortion)
• If you are breastfeeding, please discuss this with your doctor.

If a medical abortion is suitable for you, you will be booked in for a consultation with the nurse and doctor and you will have an ultrasound scan to confirm your gestation. When you book in for a medical abortion there is always a chance that after your initial assessment, you may decide with the doctor that a surgical abortion is more appropriate for you. In this instance, it will be necessary to make another appointment. If you have had previous pregnancies, including caesarean sections, or if you have an abnormality of the uterus or another medical condition, you may still be able to have a medical termination of pregnancy.

Vaginal bleeding and cramping is normal and usually starts within 1 to 4 hours of taking the second medication (misoprostol) but can take up to 24 hours. The amount of bleeding and cramping varies from patient to patient but in any case it is important you use pads not tampons to avoid infection.

• Bleeding lasts on average 10 to 16 days and it is usual for bleeding to be heavier than a normal period for 2 to 3 days
• Light bleeding can continue for 30 days or more. It does not normally continue after the first period after your treatment
• Side effects of the medication can include nausea, vomiting, diarrhoea and chills or fever but these are usually mild and short lived
• Excessive bleeding severe enough to require a blood transfusion occurs in around 1 in 1,000 cases.

Contact our aftercare service if:

• You are soaking more than 2 maxi pads per hour for more than 2 hours
• You have severe cramps or pain uncontrolled by pain medication
• You have fever, chills, severe pain or other side effects which continue more than 24 hours after taking misoprostol
• You have any concerns after taking the medication.

If bleeding does not occur, some patients may require a repeat dose of misoprostol, or another method of termination may be suggested. You should contact your doctor as soon as possible if bleeding does not occur within 24 hours. Your period should resume 4 to 6 weeks following the medical treatment. Please remember that even if you have not had your period, an egg will still be released, so it is possible for you to fall pregnant again before your next period.

There is cramping involved in a medical abortion and levels of pain experienced can vary from woman to woman. To help lessen your pain, make sure that you:

• Rest
• Use heat packs on your abdomen or back
• Massage your lower abdomen (uterine massage)
• Take pain relief medications as directed by your nurse or doctor. Do not take aspirin.

Abdominal pain should ease within 24 hours of the expulsion of the pregnancy. Call our 24-hour aftercare nurses or your own doctor if:

• Abdominal pain does not improve
• Abdominal pain improves and then worsens
• You are feeling at all unwell, sick or weak with or without a fever.

These signs may mean you have an infection which may require treatment with antibiotics. Serious infections are rare following a medical termination but can be potentially life threatening. If you experience any of the warnings signs described here you should contact us without delay.

Incomplete abortion is the most common complication (1-4%) and occurs when the pregnancy is not completely expelled from the uterus, causing cramping or heavy bleeding. A surgical procedure may be required if the bleeding or cramping is not settling but you will be advised by the aftercare nurse when you call.

A medical abortion does not affect your ability to fall pregnant or bear a child in the future. Your fertility returns immediately and, in fact, you can be at risk of another unplanned pregnancy within days of the medical abortion taking place if you are not using a reliable method of contraception.

Most of the short term side effects of a medical abortion relate to the side effects of the medication. The cramping and bleeding involved in passing the pregnancy can require you to take a day or two to rest and recuperate.

We recommend you cease breastfeeding for the duration of the medical abortion, as some of the medication can be excreted in breast milk. You should wait at least 6 hours after taking the second medication to begin breastfeeding again and dispose of milk you have produced during the medical abortion.

It is very important that you understand that mifepristone or misoprostol can damage a developing foetus. If you do not want to continue with the medical termination of pregnancy after starting, we strongly recommend that you have a surgical termination of pregnancy rather than continue the pregnancy.

We recommend you still take the second pills as soon as possible. There may be a small increase in the chance that the medical abortion will not be successful. In the event that the pregnancy is not completely expelled, you would need to have a surgical procedure to complete the termination.

Do not have intercourse or insert anything in your vagina for 1 week after bleeding commences. You should wait until bleeding stops before you start having sex again.