There are two primary methods available: surgical abortion procedures and medication abortion. Both options are safe and effective ways to end a pregnancy. To determine which option is more appropriate for each patient, the provider must consider the gestational age, the patient’s medical history, and her personal preference.
Medication abortion is currently a two-medication process that involves taking medications to abort over the course of a few days, usually while the patient is home. Medication abortion is safe, 92-95% effective, and can cost between $300-$800. This method is generally an option up to 9 weeks (63 days) following the last menstrual period (LMP), but recent studies have shown it to be safe and effective up to 10 weeks (70 days), and an increasing number of providers are expanding their services up to this higher gestational age limit. Some people prefer it because it requires no surgery or anesthesia and may feel more private or natural. At the same time, it may not be a good option for those who are concerned with someone in the home learning of the abortion. It may also not be a good option for those who do not have a reliable way back to the clinic for a follow-up visit or those who are not comfortable with bleeding and cramping pain.
There are several options available for medication abortion, but the most commonly used is one tablet of mifepristone (200mg) followed by 800 micrograms of misoprostol.
- The first pill (mifepristone) has traditionally been administered at a clinic or physician’s office, but recent research on home administration of mifepristone found favorable results, so this practice may become more popular. Mifepristone blocks the action of the hormone progesterone. Without progesterone, the lining of the uterus thins and prevents the embryo from staying implanted and growing.
- The second medication (misoprostol) is usually taken at home, although different options exist for route and timing of administration. Misoprostol, a prostagladin, causes the uterus to contract and expel the pregnancy through the vagina. Misoprostol can be taken under the tongue, between gum and cheek or vaginally and thow a patient is directed to take the medication depends on their provider.. Misoprostol will cause the patient to have cramps and bleed heavily as she expels the pregnancy.
Some people may begin bleeding before taking the second medication, but this is relatively rare. Bleeding and cramping usually lasts a few hours and large blood clots or tissue may pass at the time of abortion. Within four or five hours of taking the second medicine, more than half of patients abort. For others, it takes longer. However, most people abort within a few days.
For most patients, medication abortion is like an early miscarriage. In addition to the bleeding and cramping, individuals may also experience: dizziness, nausea or vomiting, diarrhea, temporary abdominal pain, and mild fever or chills. Acetaminophen (like Tylenol) or ibuprofen (like Advil) can help most of these symptoms, aspirin should not be taken.
A follow-up appointment is necessary (within 14 days of the initial appointment) to ensure completion of the abortion process. Individuals who are not good candidates for medication abortion include those with chronic adrenal failure, long term steroid use, current use of a blood thinning medication, known bleeding disorder, or significant anemia.
Surgical abortions take place in a medical clinic, physician’s office, operating room, or other medical facility. Depending on gestational age, a surgical abortion is performed using dilation and curettage (D&C) or dilation and evacuation (D&E). Both procedures are relatively quick, often lasting less than 10 minutes. Surgical abortions are slightly more effective than medical abortions and do not result in heavy bleeding afterwards. Costs vary widely and are determined by gestational age.
With both methods, patients will be offered medicine for pain and sometimes sedation. Depending on gestational age, device called a cervical (osmotic) dilator may be inserted in the cervix prior to the procedure to help slowly open (dilate) the cervix. These dilators absorb fluid and get bigger, slowly stretching the cervix. If dilators (also called laminaria) are used, the patient may need to come in to the office 1-2 days before the procedure to have them placed. Medication may also be used to help open the cervix. During the abortion procedure, medical instruments and a hand-held suction device or a suction machine will gently empty the uterus.
Most people feel pain similar to menstrual cramps with both of these abortion methods. For others, it is more uncomfortable. The health care provider will help to make it as comfortable as possible. General anesthesia may be offered for certain procedures. It allows a patient to sleep through the procedure — but it increases the medical risks and how long she must remain at the facility. Individuals may have cramps after an abortion and will likely want to relax the rest of the day.
Induction termination is also an option in some second trimester cases, thought it is used much less frequently than surgical abortion. Labor induction in the second trimester is stimulation of uterine contractions to expel the fetus and placenta using medical agents, such as misoprostol. There are some advantages and disadvantages to using induction termination; individuals can ask their doctors about this procedure.