Medical Procedure
The medical abortion procedure uses tablets instead of surgery to interrupt and expel an early pregnancy. Treatment requires two separate visits. During the first visit, one Mifegyne® tablet containing 200mg of mifepristone is taken. This tablet has a blocking effect on progesterone, a hormone that is needed for pregnancy to continue.
At the second visit, 36-48 hours later four tablets, each containing 200μg of Cytotec® (Misoprostol) are inserted into the vagina. This is a different type of hormone, (a prostaglandin) which helps to expel the pregnancy. In some cases, the doctor may change the doses of both drugs. A full written explanation on these medicines will be provided at AMAC.
Who can use the treatment?
Most women can have the treatment. However, you should not have the treatment if:
- You are unsure about your decision to have an abortion because once you have taken either medicine there is a risk that if the pregnancy continues, the baby may be born with abnormalities. Discuss the difficulties in making a decision with your doctor, nurse or counsellor.
- You have an ectopic pregnancy (where the egg is implanted in the tube rather than in the womb).
- The first day of your last period was more than 54 days ago. Your referring doctor will send you for a scan to check the age of your pregnancy.
- You have ever had a bad reaction to Mifepristone (Mifegyne®) or Misoprostol (Cytotec®).
- You have an IUCD in place. This must be removed before taking Mifegyne®.
In some other circumstances the treatment may also be unsuitable, so tell your doctor if:
- You are a smoker aged more than 35 years
- You have a medical condition such as a heart complaint, high blood pressure or diabetes.
- You suffer badly from asthma or are on long-term steroid treatment for any other reason.
- If you are anaemic, have a bleeding disorder or are receiving anticoagulants.
- You have had an operation on your uterus (womb).
The doctor will discuss whether or not you are able to have the treatment.
Some other precautions
- The treatment is not suitable if you do not have a telephone or are living more than one hours travelling time from emergency hospital services. This is in case of heavy bleeding needing emergency treatment.
- If you are breast-feeding you should stop for at least 14 days after taking Mifegyne®.
- You should not drink alcohol or smoke once you have taken the Mifegyne® and for at least two days after you have been given the vaginal tablets. You should not take illicit drugs.
- Some medicines may interfere with the treatment. These include some pain relief and anti-inflammatory tablets such as Aspirin, which should not be taken from the time that you take Mifegyne® until the time of your check up. If you take other medicines tell the doctor .
How is the treatment taken?
- You will be given one tablet of Mifegyne® to swallow with some water. You must take this at AMAC. You will be able to go home about an hour after taking the tablet, once the doctor is sure you will not vomit.
- Have a good supply of maxi-pads for use at home.
- If there is any cause for concern, such as heavy bleeding, you must ring AMAC for advice. In a few cases (3-5%) the abortion may occur after Mifegyne® alone.
- You will be given an appointment to return to AMAC 36-48 hours later and have the vaginal tablets inserted. After this you must stay at AMAC for up to 6 hours or until the doctor is satisfied that the abortion is complete and you are well, then you will be discharged home with written instructions on self and emergency care.
- If you have not passed the pregnancy after 6 hours, the doctor will discuss the options with you. It may be recommended that you have a surgical operation before you are discharged home. If you choose to go home without surgery it is vital that you return to AMAC in one weeks time to make sure the abortion is complete, bleeding and cramping are not proof that the abortion is complete. You will be contacted if you fail to attend.
- If you have a rhesus negative blood type, an injection called Anti D will be offered to you to protect against antibodies forming in the blood, which may cause problems in a future pregnancy.
- You will be required to make an appointment with your referring doctor in 10-14 days to make sure you have made a full recovery.
What are the effects of the treatment?
- After taking the Mifegyne® tablet, nothing much will happen for about 12 hours. You may feel unwell, perhaps a little faint or sick during the first few hours.
- After 12 hours you may start to bleed. About half of the women who take Mifegyne® will start to bleed before returning to have the vaginal tablets inserted. The bleeding may be quite heavy, like a heavy period. You may also get cramps like period pains.
- After being given the vaginal tablets, if you are not already bleeding, you will bleed and it is likely that you will get stomach pain and cramps which may be quite strong. A medical abortion is like having a miscarriage. In some cases the bleeding can be heavy and in a small number of cases (about 1 in 300), it may be necessary to give a blood transfusion and /or perform a surgical abortion to stop the bleeding.
- If you have a lot of pain, the doctor will be able to give you some painkillers such as paracetamol, codeine or something stronger if required. Pain can be worse in women who have never been pregnant before or in women who normally suffer painful periods.
- Some women have diarrhoea, sickness, headaches, dizziness hot flushes and chills after being given the vaginal tablets. Occasionally there may be a skin rash. If you get any side effects, tell the medical staff.
- In over 90% of cases, the pregnancy will be expelled in the 6 hours after you take the vaginal tablet. If the medical treatment fails, a surgical abortion will be necessary.
(Comprehensive written information on possible side effect will be provided and discussed at your appointment at AMAC).
- Many women ask if they will be able to see the embryo. The sac and placenta surrounding the embryo can sometimes be seen, but the embryo at this stage is too small to be seen clearly.
What about contraception?
It is possible for you to become pregnant again immediately after the abortion is complete, so you will need to start contraception such as oral contraceptives within 3-9 days of taking the Mifegyne®. Discuss this further at AMAC and with your doctor. You will be advised not to have sex for 14 days after the abortion is complete.
What to expect after you go home
(Comprehensive written aftercare instructions will be provided at AMAC.)
- You will be advised not to put anything into the vagina for 14 days i.e. no tampons, no sex, nor any bathing or swimming.
- A small number of women may develop an infection. This may cause a temperature, pain, discharge or unusual bleeding. See your doctor if you get any symptoms so that antibiotics can be given if needed.
- You may continue to bleed for several weeks. If the bleeding is heavy (more than two maxi-pads in an hour for two hours) you should call AMAC, your referring doctor or emergency hospital medical services.
- You should recover quickly from your abortion, but take things easy for a few days. You may feel emotional and extra counselling is available if needed.