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While legal battles over access to mifepristone, one of two drugs used for medical abortions, play court, the drug still available in states that consider abortion legal.
“While many women get medical abortion from a clinic or their OB/GYN, others get the pills on their own to self-induce or self-manage the abortion,” said Dr. Daniel Grossman, professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
“A growing body of research indicates that self-managed abortion is safe and effective,” he said.
Mifepristone blocks the hormone progesterone, which is necessary for the pregnancy to continue. the drug is approved to terminate a pregnancy up to 10 weeks gestation, which is “70 days or less from the first day of the last menstrual period,” according to the FDA.
In a medical abortion, a second drug, misoprostol, it is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as the prevention of stomach ulcers, the drug has been available in pharmacies for decades.
Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of all abortions in the United States. according to the Guttmacher Institutea research group that supports abortion rights.
“Some people do this because they can’t get to a clinic, particularly in states with legal restrictions on abortion, or because they prefer self-care,” said Grossman, who is also director of Promotion of new standards in reproductive health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.
What happens during a medical abortion? To find out, CNN spoke with Grossman. The conversation has been edited for clarity.
CNN: What’s the difference between a first-trimester medical abortion and a vacuum draw in terms of what a woman experiences?
Dr. Daniel Grossman: Vacuum aspiration is most commonly performed under a combination of oral pain relievers and local anesthetics or local anesthesia along with intravenous sedation, or what is called conscious sedation.
A local anesthetic injection is given to the area around the cervix, and the cervix is gently dilated or opened. Once the cervix is opened, a small straw-like tube is inserted into the uterus and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so, there is nothing in the tissue that is recognizable as part of an embryo.
The suction procedure takes only a couple of minutes; the person is then observed for an hour or two until the sedation wears off. We also monitor each patient for very rare complications, such as heavy bleeding.
brute man: A medical abortion is a longer process. After taking the pills, bleeding and cramping may occur over a period of days. The bleeding is usually heavier when the actual pregnancy is expelled, but such bleeding usually subsides within a few hours. On average, people continue to have light bleeding for about two weeks, which is slightly longer than after a vacuum aspiration.
Nausea, vomiting, fever, chills, diarrhea, and headache can occur after using the abortion pill, and all who have a successful medical abortion usually report some pain.
In fact, the pain of a medical abortion can be quite intense. In studies that have looked at it, the average maximum level of pain people report is seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is expelled.
The level of cramping and pain can depend on the length of the pregnancy, as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation is usually less painful and cramping than one performed at nine weeks. People who have given birth generally have less pain.
CNN: What can be done to ease the pain of a medical abortion?
brute man: There are definitely things that can be used to help with pain. Research has shown that ibuprofen it is better than acetaminophen for treating the pain of medical abortion. We typically recommend people take 600 milligrams every six hours or so as needed.
Some people take tramadol, a narcotic pain reliever, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research that I was involved in found that drugs like tramadol can be helpful if taken prophylactically before the pain starts.
Another successful regimen we studied combined ibuprofen with an anti-nausea medication called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.
Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medical abortion. It works through pads placed on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with pain signals. That’s something people could get without a prescription.
Pain can be an overlooked issue with medical abortion because honestly, as doctors, we’re not there with patients when they’re at home going through this. But as we do more research on people’s experiences with medical abortion, it’s become pretty clear that pain control is really important. I think we need to do a better job of treating pain and making these options available to patients.
CNN: Are there health conditions that make the use of a medical abortion unwise?
brute man: Having a medical abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside the uterus. It is rare, occurring in about two out of every every 100 pregnancies, and appears to be even rarer among people seeking a medical abortion.
People who have previously undergone pelvic, fallopian tube, or abdominal surgery are at increased risk of ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can increase the risk, as can smoking, a history of infertility, and the use of infertility treatments such as in vitro fertilization (IVF).
If a person is taking blood thinners or blood thinners or has a bleeding disorder, a medical abortion is not recommended. Prolonged use of steroids is another contraindication to the use of the abortion pill.
Anyone using an intrauterine device, or IUD, should have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.
People with chronic adrenal insufficiency or who have inherited a rare disorder called porphyria they are not good candidates.
CNN: Are there signs of problems a woman should watch for after undergoing a medical abortion?
brute man: It can be common to have a low-grade fever in the first few hours after taking misoprostol, the second drug in a medical abortion. If someone has a low fever (100.4 degrees to 101 degrees Fahrenheit) that lasts more than four hours, or has a high fever of more than 101 degrees Fahrenheit after taking the medications, they should be evaluated by a health care provider.
Heavy bleeding, which would be soaking through two or more thick, full-size sanitary pads per hour for two consecutive hours, or a foul-smelling vaginal discharge should also be evaluated.
One of the warning signs of an ectopic pregnancy is severe pelvic pain, particularly on one side of the abdomen. The pain can also radiate to the back. Another sign is dizziness or fainting, which could indicate internal bleeding. These are all very rare complications, but it is advisable to be vigilant.
We generally recommend that someone having a medication abortion have someone with them for the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medical abortion because they may be surrounded by a partner, family, or friends.
Most people know that the abortion is complete because they stop feeling pregnant and symptoms such as nausea and breast tenderness usually go away within a week after the pregnancy ends. A home urine pregnancy test can remain positive even four to five weeks after a successful medical abortion, simply because it takes that long for the pregnancy hormone to clear from the bloodstream.
If someone still feels pregnant, is not sure if the pregnancy passed completely, or has a positive pregnancy test five weeks after taking mifepristone, they should be evaluated by a doctor.
People should know that they can ovulate as early as two weeks after a medical abortion. Most birth control options can be started immediately after a medical abortion.
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