Medical (Pill) Abortion

What is medical abortion and how does it work?

The Medical Abortion is an option to end an early pregnancy (up to 10 weeks after the first day of a woman‚ last menstrual cycle) in three steps:

1. The medication Mifepristone (also known as RU-486) which works by blocking the hormone progesterone without which the lining of the uterus breaks down and pregnancy cannot continue. This pill is given to you by either the doctor or one of our nurse practitioners, during your first clinical visit.

   Some patients begin bleeding shortly after taking this pill, others do not. Whenever you do start bleeding you will start taking the antibiotics that we send you home with. We will call you that same evening to see how you are doing, ask if you have any questions or concerns, and remind you that YOU ARE NOT ALONE.

2. 48 hours after taking the first pill it will be time for you to take the second medication, Cytotec. Set some time aside for you and surround yourself with whatever helps you to feel comfortable. You will have four of these pills which you will need to tuck inside of your cheeks, two on each side. You will need to let them dissolve for 20-30 minutes.

   This medication will cause cramping of the uterus to expel its contents. Some women experience bleeding lighter than a period and don't notice cramps. Other women have bleeding that is much heavier than their normal period and have cramps that they find INTENSE during the expulsion phase. It is important for me to know that everything within this range is normal. Bleeding and cramps should diminish once everything is expelled. Significant cramping usually will last no longer than 24 hours. You may take up to 800 mg of Motrin every four to six hours to aid with cramping and heavy bleeding.

3. Time for your follow up visit. We will need to see you in order to make sure your abortion is complete and that you are well. We will draw blood to make sure that your hormone levels have decreased and also do a pelvic ultrasound to give you the final "A-OK."

What is a Medical Termination (the ‘Abortion Pill’)?

Medical Termination is a non-surgical, non-invasive way to terminate a pregnancy that is less than 10 weeks gestational age. A Medical Termination is safe, effective (approx. 98%) and occurs in the comfort, security and privacy of your own home. You will most likely experience moderate-severe abdominal cramps and heavy bleeding, which many women liken to a “very heavy period”. Two weeks after you initial visit (when you are given the pills), you return back for a follow-up visit to assure the procedure was completed successfully and that you are no longer pregnant.

What Should I Expect at my Visit for a Medical Termination?

On the day of your Medical Abortion visit, you should plan to spend approximately one hour at the office. You will be given routine paperwork to complete, so that we can make sure that we have all relevant information and a complete medical history. We will then show you to our lab, where you will have your blood type checked and a pregnancy test done to confirm pregnancy. Next, you will have an ultrasound to make sure you are a good candidate for a Medical Termination. Prior to giving you the Abortion Pill, we need to check that you are less than 9 weeks pregnant, and confirm that there is a pregnancy located in your uterus (on rare occasions, a pregnancy can grow outside the uterus [tubes, ovaries, cervix, etc..] and this requires different management). You will then sit and have a consult with one of our medical providers, who will explain the medication process to you in great detail. You will be given one pill in our office (Mifeprex) which will start the abortion process. You will then be sent home with an additional 4 pills (Misoprostol) which you will take at home 24-48 hours later (any time in that window that is convenient for you) which will complete the procedure at home. 

Is there any Required Follow Up for a Medical Termination?

Yes. It is required that you return to the office 2 weeks after your procedure for a follow-up visit. This visit is necessary to confirm the success of the medical procedure. You will have an ultrasound done and consult with your medical provider. 

Is a Medical Termination Safe? Is it Effective?

Medical Termination is an extremely safe procedure. Serious adverse effects (infections) occur in less than 1 in 1,000 patients (0.1%). Only 1 in 100,000 patient deaths (0.01%) from serious infection were reported.  In regards to efficacy, the abortion pill has a success rate of approximately 95%. In the event of an “incomplete” or “failed” medical abortion, your provider will review the findings with you and determine an appropriate follow-up/intervention. Most often, an incomplete/failed medical termination will necessitate repeating the medication or moving on to a surgical abortion procedure.

Can I still get pregnant after Medical Abortion?

YES. You will be able to come become pregnant after the Medical Abortion.  Once the hormones of pregnancy (Beta hcg) have become negative and your menstruation returns your chances of becoming pregnant again will be the same as it was before the Medical Abortion.  This is why it becomes so important to start using birth control after your two week appointment to prevent an unintended pregnancy.  At My Choice Medical Center we offer all forms of family planning including oral contraceptives, Depo Provera, IUD, patch and NuvaRing.

How Can I Be Sure That The Abortion Was Successful?

We schedule follow-up appointments approximately 2 weeks after your procedure for this purpose. You will have a follow-up ultrasound done to confirm that you are no longer pregnant. Further testing/evaluation is only done if needed.

What Happens If I Have Any Complications After My Abortion?

Almost all abortions occur without serious complications, but in the event you have a concern/complication/problem, you will be given a phone number for our on-call provider who will evaluate you over the phone at any time of day or night to determine if you need any immediate attention or evaluation. Most other facilities will simply refer you to the emergency room for most your concerns. Our center will evaluate you by the physician and only in rare and truly necessary cases will refer you to the emergency room. It is truly important that you call us if you have concerns or emergencies since many concerns will be resolved after speaking with the experienced physician.

When will I receive my first period after Medical Abortion?

Most patients will receive their first menstrual cycle after Medical Abortion six weeks from the time the Mifeprex was taken.  For the first six weeks there will be spotting, then no bleeding and passing blood clots with cramps.  The first menstrual cycle will be heavier than your normal menstrual cycles.  The following cycle should be the same as it was before you became pregnant.

Will It Hurt? Will I Get Any Pain Medication?

Most women report that having a medical termination feels like a very heavy period. You will likely experience heavier cramping and heavier bleeding than your average cycle. The amount of bleeding and cramping is directly proportional to the size of pregnancy.  We will provide you with a prescription for pain medication at your visit, or you have the option of purchasing pain medication directly from our office if you wish to stay strictly confidential and not visit an outside pharmacy. All pain medication is optional, but the majority of women report that having pain management is helpful. 

What If The Pill Doesn’t Work?

Our providers will determine if the medical termination was successful or not. In the unlikely event you did not have a complete abortion, depending on the scenario you may need a surgical termination.

What If I Don’t Bleed After Taking The Pills?

You will be given a full set of instructions prior to leaving the office on the day of your visit, but if you do not experience any bleeding 24 hours after taking the Misprostol at home, please contact us.

What If You Can’t See Anything On My Ultrasound?

An ultrasound is always performed prior to a medical termination to assure that you are a good candidate for the procedure. We are looking to confirm that you are under 10 weeks pregnant (after 10 weeks the abortion pill is not an acceptable method), and we are also confirming that we see a pregnancy located inside of your uterus. On rare occasions, you may have an Ectopic pregnancy in which the embryo grows outside of the uterus in a secondary location. This situation is very serious and can be life threatening. Sometimes, if you are very early in your pregnancy, we will not see anything inside of the uterus yet. However, until we can see inside the uterus we cannot exclude an ectopic pregnancy. This does not exclude your ability to do the  medical termination that day. If you elect to continue with the procedure we will accommodate you, but there will additional lab work done that day to obtain a blood pregnancy hormone level. You will need to have this blood level repeated a week after your termination to confirm a successful termination. If your blood pregnancy hormones are declining properly, we are assured of a successful procedure. If your levels plateau or rise, and your ultrasound still shows an empty uterus, we will evaluate further for an ectopic pregnancy. You also have the option of waiting 7-10 days and returning to the office to recheck your ultrasound and do the medical termination at a later date. Our staff will review all options with you in the office if this happens. Our number one priority is always to assure that you are given the safest, highest quality of care possible. 

If I am RH Negative, What Do I Need To Do Differently?

If you are an RH Negative blood type, you will need to be given an injection called RhoGAM which will protect your body from developing harmful antibodies against the pregnancy.

Most women report that having a medical termination feels like a very heavy period. You will likely experience heavier cramping and heavier bleeding than your average cycle. The amount of bleeding and cramping is directly proportional to the size of pregnancy. We will provide you with a prescription for pain medication at your visit, or you have the option of purchasing pain medication directly from our office if you wish to stay strictly confidential and not visit an outside pharmacy. All pain medication is optional, but the majority of women report that having pain management is helpful.