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Mifepristone, one of two drugs used for medication abortion, can continue to be given to patients without an in-person visit with a doctor after the US Supreme Court rejected a lawsuit challenging the regulation of the abortion pill.
“While many women obtain medication abortions from a clinic or their OB-GYN, others obtain the pills themselves to induce or self-manage their 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-administered abortion is safe and effective,” she said.
Mifepristone blocks the hormone progesterone, which is necessary for a pregnancy to continue. The drug is approved to terminate a pregnancy at 10 weeks of gestation, which is “70 days or less from the first day of the last menstrual period.” according to the US Food and Drug Administration.
In a medication abortion, a second drug, misoprostol, is taken in 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 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 — especially in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advance 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 women’s health.
What happens during a medication abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.
CNN: What is the difference between a first trimester medication abortion and a vacuum suction as to what a woman experiences?
Dr. Daniel Grossman: Vacuum aspiration is most commonly performed under a combination of local anesthesia and oral pain medication or local anesthesia with intravenous sedation, or what is called conscious sedation.
An injection of local anesthetic is given to the area around the cervix, and the cervix is dilated or opened. When the cervix is opened, a small straw 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 more, there is nothing in the tissue that could be recognized as a part of an embryo.
The suction procedure only takes a couple of minutes. Then the person is observed for one to two hours, until all sedation has disappeared. We also monitor each patient for very rare complications, such as heavy bleeding.
A medication abortion is a longer process. After taking the pills, bleeding and cramping may occur for a period of days. Bleeding is typically heavier when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average, people continue to have light bleeding for about two weeks or more, which is a little longer than after a vacuum aspiration.
Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.
In fact, the pain of medication abortion can be very intense. In the studies that have been looked at, the maximum average level of pain that people report is about seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be short, ending as soon as the pregnancy is expelled.
The level of cramping and pain can depend on the duration of the pregnancy, and even if someone has given birth before. For example, a medical abortion at six weeks or less of gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth usually have less pain.
CNN: What can be done to help with the pain of a medication abortion?
Grossman: There are certainly things that can be used to help with the pain. Research has shown that ibuprofen it is better than acetaminophen to treat the pain of abortion medication. We usually advise people to take 600 milligrams every six hours or more as needed.
Some people take tramadol, a narcotic pain reliever, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research that has been involved in medications found such as tramadol can be useful if taken prophylactically before the pain.
Another successful regimen we studied combined ibuprofen with a nausea medicine called metoclopramide that also helps 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 medication abortion pain. It works through pads placed on the abdomen that stimulate the nerves by means of light electric shocks, thus interfering with the pain signals. It’s something people could get without a prescription.
Pain can be an overlooked problem with medication abortion because, quite honestly, as clinicians, we’re not there with patients when they’re at home going through it. But as we did more research on people’s experiences with medication abortion, it became quite 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 it unwise to use a medication abortion?
Grossman: Under a medication abortion can be dangerous if the pregnancy is ectopic, which means that the embryo develops outside the uterus. It’s rare, it happens in about 2 out every 100 pregnancies – and it seems to be even more rare among people who seek medical abortion.
People who have undergone pelvic, fallopian tube or abdominal surgery are at greater risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can be a risk, such as smoking, a history of infertility and the use of infertility treatments such as in vitro fertilization.
If a person is on anticoagulants or blood drugs or has a bleeding disorder, a medication abortion is not recommended. Long-term use of steroids is another contraindication for the use of the abortion pill.
Anyone using an intrauterine device, or IUD, should have it removed before taking mifepristone because it can be partially expelled during the process, which can be painful.
People with chronic adrenal failure or who have inherited a rare disorder called porphyria they are not good candidates.
CNN: Are there signs of trouble a woman should watch out for after having a medication abortion?
Grossman: It can be common to have a low-grade fever in the first hours after taking misoprostol, the second drug in an abortion medication. If someone has a low-grade 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 medication, they need to be evaluated by a health care provider .
Heavy bleeding, which would soak two or more large size pads an 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 in a part 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 wise to be careful.
We usually recommend that someone having a medication abortion have someone with them during the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can 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 disappear, usually within a week of passing the pregnancy. A urine pregnancy test at home can be positive even four to five weeks after a successful medication abortion, simply because it takes so long for the pregnancy hormone to disappear from the blood.
If someone still feels pregnant, is not sure if the pregnancy has passed completely or has a positive pregnancy test five weeks after taking mifepristone, they should be evaluated by a clinician.
People should know that they can ovulate as soon as two weeks after a medication abortion. Most birth control options can be started immediately after a medication abortion.
