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Medical abortion procedures are available for terminating a pregnancy during the early weeks of the first trimester. For women seeking a medical abortion procedure, a sonogram is recommended to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating.
Medical Abortion (brand name Mifeprex) is a form of early abortion caused by the combination of two medications, mifepristone and misoprostol that is an option for women who are 8 weeks pregnant or less. Also known as RU486 or medication abortion.
During the first appointment at the clinic you receive the mifepristone pill to take orally. Then 24 to 72 hours later, in the privacy of your own home, you take the the second medication, misoprostol. Misoprostol causes contractions resulting in a miscarriage. When used in combination, mifepristone and misoprostol are 95-97% effective within two weeks. Mifepristone and misoprostol are FDA approved.
How Does It Work?
Mifepristone blocks the hormone progesterone needed to maintain the pregnancy. Because this hormone is blocked, the uterine lining begins to shed, the cervix begins to soften and bleeding may occur. With the later addition of the second medication, misoprostol, the uterus contracts and the pregnancy is usually expelled within 6 to 8 hours.
Because the woman chooses when she takes the second medication within the time frame of 24 to 72 hours after the first medication, she has some control over the timing of when she expels the pregnancy and experiences the side effects of bleeding and cramping. Some women choose the Medical Abortion because of the privacy it offers. Some women feel empowered by taking an active role in the process.
Use
At your first appointment at the clinic, an ultrasound is performed to confirm you are less than 8 weeks pregnant. You then speak with an experienced counselor who explains how mifepristone and misoprostol work and makes sure you get answers to all of your questions. Your health history is carefully reviewed and if you meet the criteria, the doctor will give you the mifepristone to take orally. You are also given one bottle containing four tablets of misoprostol to be used 24 to 72 hours after taking mifepristone. If this first dosage fails to induce a miscarriage, please call the clinic to receive instructions on using your back-up misoprostol tablets.
What To Expect
Upon taking mifepristone at the clinic you may begin to bleed. As each woman's body is different, bleeding varies from woman to woman. Some may experience light bleeding much like spotting towards the end of a menstrual period. Others have heavier bleeding like their regular menstrual period, or like a heavy period. Some women do not experience any bleeding until taking the misoprostol.
Upon taking the second medication misoprostol tablet, cramping, bleeding, and clotting may begin as soon as 20 minutes. Within the next 6 to 8 hours, most women will miscarry. Cramping may come in waves with increasing and decreasing intensity. You can expect bleeding heavier than a menstrual period with large clots. During this time, you will pass the embryo although you may not see it since it is very small. The amount of bleeding when using the Medical Abortion is greater than with aspiration abortion.
Aftercare
A follow-up exam is scheduled for two weeks later to make sure the process is complete. If you have not yet miscarried, we will perform a aspiration abortion. A very small percentage (5%) of women does not pass the pregnancy tissue and need a suction procedure to complete the process.
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