Medical Abortion
Medical abortion is suitable for pregnancies up to nine weeks’ gestation. In September of 2000 the Federal Drug Administration (FDA) approved the use of the drug mifepristone
(brand name Mifeprex®) for medical abortion in the USA. Our practice conducted the clinical trials which provided the data and led to the FDA approval of this medicine. (Refer to published articles in JAMA and J Fam Pract.) Our experience and success with this method of abortion is unmatched anywhere in the country.
The Procedure
First, there is a thorough discussion and review of your medical history. An ultrasound exam is then performed transvaginally. Ultrasound is essential for dating the pregnancy. When we know exactly how far along the pregnancy is, the various options can be discussed. A consent form is reviewed and signed. Then the patient takes a single mifepristone pill by mouth, given to her by the clinician in the office. Mifepristone is an anti-hormone, which works by counteracting the effect of the hormone progesterone. It prepares the uterine lining to respond to the misoprostol (second medication). Mifepristone generally has no side effects. Women may go about all their usual activities including work, school, or exercise. Occasionally, some bleeding may occur before the woman has a chance to use the second medication. This does not indicate a problem.
From 24 to 72 hours later, the patient inserts four small tablets of misoprostol into her vagina. This medication has the effect of causing the uterus to cramp and the cervix to dilate. If a woman is unable to insert the misoprostol tablets herself, she has the option to return to our office and the clinician will place this medication for her. Cramping and bleeding usually begin after the insertion of the misoprostol. A few women experience some side effects of misoprostol which may include nausea, vomiting, diarrhea, or fever. The clinician provides a prescription for cramping or discomfort. This is because the over-the-counter products such as Ibuprofen (Advil, Motrin), Aleve, or aspirin, will counteract the action of the misoprostol.
The uterus then passes blood and tissue. The cramping and bleeding usually last between one and ten hours. However, only a portion of this time has pronounced bleeding and cramping. During that time, it is advisable to take the pain medicine prescription provided by our clinician. The cramping and bleeding will eventually subside.
A very important part of the procedure is the follow-up ultrasound. This is performed one to two weeks after the procedure, and is the only way to be completely sure that the procedure has worked. It is essential that women return for their follow-up ultrasound!
