There are many misconceptions – both favorable and unfavorable - about the Abortion Pill. Some women assume that taking a pill to end a pregnancy will be considerably easier than having a procedure. They think that the Abortion Pill will simply bring on their late period, maybe with some tolerable cramping. On the other side, women have heard horror stories about the Abortion Pill, and are frightened by stories of uncontrolled bleeding, and intolerable cramping.
What’s accurate? The simple answer: both sides of the story.
I’ve been providing the Abortion Pill for almost a decade. I was one of the original researchers of the Abortion Pill before the FDA approved its use in the United States. I have seen a wide range of experiences with the Abortion Pill. I thought it might be helpful to share a doctor’s perspective on realistic expectations. Also, many women do not know of their other nonsurgical option – the Aspiration Procedure. This simple gentle procedure has many advantages over both the Abortion Pill, and surgical abortion. It’s important to compare all of these options.
Most women who take the Abortion Pill have a positive experience with it. Studies indicate the 90% of those who take the Abortion Pill would choose it again, or recommend it to a friend. In my experience, it is most important to prepare patients for what their experience will be, and equip them with strong pain medications, anti-nausea medication, and explicit directions on how to take these medications. With proper preparation and premedication with pain medicines, most women will have a positive experience of the Abortion Pill, and appreciate the ability to induce an early miscarriage in their own home.
That said, about 10-20% of women will have a terrible experience, no matter what pain medicines they are given. We instruct women to take 800 mg of ibuprofen and an anti-nausea medication at the same time they take the misoprostol tablets. Then, at the first sign of cramping, we instruct them to take acetaminophen with codeine. It’s important to take this early, before the cramps build, in order for the medications to be most effective.
Most women who take their medications this way will have a positive experience with the Abortion Pill. They will experience 1-2 hours of strong period-like cramps, and describe the process as tolerable. Women who choose the Abortion Pill appreciate being able to be at home, often with their husband or companion. They often appreciate feeling like the pregnancy passes “naturally,” like a miscarriage, rather than with a procedure.
Most of our patients do well on this protocol. A minority of women, however, do not. They experience extreme cramping, sometimes for hours, with no relief. I often get phone calls from desparate friends and partners, who don’t know what to do, as I hear my patient screaming in pain in the background. Unfortunately, there is little to do at this stage aside from applying heat and lying on one side in with legs to the chest – and wait for the pain to pass. I reassure them that they definitely will get better.
And the bleeding? A similar story. Most women find it tolerable – they bleed heavier on the first day, and then it becomes more like a period that comes and goes for 1-3 weeks. However, 50% of women bleed longer than 6 weeks. The bleeding typically is intermittent, and more annoying than upsetting – as soon as you think it’s over, you start to bleed again. In ten years of providing the Abortion Pill I have never seen anyone hemorrhage on the first day of the miscarriage – and this is consistent with national results. Problems with bleeding occur later. Women who have needed transfusions (less than 1/400) have been women with lengthy bleeding who did not get proper follow up. If a patient is having extended bleeding, it can be treated with a procedure – preferably the nonsurgical Aspiration procedure, or a surgical procedure – and a transfusion should be avoided.
Personally, I highly recommend the Aspiration Procedure over the Abortion Pill. This nonsurgical procedure can be completed in minutes, and is noninvasive – it does not involve scraping, electric suction, or general sedation. It has a higher success rate (>99%) than medical abortion (95-98%). It only requires one visit to the doctor, rather than two. There is immediate recovery. Most women have never heard of the Aspiration Procedure. In my office when women discover the advantages of this simple gentle procedure, very few choose the Abortion Pill. Those who do choose the Abortion Pill over the Aspiration procedure typically want to have a private experience in their own home, or have unusually strong aversions to doctors and medical procedures.
Unfortunately, most women do not have access to the Aspiration Procedure. In this situation, I would recommend the Abortion Pill as a sound nonsurgical option.
Tags: Abortion Pill, Aspiration Abortion, bleeding after abortion pill, cramping after abortion pill, expectations, medical abortion