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What is an abortion?

An abortion can happen in two ways:

  • The natural loss of a pregnancy, which is called a miscarriage.
  • If a woman is pregnant and chooses to take actions to end the pregnancy

A woman may choose to end a pregnancy either by taking pills (medication abortion) or by having a minor operation (surgical abortion)

Medical abortion involves taking pills (2 different medicines) to end the pregnancy. The effects of abortion pills result in a process similar to a miscarriage. Abortion pills (mifepristone and misoprostol) are a safe and effective way to end a pregnancy in the first 12 weeks of pregnancy. The term “medication abortion” refers to the use of either the combination of mifepristone plus misoprostol or misoprostol taken alone to end a pregnancy. Medication abortion works better, is quicker and has less risk of complications when done earlier in pregnancy, so women who decide to have an abortion should do so as early as possible.

Medication abortion usually involves taking a combination of the two medicines mifepristone and misoprostol. If mifepristone is not available, misoprostol can also be used alone. In the absence of mifepristone, a woman will need to take more misoprostol pills, the process tends to be longer, and she may experience more side effects to achieve comparable success.

Depending on the setting and context, a woman can have a medication abortion in a health facility, at home (or another private place where she feels secure and comfortable), or in a combination of the two. Women can have a successful abortion if they have accurate information, access to quality medications, and know the signs of complications for which they should seek immediate medical care. Medication abortion is suitable for women of all ages and sizes, including adolescents. An uncomplicated medication abortion will not affect a woman’s ability to carry future pregnancies.

A visit to a health facility is not usually necessary following an uncomplicated medication abortion. If a woman is unsure that the abortion was successful, she may choose to visit a health facility to confirm that she is no longer pregnant.

What are mifepristone and misoprostol

Mifepristone is a medicine that blocks the hormone needed for a pregnancy to progress. Misoprostol is a medicine that causes the uterus to contract and expel a pregnancy.

Both mifepristone and misoprostol are available as tablets. In many countries, misoprostol alone is sold under the brand name Cytotec. Misoprostol is sometimes sold as a stomach ulcer medication and/or for other indications like the treatment of heavy bleeding after childbirth.

Mifepristone and misoprostol are sometimes available together in a combination pack (sometimes known as a “combipack”). Combipack and mifepristone brand names vary by country, so you should know which names these drugs are sold under in your setting.

Misoprostol comes in various dosages. It is most sold in a pack of several 200 microgram (mcg) pills. The 200mcg pill is the best option for medication abortion, and multiple pills are needed for each abortion. They should only be taken according to the dosages recommended.

Misoprostol breaks down when exposed to humidity, compromising its ability to act on the body the way it should. To help ensure a high-quality product, misoprostol should only be bought and used when it is packaged in double-sided aluminum pill casing. The aluminum pill case should be kept sealed until the time of administration.

Medication abortion using mifepristone and misoprostol

Using mifepristone in combination with misoprostol is a highly effective (approximately 95% effective) and safe way to end an early pregnancy.

Most women generally experience an abortion within the first 24 hours after taking the dose of misoprostol, although it sometimes takes longer. The pregnancy is generally expelled quicker when a woman takes mifepristone in combination with misoprostol compared to using misoprostol alone.

How to take mifepristone with misoprostol in first 12 weeks since last period

  • Swallow the first pill (mifepristone) with water.
  • Wait 1–2 days
  • Take Misoprostol either:
    • Place 4 tablets under the tongue, hold them there for 30 mins, then shallow whatever is left.
    • Place 2 pills (misoprostol) between the cheek and lower gum on each side of her mouth (4 pills total) and keep them there until they dissolve. After 30 minutes, she should swallow whatever is left with water

Medication abortion using misoprostol alone

If mifepristone is not available, misoprostol can also be used alone to end a pregnancy.

Taking misoprostol alone is still an effective way to end a pregnancy, but it is more effective when taken in combination with mifepristone.

Most women will experience an abortion within the first 24 hours after taking misoprostol, although it sometimes takes longer.

When misoprostol is used alone, a woman will need repeat doses of the medicine to achieve a successful abortion.

The recommended regimen is three repeat doses of 800mcg misoprostol placed either under the tongue (sublingual route) or against the cheek (buccal route) every three hours. Since more doses are required, women should make sure they have at least 12 pills of 200mcg available to take.

Even if bleeding starts after the first or second dose, the woman should take all three doses for best results. Sometimes, to achieve a successful abortion, more than three doses of misoprostol (800mcg) may be needed.

Inserting misoprostol pills into the vagina (vaginal route) works well too but is not recommended in legally restricted settings as the pills may be detectable even several hours later. In some cases, women seeking medical attention have been reported to the police for having an abortion without the approval of a health provider.

How to take misoprostol alone in first 12 weeks since last period

  • Place the 4 pills (misoprostol) under the tongue and hold them there until they dissolve. After 30 minutes, swallow whatever is left with water. take more pills the same way every 3 hours, taking 12 pills total.
  • Place 2 pills (misoprostol) between the cheek and lower gum on each side of the mouth (4 pills total) and keep them there until they dissolve. After 30 minutes, swallow whatever is left with water. take more pills the same way every 3 hours, taking 12 pills total

Which contraceptive methods can be used with or after medication abortion?

With the exception of the intrauterine device (IUD), most methods of contraception can be started right away with medication abortion (as early as the day of taking the first abortion pill—mifepristone or misoprostol). Choices include:

Contraceptive implants

Trained providers can perform a minor procedure to place and remove a small plastic rod that is kept under the skin on the inside of a woman’s arm. Depending on the type used, the implant can remain in place and prevent pregnancy for 3-5 years. An implant can be inserted as early as on the day you take the first abortion pill (mifepristone or misoprostol).

Intrauterine device (IUD)

A small, T-shaped device inserted into a woman’s uterus by a trained health provider. Depending on the type used, the IUD can stay in place and prevent pregnancy for up to 12 years. A health provider can remove the device at any time. An IUD should be placed only when it is reasonably certain a woman is no longer pregnant after taking abortion pills.

Contraceptive injection

A trained provider injects the contraceptive into a muscle in the arm or leg once every 1-3 months, depending on the type used. In some settings, women can self-administer injectable contraceptives if they have the right training and access to a health provider when needed. A contraceptive injection can be given as early as the day when the woman takes the first abortion pill (mifepristone or misoprostol). In some settings, this injectable contraception may be available at the same pharmacy or drug seller where a woman buys her abortion medications.

Oral contraceptive pills

There are two types of oral contraceptive pills: the “combined” oral pill (which contains two hormones) and the progesterone-only pill. A woman must swallow either type of pill and must take them regularly and consistently to prevent pregnancy. The contraceptive pill can also be started as early as the first day of medication abortion and may be available to buy at the same place women buy abortion pills.

condoms content

Condoms (male and female)

Consistent and correct use of a condom is good for preventing the sexual transmission of HIV and reducing the risk of other sexually transmitted infections, such as chlamydia, gonorrhea, and syphilis. They are also effective in preventing pregnancy if used every time and correctly.

Tubal ligation

Tubal ligation, also known as female sterilization, is minor surgery to permanently prevent pregnancy. This a permanent method of contraception and can only be provided by a trained clinical provider.

Surgical abortion involves an operation to remove the pregnancy from the womb. It may be done with:

  • local anaesthetic (to numb the cervix)
  • conscious sedation (where you’re relaxed but awake)
  • deep sedation or general anaesthetic (where you’re asleep)

Most people having deep sedation will not remember anything and will not be aware during the operation. If you have a general anaesthetic, you’ll be fully asleep during the operation and will not remember anything.

What kind of anaesthetic or sedation you have depends on your circumstances, how many weeks pregnant you are and your own preference.

Before a surgical abortion, you’ll be asked to have a medicine to open the cervix. This happens either a few hours or 1 to 2 days before the operation, depending on the medicine used.

There are 2 methods of surgical abortion.

  1. Vacuum or suction aspiration
    This can be used up to 14 weeks of pregnancy. Vacuum aspiration involves a small tube (cannula) which is inserted into the vagina, through the cervix (the mouth of the uterus) and into the uterus. The contents of the uterus are then suctioned out. Vacuum aspiration is a simple and very safe procedure that should only take about 5-10 minutes. It is highly effective for both abortion and treatment of incomplete abortion (when an abortion has started but the contents of the uterus have not been fully expelled) and can be used from early to later pregnancy.
  2. Dilatation and evacuation (D&E) This is used after 14 weeks of pregnancy. D&E is a form of abortion that uses a combination of specialized forceps and vacuum aspiration to empty the uterus, it involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy. The procedure can be used for an abortion in later stages of pregnancy than the MVA procedure, and for treatment of incomplete abortion or postabortion care. D&E is usually carried out under sedation or general anaesthetic. It normally takes about 10 to 20 minutes and you’re usually able to go home the same day.

After an abortion

You do not usually need to have any other tests or appointments after a surgical abortion, or a medical abortion in hospital.

If you have a medical abortion at home, you may need to have a special kind of pregnancy test or scan to make sure the pregnancy has ended.

If you have a medical abortion, you may have short-lived side effects from the medicines, such as diarrhoea and feeling sick.

If you have a surgical abortion, the general anaesthetic and sedation medicines can also have side effects.

For all types of abortion, it’s likely you’ll have some stomach cramps (pain) and vaginal bleeding. Bleeding usually lasts a week or two. Sometimes light vaginal bleeding after a medical abortion can last up to a month.

After an abortion, you can:

  • take painkillers like ibuprofen or paracetamol to help with any pain or discomfort
  • use sanitary towels or pads rather than tampons until the bleeding has stopped
  • have sex as soon as you feel ready, but use contraception if you do not want to get pregnant again as you’ll usually be fertile immediately after an abortion.

You can usually return to normal activities as soon as you feel comfortable to, including having a bath or shower, using tampons, exercising (including swimming) and heavy lifting.

When to get medical help

Get advice if you:

  • have pain or bleeding that does not get better in a few days
  • still feel pregnant after about a week
  • have a temperature, flu-like feelings or unusual vaginal discharge – these could be signs of infection
  • have any other worries

You may experience a range of emotions after an abortion. This is common.

If you need to discuss how you’re feeling, contact the provider or your general doctor.

They will be able to provide counselling or refer you for counselling if you need it.

What will happen when I take the pills?

  • The pills should cause bleeding and cramping, and you may see clots. Your bleeding may be more than your normal period. Every woman will experience bleeding and cramping differently.

When should I seek help?

  • Heavy bleeding or soaking more than 2 sanitary pads per hour for 2 hours in a row,
  • Unusual or bad-smelling vaginal discharge,
  • Any of the following the day after you take the 4 pills of misoprostol:
    • Fever,
    • Severe Abdominal pain,
    • Feeling very sick with or without fever,
    • Persistent severe nausea or vomiting.

When can I have sex again?

  • You can have sex as soon as you like.

When can I get pregnant again?

  • You can become pregnant again as soon as 8 days after the abortion.

How can I NOT get pregnant?

  • If you do not want to get pregnant, use contraception, Talk to a health worker about contraception. You can start most methods at the same time you take the abortion pills.