Medical Termination of Pregnancy

Vilma Ruddock
session with psychotherapist

Women have the option of using medicines to terminate a pregnancy at home during the first trimester. Otherwise known as a medical abortion, it is a safe and effective alternative to a surgical procedure in a clinic. The medical termination option is available for women who elect to have an abortion, or those who must terminate nonviable pregnancies.

Mifepristone-Misoprostol Pregnancy Termination

Mifepristone, the abortion pill (also previously known as RU-486) in combination with misoprostol is the current standard medical pregnancy termination procedure in the United States in 2017. The drugs are approved by the Federal Drug Administration (FDA) for termination of first trimester pregnancies up to 10 weeks from the last menstrual period. This was increased from seven weeks in 2016.

The drugs can be used to abort viable as well as non-viable pregnancies. Because the pregnancy is expelled at home, the process avoids a first trimester invasive surgical abortion procedure at a medical facility.

The Termination Process

There are two mifepristone-misoprostol protocols used by doctors in the United States to terminate a pregnancy. They are both sanctioned by the American College of Obstetricians and Gynecologists (ACOG).

1. With the FDA-approved protocol:

  • You take three 200 milligram (mg) mifepristone tablets (600 mg) by mouth in a doctor's office or family planning unit, and then go home.
  • You return to the medical facility about six to 48 hours later to take two 200 microgram (mcg) misoprostol tablets (400 mcg) and return home to await the abortion.

2. With the alternate, less costly protocol:

  • You take one 200mg mifepristone tablet in the medical office.
  • At home 24 to 48 hours later, you use misoprostol 800 mcg (four tablets) by a vaginal, buccal (between gum and cheek), or sublingual route. Alternatively, some doctors prescribe vaginal misoprostol in the office at the time of the mifepristone or up to six hours later.

According to the ACOG reference above, the second protocol is slightly more effective in expelling the entire pregnancy than the first (95 to 99 percent versus 92 percent). The Guttmacher Institute notes three states require doctors to follow the FDA-approved protocol.

What to Expect

With either protocol, after the misoprostol dose, expect the following:

  • stomach ache
    You will pass the products of your pregnancy about three to four hours later.
  • You are likely to have strong uterine cramps and heavy vaginal bleeding during the process.
  • You might also see clots and tissue pass from your vagina. You can take ibuprofen as recommended by your medical facility for the pain.
  • You go to your doctor for a checkup two weeks after you abort the pregnancy to make sure the termination is successful.

After the Termination

After termination of the pregnancy, the uterine cramps might continue for one to two days. Bleeding can last for a few weeks but should get lighter each day. Call your doctor or facility medical staff if:

  • Your pain or bleeding is not progressively decreasing.
  • You have heavy bleeding - soaking through a sanitary pad in an hour.
  • You have persistent fever, which might indicate a uterine infection.

How the Medicines Work

Mifepristone blocks progesterone, which is vital to support a pregnancy, from working in the uterus. This causes the uterine lining, including the implantation site, to break down and disrupt the pregnancy. The drug can also cause the uterine muscle to contract.

Misoprostol, a form of prostaglandin, causes strong contractions in the uterus after the priming action of mifepristone on the uterine muscle. This serves to expel the products of conception and endometrium out of the uterus.

Side Effects

Since being approved in 2000, medical pregnancy termination with mifepristone and misoprostol has proven to be effective and safe with few side effects. The most common side effects are nausea, vomiting, diarrhea, chills, and mild fever.

The Risks

There is a small risk of failure to pass some or all of the embryo or fetus, which would require a surgical procedure to complete the process. This risk is greater the further along the pregnancy. There is also a risk of an ectopic pregnancy, but this is also true for surgical termination procedures.

The Cost

The average cost of a medical pregnancy termination is about $500, which is less expensive than a surgical termination. Your cost might be lower or higher depending on which facility you use. Check with your medical insurance company to see if they cover any of the cost. In some states in the U. S., there are restrictions on insurance coverage of any abortion procedure.

FDA Safety Regulation

For safety, mifepristone prescribing is highly regulated by the Federal Drug Administration (FDA) and the manufacturer. This is to prevent people diverting and misusing the drug.

You cannot get the drugs from a pharmacy. You can only get the two-drug regimen from a doctor's office or a family planning unit at a hospital or free-standing facility. For your safety, don't buy mifepristone or misoprostol on the internet or from other unregulated sources.

Other Medical Regimens

Methotrexate (MTX) alone by vaginal or intramuscular route, or methotrexate followed by vaginal misoprostol has also been used to terminate a pregnancy. MTX is rarely used for medical abortions in the U. S. anymore since mifepristone became available. However, it is still used for medical treatment of ectopic pregnancies.

Another option is to use misoprostol alone, either by the vaginal or sublingual route. This regimen is less effective than combined mifepristone and misoprostol and is not frequently used in the U. S. It might be used in other countries where mifepristone is not available.

Consider Your Options

Consider your options for treatment if you have to terminate a pregnancy. Review the details with your doctor to make sure you understand the process, benefits, and risks. Medical pregnancy termination is safe if you are healthy and have no contraindications to taking the drugs.

Medical Termination of Pregnancy