Medical abortion is the use of medications that will bring about an abortion or termination of pregnancy. The most effective medication combinations is mifepristone with misoprostol, available in Canada as Mifegymiso®.
If you want to end your pregnancy, and it is 9 weeks or less, counting from the first day of your last normal menstrual period, medical abortion is the most common way to do this. There is no cost for the medication. It is covered by the Ministry of Health for all BC residents with a valid MSP number. For women from out of province the cost of the visit is covered but not the cost of the medication. Some extended health plans cover the cost of the medication. For women with no Canadian health insurance, please tell the staff when you call to book an appointment. They will review the cost with you.
Mifepristone works specifically on the uterus. It was first approved and used in 1988 in France and China. It has been used with millions of women worldwide to induce an abortion. The mifepristone/misoprostol combination is over 99.99% effective and for 95% it is completed in 7 days, though rarely it can take up to 14 days. The approved mifepristone is a single tablet that is swallowed. 24-48 hours later, misoprostol is used.
Misoprostol stimulates bleeding at home, like a miscarriage, blood and tissue is passed. The timing should be convenient to you. Many women choose this option because it is more private, does not usually involve having a procedure, and you will not need to have someone bring you to the hospital for the abortion. A few women do not like medical abortion because there is more bleeding and stronger cramping than a surgical abortion.
If you are interested in a medical abortion, you will meet with our nurse educator to discuss the procedure in detail. Your medical history will be taken, You can discuss a birth control plan. Then our physician will do an ultrasound to confirm your pregnancy meets the eligibility criteria. Bloodwork is done, STI swabs are taken and consents are signed. You can start the process the same day as you appointment. It is essential that you are able to return to the clinic for a follow-up ultrasound or go to a laboratory for a blood test that will determine if the abortion is complete. You must also be willing to have a uterine aspiration procedure (D&C) if the medication fails to end the pregnancy as there is some evidence that the medications can cause fetal damage if the pregnancy continues.
Day 1: You will take the first medication, mifepristone. Mifepristone will destabilize the lining of your uterus and end the pregnancy. Once you take this medication these effects are not reversible. An appointment will be made for you to return to the clinic for an ultrasound in 14 days or be given a requisition to have laboratory bloodwork done to determine if your pregnancy has ended.
24-48 hours after; You will take the second medication, misoprostol. You insert the misoprostol tablets into your vagina or into the cheeks of your mouth. You will start to bleed within 1-4 hours. As you can expect to have heavy bleeding and strong cramping you should choose a time when you are able to stay home for the rest of the day. The bleeding and cramping may continue for several hours. After that, lighter bleeding may continue off and on for 3-4 weeks or more.
Day 10-14: You will either return to the clinic for an ultrasound or go to a lab for a blood test to confirm that your pregnancy has ended. If our physician determines that the abortion is complete, then no further treatment or appointments are necessary. There is a 1% failure rate with these medications. If they have failed to induce an abortion it is required you book for a uterine aspiration (D&C) to complete the procedure as the medications are known to cause fetal damage.
Side Effects: Most women will need pain medications such as Ibuprofen or naproxen and Tylenol to help with the pain associated with medication abortion. In addition, narcotics may be required. Heavy bleeding resulting in soaking 1-2 maxi-pads every hour can occur for 2-3 hours. Nausea, vomiting, diarrhea, fever, chills, headaches and fatigue are common expected side effects of the medications. Some women will find these side effects can be intense, but are short-lived, usually 2-3 hours.
Medical vs. Surgical
There are pros and cons to each method of abortion. You are at home for a medical abortion so this may seem more private or feel more natural to you. Your pregnancy must be early under 9 weeks from your last period. As well, you can choose to have someone with you if you prefer. You also avoid anaesthesia, or instruments in your body. You can do it on your day(s) off, so may be able to avoid losing time off work or school. You don’t need someone to drive you to the appointments.
On the other hand, a surgical abortion takes few minutes and can be done even when the pregnancy is over 9 weeks. It takes place at the hospital. The pre-operative and post-operative time is 1-2 hours. So in total you are usually there for 3-5 hours. The physician will be placing instruments inside the uterus and you will be given sedative medications by an anesthetist which may cause side effects. You must have someone to drive you home as you will be legally impaired by the medications. Procedures are not done in the evenings or on weekends.
Please consider carefully which method of abortion best suits you. Our staff will be happy to assist you and answer your questions and address any concerns before you make your choice.