Women who choose medical abortions often do so because they prefer to abort in the privacy of their own home with a partner or friend and because they feel it is less invasive and more natural. Some women say they feel more in control during the process.
Medical abortions are like natural miscarriages but usually take longer and there is usually more bleeding and cramps than a surgical abortion.
What happens when you call the office? Reception will ask you when your last period was and for your email address. We will email you an invitation to our secure web portal, healthmyself, and send you a lab requisition and an ultrasound requisition through this. (Check your spam box in case the invite goes there by mistake). The ultrasound is helpful to ensure you do not have an ectopic pregnancy (outside the uterus, as this is a life threatening emergency). It is helpful to get your blood work done the same day. We will notify you through the portal of your appointment with the doctor within the next 24-72 hours after your blood work.
What happens at the visit with the doctor? She will talk to you and make sure you are comfortable and go over some paperwork with you. You may have an ultrasound in the office, depending on your history and if you have had an ultrasound already. She will then give you your prescription so you can go pick it up at the pharmacy. She will go over what to expect and how and when to take your medication.
When and where does the abortion actually happen? 24-48 hours after taking the mifepristone tablets, you will insert misoprostol tablets either between your teeth and your cheek (buccal) or into your vagina. The misoprostol tablets make the uterus cramp. You will bleed heavier than a period and the pregnancy will come out.
How well do the drugs work?
95% of women will be done after taking the misoprostol. This will be confirmed at your follow up visit in one week. About 0.5% of abortions with mifepristone fail and require surgery because the pregnancy is still growing. About 2% of women request surgery because they don’t want to wait for the bleeding to start (a delayed reaction).
What about side effects? There are few side effects from the mifepristone. After the misoprostol you can expect bleeding, cramping and some women get flu-like symptoms such as nausea, diarrhea, headache, fever and chills. Many women have few or no side effects.
What are the costs?
If you have OHIP, your office visits for the medical abortion are covered in Ontario, as well as the medication, bloodwork and ultrasound.
How can we know if the abortion is completed? Your follow up visit will be about a week later and will last about 15-20 minutes. For most women, this will be their last visit. We can follow the progress of the abortion with blood tests and arrange Ontario Telemedicine visits for follow up if it is difficult to make it back into the clinic.
What if it doesn’t work? In about 0.5% of women this procedure will not work and a surgical abortion will be required. We will give you the number to make arrangements at a local surgical abortion clinic. Less than 1% have complications such as infection or serious bleeding.
What are the possible complications?
Mifepristone and misoprostol have been formally studied and used safely. The risk of excessive bleeding or serious infection is very low. Rarely, women may be allergic to the medications.
Are there emotional issues specific to this method?
Some women are anxious waiting for the abortion process to complete. Viewing the pregnancy tissue can also be difficult for some.
What are the advantages of Medical Abortions?
Effective and safe for very early pregnancies (63 days or 9 weeks gestational age). Avoids anesthesia, instruments or vacuum aspiration, unless it fails (however, blood work and a vaginal ultrasound are required. An injection may also be needed if your blood type is RH negative).
Induces a miscarriage-like process, so if you need someone in your life to think it is a miscarriage, this may be the best option.
Being at home instead of a clinic during the actual abortion may seem more comfortable and private.
What are the disadvantages of this method?
It is not completely predictable – there is more uncertainty about when you will bleed and pass the pregnancy. Bleeding can be heavy and last longer than with a surgical abortion. Cramping can be strong and last longer than with the surgical abortion. At least two visits are required, sometimes more. Failure rate is higher than with surgical abortion.
Who should not use this method?
If it is more than 10 weeks from your last period, you are on blood thinners, have an allergy to the medications, blood clotting problems, porphyria, severe anemia or uncontrolled seizures, you should not use mifegymiso.
Are there any long term effects? The medications leave your body within one week and will not affect future pregnancies or general health.
Thank you to http://www.willowclinic.ca/ for their information page.
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