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Mifepristone, one of two drugs used for medication abortions, can continue to be mailed to patients without an in-person visit to a doctor following the U.S. Supreme Court's rejection of a lawsuit challenging regulation of the pill abortive.
“While many women obtain their medication abortion from a clinic or their OB-ginn, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
“A growing body of research indicates that self-managed abortion is safe and effective,” she said.
Mifepristone blocks the hormone progesterone, which is necessary for pregnancy to continue. The drug is approved to terminate a pregnancy up to 10 weeks of gestation, which is “70 days or less from the first day of the last menstrual period,” according to the U.S. Food and Drug Administration.
In a medication abortion, a second medication, misoprostol, is taken within 24 to 48 hours. Misoprostol causes the uterus to contract, causing cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available in pharmacies for decades.
Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.
“Some people do this because they can't get to a clinic, particularly in states with legal restrictions on abortion, or because they prefer self-care,” said Grossman, who is also director of Advancing New Standards in Reproductive Health, a research group. which evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman's health.
What happens during a medical abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.
CNN: What is the difference between a first trimester medication abortion and a medication abortion? a vacuum aspiration In terms of what a woman experiences?
Dr. Daniel Grossman: An vacuum aspiration is most commonly performed under a local anesthetic anesthetic and oral or anesthetic annesthetic along with intravenous sedation, or what is called conscious sedation.
An injection of local anesthetic is given to the area around the cervix and the cervix is gently dilated or opened. Once the cervix is opened, a small straw-like tube is inserted into the uterus and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is performed before nine weeks or so, There is nothing in the tissue that is recognizable as part of an embryo.
The aspiration procedure lasts only a couple of minutes. The person is then observed for one to two hours until the sedation wears off. We also monitor each patient for very rare complications, such as heavy bleeding.
A medical abortion is a longer process. After taking the pills, bleeding and cramping may occur over a period of days. Bleeding is usually heavier when the pregnancy is expelled, but usually subsides within a few hours. On average, people continue to have light bleeding for about two weeks, which is slightly longer than after a vacuum aspiration.
Nausea, vomiting, fever, chills, diarrhea, and headache may occur after using the abortion pill, and all people who undergo a successful medical abortion usually report some pain.
In fact, the pain of a medical abortion can be quite intense. In studies that have looked at it, the average maximum level of pain that people report is seven to eight out of 10, with 10 being the highest. However, people also say that the pain may be brief and peak just as the pregnancy is expelled.
The level of cramping and pain can depend on the length of the pregnancy and whether or not someone has given birth before. For example, a medical abortion at six weeks or less of gestation usually has less pain and cramps than one performed at nine weeks. People who have given birth generally feel less pain.
CNN: What can be done to help with the pain of a medical abortion?
Brute man: There are definitely things that can be used to help with pain. Research has shown that ibuprofen It is better than acetaminophen for treating medical abortion pain. We typically recommend people take 600 milligrams about every six hours, as needed.
Some people take tramadol, a narcotic pain reliever, or vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found that medications such as tramadol can be helpful if taken prophylactically before pain begins.
Another successful regimen we studied combined ibuprofen with an anti-nausea medication called metoclopramide that also helped with pain. In addition to ibuprofen, these medications require a prescription.
Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medical abortion. It works through pads placed on the abdomen that stimulate the nerves with mild electrical discharges, thus interfering with pain signals. That's something people could get without a prescription.
Pain can be an overlooked issue in medication abortion because, honestly, as doctors, we are not there with patients when they are at home going through this. But as we dig deeper into people's experiences with medical abortion, it's becoming pretty clear that pain management is really important. I think we need to do a better job of treating pain and making these options available to patients.
CNN: Are there health conditions that make the use of a medical abortion unwise?
Brute man: Undergoing a medical abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside the uterus. It is rare, occurring in about 2 out of every
People who have previously had pelvic, fallopian tube, or abdominal surgery are at increased risk for an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can increase the risk, as can smoking, a history of infertility, and the use of infertility treatments such as in vitro fertilization.
If a person takes blood thinners or blood thinners or has a bleeding disorder, a medical abortion is not recommended. Long-term use of steroids is another contraindication to the use of the abortion pill.
Anyone who uses an intrauterine device, or IUD, should remove it before taking mifepristone because it may be partially expelled during the process, which can be painful.
People with chronic adrenal insufficiency or who have inherited a rare disorder called porphyria are not good candidates.
CNN: Are there any signs of problems a woman should watch for after undergoing a medical abortion?
Brute man: It may be common to have a low-grade fever in the first few hours after taking misoprostol, the second medication in a medication abortion. If someone has a low fever (100.4 degrees to 101 degrees Fahrenheit) that lasts more than four hours, or has a high fever of more than 101 degrees Fahrenheit after taking medications, they need to be evaluated by a healthcare provider.
One should also evaluate for heavy bleeding, which would be soaking two or more full-size thick sanitary pads per hour for two consecutive hours, or a foul-smelling vaginal discharge.
One of the warning signs of an ectopic pregnancy is severe pelvic pain, especially on one side of the abdomen. The pain may also radiate to the back. Another sign is becoming dizzy or fainting, which could indicate internal bleeding. These are all very rare complications, but it is advisable to be vigilant.
We generally recommend that someone undergoing a medication abortion have someone with them for the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can be surrounded by their partner, family, or friends.
Most people know that the abortion is complete because they stop feeling pregnant and symptoms such as nausea and breast tenderness disappear, usually within a week of pregnancy. A home urine pregnancy test can remain positive even four or five weeks after a successful medical abortion, simply because it takes that long for the pregnancy hormone to disappear from the bloodstream.
If someone still feels pregnant, is not sure if the pregnancy passes completely or has a positive pregnancy test five
People should know that they can ovulate as early as two weeks after a medical abortion. Most contraceptive options can be started immediately after a medical abortion.
