Early Medical Abortion | Abortion by Pill (3 to 24 weeks)
There are many names that are used to suggest what a Medical Abortion is. Some names used are Abortion Pill, Abortion by Pill, Early Non-Surgical, Chemical or Instrument-Free Abortion.
The US FDA approved the first and only medication indicated to terminate pregnancies in the year 2000.
The Abortion Pill is the combination of two medications to end a pregnancy:
1) Mifepristone (RU 486, Mifeprex, Mifegyne, French Pill) and 2) Misoprostol (Cytotec).
Approximately 39% of the abortions performed in the US were Medical Chemical Abortion procedures.
The Medical Chemical Abortion process is highly effective and safe. Serious complications and side effects requiring hospitalizations or surgery is rare.
Maternal death occurs 11 to 14 times more often in women who deliver a term pregnancy than undergoing a chemical abortion procedure.
How Does The Abortion Pill Work?
It blocks the hormone Progesterone from attaching to its receptors on the Uterus (womb). Progesterone is responsible for maintaining the growth of the pregnancy and Uterine Quiescence (no contractions)
When the Progesterone hormone is blocked or unable to be during pregnancy the following occurs:
- The lining of the Uterine wall begins to separate which reduces the nutritional and oxygen supply to the fetus
- Local prostaglandins are produced by cells lining the wall of the Uterus that in turn causes contractions
- The cervix (opening at the lower part of the Uterus) begins to soften and dilate (open).
- The pressure inside of the Uterus rises and contractions begin.
Essentially how Mifepristone works is to cause the fetus to separate from the wall of the Uterus.
Misoprostol is a Prostaglandin E1 tablet that causes contractions of the Uterus. This leads to bleeding and the fetus being expelled through the Vagina.
How Far Along In Pregnancy Can The Medical Chemical Abortion Procedure Be Performed?
The FDA has approved the “on label” usage of the Abortion Pill Procedure up to 11 weeks from a woman’s last menstrual period (LMP).
There is extensive medical data and studies around the world where millions of women under medical supervision have terminated their pregnancies in the first trimester (3 to 14 weeks), second trimester (14.1 to 28 weeks) and third trimester of pregnancy (28.1 or further).
It is possible up to 4, 5, 6 or 7 months or further to undergo a medical chemical abortion process.
In essence; there is not a upper gestational age limit or cut off in performing the Abortion Pill Procedure if medically indicated or in countries that have no elective upper limit for termination of pregnancy (Canada, Vietnam, North Korea, China).
Historical Perspective Of The Medical Chemical Abortion:
Medical Chemical Abortion Using Methotrexate:
- FDA approved in the 1950’s to treat many forms of cancer(oral, breast, colon, choriocarcinoma), arthritis.
- Noted to cause early miscarriages and severe fetal abnormalities
- 1990’s- Developed Indications for treating ectopic pregnancies
- Late 90’s – Use of Methotrexate alone noted to terminate pregnancies alone in nearly 100% of cases in patients 6 weeks or less. Normally takes 4 weeks before bleeding begins and process is completed by day 35 to 40.
- Combination of Methotrexate and Misoprostol found to terminate pregnancies up to 9 weeks in 88 to 95% of women.
Between the early 90’s to Sept. 2000, the medical chemical abortion procedure could only be performed using Methotrexate and Cytotec in the US.
How Does Methotrexate Work To Cause A Medical Chemical Abortion?
Methotrexate stops the growth specialized placental cells called Cytotrophoblasts. The Cytotrophoblast are responsible for producing a specialized cell called the syncytiotrophoblast. These cells are responsible for producing the hormone HCG. When Methotrexate destroys those cells, the placental tissue is no longer has the ability to spread and grow.
Methotrexate stops the growth of the placenta. Mifepristone causes the fetus to separate from the wall of the Uterus.
The combination of Methotrexate and Misoprostol is still used in the US to terminate first trimester abortions by Physicians and medical personnel who have the knowledge and experience in using it.
Why Do Most Physicians And Clinics Who Perform The Medical Abortion Procedure Do Not Use Methotrexate?
- The Physician has no experience
- The Methotrexate is not FDA approved for termination of pregnancy. Many medications are used “off label” for other indications than what they were FDA approved for
- The combination of Methotrexate and Misoprostol is less effective at ending pregnancy (88 to 94%; 9 weeks or less) compared to Mifepristone and Misoprostol (92 to 98%; 9weeks or less)
It is that small difference in success rate that encourages Physicians and medical facilities to primarily make the decision not to offer Methotrexate and Misoprostol to patients
Physicians with years of experience are able to get nearly a 100% success rate using either combined method with minimal to no complications, hospitalizations, infections, blood transfusions or maternal death.
The term “Abortion Pill” has become synonymous with using only the combined method of Mifepristone and Misoprostol. In order for women to be fully informed, the combination of Methotrexate and Misoprostol should be discussed.
There are times when Mifepristone cannot be used and Methotrexate possibly substituted under the following circumstances:
- Chronic steroid usage
- Allergic to Mifepristone
- Unable to swallow a pill or present with continuous nausea and vomiting and unable to swallow a pill
- Methotrexate is injectable
Discovery of Mifepristone:
Mifepristone was discovered in a lab in France in the 1970’s. The Researchers were trying to find a drug that could be used to treat Cushing’s Disease. Particularly the elevated blood glucose that occurs in Patients.
It was discovered to have anti-Progesterone effects and causes miscarriages. It was eventually approved in France, Norway and other Norwegian Countries for first trimester termination of pregnancy in the late 80’s.
Over 90% of abortions in France, Norway and Norwegian countries use the Medical Abortion process.
Approximate 42 to 45 percent of abortions performed at 8 weeks or less are performed using the Medical Chemical Method.
Our Women’s Center’s Experience Using The Medical Chemical Abortions:
The founder of the Orlando Women’s Centers has been performing the medical chemical abortion procedure since 1991. It would be hard to find anyone with that many years of clinical experience in the U.S. or around the World.
The Physicians and medical staff at our Abortion Clinics in Orlando, Tampa and Ft. Lauderdale have been trained in the latest and up-to-date techniques of the medical chemical abortion procedure and how to apply them in everyday clinical practice.
We have been performing the medical abortion procedure in the early second trimester (14.1 to 16.3 weeks) and late second trimester (from 16.5 to 24 weeks) since 1995.
Second Trimester Abortion Procedures at first were performed with Misoprostol alone. With FDA approval of Mifepristone in 2000, we began using the combination. With doing so, the following occurred:
- Reduced Induction to Delivery Time (start to completion shortened)
- Surgical Instrumentation rarely needed due to less retained pregnancy tissue after delivery
- Less medication side effects due to less amount of dosage required to terminate a pregnancy
We are able to perform the medical abortion procedure in 24 hours or less in 99% of cases in a highly effective, efficient and safe manner. Surgery is not required in over 99% of the time.
For patients who wish to have the chemical medical abortion (Abortion Pill) procedure performed and past 11 weeks from their last period, please know that we are able to perform this service and provide the care you deserve.
Women come from all over the country and throughout the world to have our one day early, first trimester, second trimester and late term abortion pill procedure performed.
First Trimester Medical Chemical Abortions (3 to 11 weeks)
There are two options for performing the early medical abortion for women who are generally no more than 11 weeks pregnant.
Methods Used To Perform The Medical Chemical Abortion:
1) First Option:
During the first appointment you will receive the Mifepristone tablet by mouth or Methotrexate which can be taken by injection or by mouth.
Either simultaneously in the medical office, or 12, 36, 48 or 72 hours later in the privacy of your own home, you will insert Cytotec (Misoprostol) tablets into your vagina, take orally (swallow), placed between the cheek and gum (buccally) or underneath the tongue (sublingually).
Cytotec (Misoprostol) tablets can be taken later than 72 hours if one’s schedule does not permit the tablets to be used before then. When used in combination, there is a 90 to nearly 100% rate of success.
The success rate decreases with the further number of gestational weeks. There is nearly a 99.9% success rate for patients 6 weeks or less from their last menstrual period.
2) Second Option:
Same Day (One Day):
There is less than a 1% chance for surgical instruments to be required. Less complications and side effects have been found with our same day option and as a result more women prefer this shortened abortion pill procedure because it eliminates the potential for a longer drawn out process.
There are no other facilities in the State of Florida or the U.S. with the vast knowledge and experience regarding the medical chemical abortion method. The techniques used are highly efficient, effective and safe.
Are The Abortion Pills Able To Be Purchased Over-The-Counter?
Abortion Pills are not able to be purchased over-the-counter in the US. A prescription cannot be written by the majority of Physicians or dispensed at Pharmacies (Walmart, CVS, Walgreens, etc.) This is due to tight Government controlled restrictions.
The only way to get Mifepristone legally in the US are the following:
- Family Planning Clinics that perform abortions
- A Private Physician office who meets certain criteria and has experience
- Hospitals (rare)
How To Find A Medical Chemical Abortion Facility:
One may go online and do a search for the keyword “medical chemical abortion”, “medical chemical abortion clinic”, “medical chemical abortion near me” or several other phrases used to describe the non-surgical medical abortion pill procedure.
Having reviewed the information on the business web pages, one can decide to contact the medical office facility over the phone, email or other means.
After the decision is made to contact the facility by phone then please proceed to do so. It is understandable for one to be afraid and have anxiety in making the phone call.
Most individuals who answer these phone calls are able to listen and care for women who are going through one of the most difficult in their lives.
If at any point during the conversation the woman is uncomfortable with the answers or the approach that is being used, then perhaps that is the wrong facility to go to.
Things to look for and take from the phone call should be the following:
- Hours of service
- Up to the number of weeks the medical chemical abortion procedure is performed
- Most facilities on go as far as 10 weeks but some may go to 13 to 15 weeks
- There are only a few that perform the procedure at 20 weeks or further.
- Medical Chemical Abortion or Surgical advantages and disadvantages can be discussed.
- Quite often the discussion of Twins or breastfeeding arises.
- Neither a twin pregnancy nor other multiple gestations is a contraindication to a medical abortion
- Breastfeeding is not a contraindication to a medical chemical abortion
- Appointment- Date and time
- Basic Instructions on what to wear and take to the appointment.
It is imperative that all questions are answered. Women should not feel rushed off the phone. Most women are afraid, scared and lack knowledge when it comes to this topic. It is extremely important to listen and care for all women who are going through one of the most difficult in their lives.
What occurs at the first visit?
At the first appointment, paper work is given that includes a medical history form to fill out to alert the staff and physician of any medical problems. This is very important to determine if you meet the criteria for undergoing the abortion using the non-surgical procedure method.
The abortion and birth control consent forms are also given for the patient to review.
Lab tests are performed (blood and urine to verify the pregnancy, check the blood count and determine your Rh factor.
Each patient will undergo counseling and the abortion procedure will be explained in detail. The risks, benefits and alternatives to the abortion procedure will be explained.
More importantly, it will be determined if having an abortion is the right thing for you at this time. The decision to have an abortion is one of the most difficult decisions a woman may have to make in her lifetime. The decision is based on age, family, religious, ethical, moral, financial, social, and personal values.
No one truly wants to have an abortion. The question is whether or not it’s the right time to become a mother.
A sonogram will be performed to determine the number of weeks of the pregnancy and to assure it is not an ectopic pregnancy (pregnancy that is outside the uterine cavity).
If an ectopic pregnancy is diagnosed, or there is suspicion of one, then the patient should be referred to the emergency room.
The Medical Chemical Abortion Pill Procedure is contraindicated in women who have an ectopic pregnancy. This is potentially a life threatening situation and must be treated as such.
If more than 10 weeks pregnant and the abortion facility does not perform the procedure any further, then the patient should find another facility that does and make the necessary arrangements to do so.
Prior to being discharged, the patient is given written discharge instructions regarding complications when to call the 24 hour emergency number. A medical staff person is always on call.
After the Physician goes over patient’s history, answers her questions and performs a medical exam she is given the chemical medical abortion pills to take.
What to Expect
Drugs and Doses:.
The first tablet (Mifepristone-200mg) is taken at the medical facility. Most women do not experience any side effects after taking Mifepristone but the following may occur:
- High or Low Blood Pressure
- Swelling around the eyelids
- Nausea and vomiting
- Jaw Pain
- Shortness of breath
- Chest and shoulder discomfort
- Lower back or Abdominal pain
- Cramps but no bleeding
- Little Bleeding
- Clear to yellow vaginal discharge
- 0.5 to 1% chance of miscarriage with taking Mifepristone alone
- Maternal Death -11 to 14 times less chance of dying than having term delivery. The chance of dying is similar to having a spontaneous miscarriage
Optional First Medication:
Methotrexate may be given by injection or taken orally. The benefits of Methotrexate are following:
- Nearly 100% success rate when given to patients who are 6 weeks or less
- Though not as effective as Mifepristone and Misoprostol between 7 and 9 weeks in the medical literature, the completion rate is still high (94 to 98% vs 88 to 96%). In experienced hands, both methods reach over 99% in terminating pregnancies from 3 to 9 weeks
- Women who are able to hold the tablets down due to Severe vomiting
- Patients who have adverse reaction to swallowing tablets
- Using Methotrexate for the chemical abortion is less expensive
Side Effects Of Methotrexate:
- Ringing in ears
- Mouth sores
- Facial skin rash due to sun exposure
- Burning with urination
- Lower abdominal discomfort
- Low white cell count and increase susceptibility to infection
- Liver or kidney failure in patients with chronic disease of either
The Second Medication (Misoprostol 200ug tablet -dosage and frequency vary) may be taken simultaneously or up to 96 hours after taking Mifepristone. The time variation comes down to time convenience and how quickly the patient wants to end the pregnancy.
The most common side effects and complications associated with Misoprostol are the following:
- Shivering, chills
- Mild rash
- Itchy palms
- Lower abdominal pain due to uterine cramping
- Little, light, moderate to heavy bleeding (bleeding more than two pads for 2 hours in a row.
- Low grade Temperature to consistent temp at 100.4
- Yeast infection
Less common but more significant side effects and suggest something has gone wrong may include the following:
Experience Of The Medical Chemical Abortion Process:
Most women do not experience any bleeding until after taking the Misoprostol. Once the Misoprostol is inserted, one can expect to experience lower abdominal cramping, with a range in bleeding from very light, to the same as a normal period. Some women experience very heavy vaginal bleeding but this is not common.
Nausea, vomiting, and diarrhea may occur. The bleeding and cramping can begin as soon as 15 minutes after taking the Misoprostol tablets.
The cramps usually become stronger and the bleeding heavier just prior to passing the pregnancy tissue and then both subside.
Most women miscarry within 30 minutes to 4 hours of taking the Misoprostol pills . Over 90% pass the pregnancy tissue in 24 hours or less.
How Much Pain Is Associated With The Medical Chemical Abortion Procedure?
Over 50% of women do not require pain medications. Approximately 40% of women only need over-the-counter medications (Tylenol, Ibuprofen, Advil) to control discomfort. Less than 8% of women require narcotics for pain control.
Does Having No Bleeding Or Cramping Always mean The Abortion Failed?
Women who are very early in their pregnancy (3 to 4 weeks) may not experience any bleeding or cramping.
Less than 0.5% of patients may abort and have no bleeding until the time of their first menses after taking the chemical abortion medication.
Duration Of Bleeding And Cramps Associated With Medical Chemical Abortion:
The vaginal bleeding and cramps normally lasts between between 6 to 14 days. Approximately 8% of patients have bleeding up to 30 days and 1% may have spotting and bleeding up to 60 days.
Experience of Medical Abortion Procedure In Patients 6 Weeks Or Less:
Generally the earlier in pregnancy the medical abortion procedure is performed, the higher the success rate, the pain and cramps experienced is less, there is less vaginal bleeding and the length of cramps and bleeding is shorter. It is not unusual to last only 3 to 5 days.
Thus one can see why having the medical abortion procedure at 6 weeks or less is always encouraged
Approximately 45 percent of abortions at 8 weeks or less are now performed using the medical abortion procedure. The experience that women have with the medical abortion procedure is overwhelmingly satisfactory. Over 90% would choose to have the procedure performed in the future if required.
Most women are able to return to school or their job the following day after taking the Misoprostol tablet.
Women who are 6 weeks are less normally feel well enough to return to their regular routine the same day. They may have sex the same day if they choose.
It is necessary for all patients to return in 3 to 4 weeks for a pregnancy test sonogram and possible pelvic exam to make sure that the medical abortion procedure was successful and complete.
A small percentage of patients may have an incomplete passage of tissue. For patients who are experiencing no pain or bleeding, only observation may be required. Repeating the Misoprostol dosage or the surgical procedure are options.
Upon returning and the patient is pregnant, a surgical dilation and curettage procedure may be suggested. Some facilities may charge an additional fee for this service.
Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications, such as continuous ot profuse blood loss. In rare cases a blood transfusion may be required.
Misoprostol has been associated with causing severe birth defects when taken in the first trimester of pregnancy. It may cause skull and upper and lower limb defects.
With the recent use of the non-surgical regimen to end the pregnancy, how long will the pregnancy test remain positive? Is there a possibility of still being pregnant?
A pregnancy test may remain positive up to 4 to 6 weeks after the procedure is complete in 3 to 6% of the patients.
Just a small amount of gestational tissue may produce the pregnancy hormone for that length of time. There may be no evidence of fetal or pregnancy tissue noted on the sonogram.
Side Effects and Risks Associated with RU486 (Mifegyne, Mifeprex, Mifepristone, French Pill), Non-Surgical, Chemical, Abortion Pill and Misoprostol (Cytotec)
Be sure to contact our office immediately if you have any of the following:
Failed Abortion- The pregnancy has continued. It may be viable (continues to grow) or non viable.
The failure rate is approximately .04 to 1%.
Suggestions of the abortion medications not working are no uterine or lower abdominal cramps, pain, bleeding or blood clots.
Women can elect to repeat the pill process vs electing to undergo the surgical aspiration procedure
Heavy Vaginal Bleeding;
Bleeding enough to soak through two, full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding.
Approximately 1 out of 150 to 200 women, require a surgical procedure (Surgical Abortion/D&C) to stop the Vaginal bleeding.
Blood Transfusion may be required 0.1 to 0.2% of the time due to the possibility of heavy or continuous vaginal bleeding.
Symptoms of hypovolemic shock (loss of large amount of blood) is a rapid heart rate (100 beats per minute), inability to sit, stand or walk, excessive weakness, sweating, dizziness and blurred vision.
Symptoms include continuous cramping, abdominal pain or discomfort, nausea, vomiting, diarrhea, passing blood clots, bleeding after 3 weeks, signs of infection that include uterine tenderness and low grade Temperature of 100.4 or greater for 24 or more not relieved with Tylenol, Morin or Ibuprofen should call the medical office immediately.
In the days after treatment, if you have a fever of 100.4F or higher that lasts for more than 24 hours, you should contact us immediately. Fever may be a symptom of a serious infection or other problem (including an ectopic pregnancy).
Long Term Side Effects and Risks:
Chronic Pelvic Pain: A rare percentage of patients who have a pelvic infection can develop chronic pelvic pain.
Pelvic Inflammatory Disease (PID): Pelvic Inflammatory Disease is commonly caused by untreated Gonorrhea, Chlamydia, Bacterial Vaginosis and other rare bacteria.
Infertility: 10 to 11% of patients who develop PID may become infertile. Over 33% of women who develop PID a second time have more than a 30% chance of becoming infertile.
In the past, abortions were thought to increase the chance of developing psychological problems in the long term. This is no longer thought to be the case. Patients who have no support or who have a history of psychological problems possess a higher chance of developing them after the abortion process is complete.
Maternal death is rare. It occurs in 1:100,000 abortions. It is 10 times safer to have an abortion than it is to have a full term vaginal delivery. Maternal death is due to a rare bacterium (Clostridium Sordellii) which migrates into the bloodstream and may lead to multiple organ failures and death.
Eligibility for Medical Abortion
- There is no limit in weeks of gestation to use the Abortion Pill Method. It can be performed from 3 to 24 weeks from your last menstrual period
- You must have reliable transportation and a support person to take you to the hospital or bring you back to our medical offices if necessary
- You must live no more than 2 hours away from the hospital or our medical offices
- You must be able to make the follow-up appointments (possibly 2 or more)
- You must agree to have a surgical procedure performed if the medical abortion fails
The Medical Abortion is contraindicated in patients with the following problems:
- Severe anemia
- Blood clotting problem or currently taking anticoagulant medication
- Possible ectopic pregnancy
- Have a mass in the tubes or ovaries or ectopic pregnancy (pregnancy outside the uterus)
- Inherited porphyria
- Intrauterine Device (Must be removed before having a medical abortion procedure)
- Unable to get emergency medical help in the 3 to 4weeks after taking the medications
- Allergy to Misoprostol or other prostaglandins, Mifeprex, or Methotrexate
Other Options For Early Abortion (3 to 6 weeks)
Early Abortion: Choosing Medical or Surgical
Because our Physicians are highly trained to perform the early abortion procedures surgically and medically, both are equally safe and effective.
More women are choosing the medical abortion method because they feel it is more natural and there are no instruments used in the procedure.
Most women are very satisfied with the outcome of either method.
Ovulation may occur as early as 5 days after the abortion process is complete.
When can I have sex?
With the medical abortion procedure, you can have sex at any time. For the early abortion procedure, (6 weeks or less) we suggest you wait 24 hours before having sex again.
Abortion Pill (RU486, Mifegyne, Mifeprex, Mifepristone), Cytotec (Misoprostol) Fees/Costs/Prices:
The cost of the Medical Chemical Abortion Procedure in the first trimester of pregnancy ranges from $0.00 to $2,000.00.
The cost of a second trimester abortion (14.1 to 24 weeks) using the Abortion Pill Procedure may range from $0.00 to $35,000.
The cost of the procedures can be significantly reduced for patients who meet our qualifications, or are able to receive money from private donors or non-profit organizations.
From time to time our Women’s Centers are able to provide the abortion pill procedure in the first trimester for free (no cost), with the exception of the fee required for the State mandatory Sonogram (Ultrasound).
As previously indicated, all Medical Chemical (Abortion Pill) Procedures (3 to 24 weeks) can be performed in 24 hours or less in 99% of cases with minimal to no complications. Surgery is not required in the majority of patients.
Please contact our office today to have your questions answered and to schedule an appointment.
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