A medical abortion uses drugs to empty the contents of the uterus. Medical abortions can be done only early in pregnancy. There are two drug combinations used to cause abortions:
1. methotrexate and misoprostol
2. mifepristone (RU 486) and misoprostol
Only the first combination is currently available in Canada. The second combination mifepristone (RU 486) and misoprostol is not currently approved for sale in Canada.
Methotrexate is a drug used to treat psoriasis, and cancer. It also stops the growth of the pregnancy when given to a woman very early in pregnancy. Methotrexate is usually given by injection.
Misoprostol is a drug used to treat stomach ulcers. It causes the muscles of the uterus to contract, pushing out the contents. Tablets of misoprostol are placed in the vagina five to seven days after the methotrexate injection is given. In most cases the uterus will be emptied within 24 hours, but in about 35 percent of cases, it can take several days or weeks. Pain medication is used to ease the pain of the cramps, which occur when the pregnancy tissue comes out of the uterus.
The drugs that induce medical abortions cause birth defects. A woman who takes these drugs must be prepared to have a surgical abortion if the medical abortion is unsuccessful. A follow-up exam is done one or two weeks after the methotrexate injection to make sure that the abortion has happened.
When is the procedure done?
Most places will only do a medical abortion using methotrexate and misoprostol up to seven weeks or six weeks and six days by ultrasound. Where the mifepristone and misoprostol combination is available, it may be used slightly longer, up to nine weeks after your last period.
Advantages
- avoids surgery and the risk of damage to the uterus with surgical instruments
- can be done early before signs of pregnancy occur
- may feel less invasive than surgery
- may seem more private to some women since much of the procedure can occur at home
Disadvantages
- takes place over a week or more and involves several visits to the doctor
- ten percent risk that the procedure will be incomplete and a surgical abortion will need to be done
- sometimes causes heavy bleeding
- the drugs may have unpleasant side effects including nausea, diarrhea, abdominal cramping or pain, vomiting, hot flashes
