The main points
- Medication abortion offers a safe, reliable and non-surgical means of abortion.
- Mifepristone (RU486) is an oral medication that is taken to end a pregnancy by blocking the action of the hormone progesterone.
- Mifepristone is not suitable for all women seeking abortion.
Medication (non-surgical) abortion, also known as the abortion pill, offers an alternative to surgery for women in the early weeks of pregnancy. The most well-known method of medication abortion uses mifepristone in combination with another drug, misoprostol, to end a pregnancy up to nine weeks. Mifepristone is also known as RU486 or the ‘abortion pill’.
Medication abortion is a low-risk, non-invasive way to terminate (end) a pregnancy. The success rate is up to 98 per cent, which is only slightly lower than the rate for surgical abortion. In some countries, mifepristone is also used to treat a range of medical conditions,
including endometriosis and cancer of the uterus (womb).
Preparing for a medication abortion
Medication abortion involves using medication instead of surgery to end a pregnancy. It can be done as soon as pregnancy is detected and the pregnancy can be seen in an ultrasound. In Australia, a medication abortion can be performed up to nine weeks of pregnancy. Before you can have a medication abortion, you will need to:
- have an ultrasound to check the stage of your pregnancy
- talk with a nurse, doctor or counsellor
- see a doctor, who will also ask you about your medical history.
The most well-known and effective form of medication abortion uses mifepristone.
Medication abortion procedure
A pregnancy needs high levels of the hormone progesterone to continue. Mifepristone works by blocking the action of progesterone to cause a miscarriage early in the pregnancy. If there are no medical reasons that would make a surgical abortion a safer option and you decide to have the procedure, you will be asked to sign a consent form. You will then:
- take a tablet of mifepristone at the clinic and then go home
- 36 to 48 hours later, take the second dose of tablets (this dose contains the drug misoprostol, which softens the cervix and helps the uterus push out the pregnancy)
- experience a miscarriage of your pregnancy between one and 24 hours later.
You will then:
- go back to the clinic in two weeks for a follow-up appointment to make sure the pregnancy has ended (this may involve having blood tests or an ultrasound)
- have telephone contact with the clinic if needed in case you have any questions or concerns.
What to expect after a medication abortion
After you have taken mifepristone, you may experience nausea for a short time and light vaginal bleeding. After you have taken misoprostol, you may experience nausea, vomiting, headache, diarrhoea and chills. You may also have heavy bleeding and cramps that may be heavier and more painful than a normal period, usually beginning within four hours. The most severe symptoms usually settle within a few hours once the abortion is complete.
Follow-up after a medication abortion
You will need to have a follow-up appointment with your doctor or healthcare professional to confirm the pregnancy has ended. At this appointment, you may have an ultrasound (and possibly a blood test) to make sure the termination is complete. In about two per cent of cases, the abortion is not complete and a surgical termination is needed.
Self-care at home
You should take care of yourself in the 48 hours after having the procedure by following the advice of your doctor or healthcare professional. This can include:
- using over-the-counter anti-inflammatory medication to help manage the cramps (your doctor can prescribe stronger medication if needed)
- not smoking, drinking alcohol or using illicit drugs.
To lessen the risk of infection during the week after having the procedure, you should not:
- insert anything into the vagina, including tampons (do not use tampons until your next period)
- have vaginal sex
- perform any strenuous activity, including sport or heavy physical work, until the bleeding stops
- go swimming or have a bath (you can shower).
Some women should not take mifepristone
Mifepristone is not recommended for all women and may not be suitable for you if you:
- have certain medical conditions such as bleeding problems, adrenal failure or high blood pressure
- are taking long-term steroid or blood-thinning medication
- have an ectopic (tubal) pregnancy
- are more than nine weeks pregnant
- have had allergic reactions to medication containing mifepristone
- are fitted with an intrauterine device (the device needs to be removed before taking mifepristone).
Advantages of medication abortion
The World Health Organization (WHO) believes mifepristone is an important treatment that should be made available to all women. Advantages of taking mifepristone include that:
- For at least 95 per cent of women up to nine weeks gestation, taking mifepristone with misoprostol results in complete abortion within a few hours.
- Unlike surgical abortion, medication abortion does not need a surgeon, making it a suitable alternative for women living in remote areas.
- The risk of maternal death is extremely low.
- Some women who have used mifepristone have said the procedure is less clinical and stressful than surgical abortion.
- The abortion happens at home.
- Anaesthesia is not needed.
Disadvantages of medication abortion
Disadvantages of taking mifepristone include that:
- You may have a lot of bleeding, which could mean you need to have a surgical abortion or, in rare cases, a blood transfusion.
- You may get an infection, but this is uncommon and can usually be treated with antibiotics.
- The procedure fails in around two per cent of women, who may then need a follow-up surgical abortion.
- Though rare, mifepristone can take days to work, whereas a surgical abortion only takes about 15 minutes.
If you have a booking for a Medication Abortion at Family Planning Victoria, please refer to our Patient Information Medication Abortion information sheet.