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When a woman chooses to end a pregnancy, the procedure is called an elective abortion.

The unborn child may be removed from the uterus by means of an elective surgical abortion or an elective medical abortion. A medical abortion is done by giving the woman medicines that will end the pregnancy.

Who is a candidate for the procedure?

Any woman who chooses to end a pregnancy for health or personal reasons is a candidate for an elective abortion. Abortions are legal in the United States during the first 12 weeks of pregnancy. After that, abortion is regulated by each state.

How is the procedure performed?

Before an abortion is done, a healthcare professional must confirm that a woman is pregnant. The length of a pregnancy will be measured either by noting the number of days that have passed since the first day of her last menstrual period, known as the LMP, or by an ultrasound. A medical abortion can be done as soon as the pregnancy is confirmed.

Because medical abortions do not work as well later in pregnancy, they are not generally used beyond 7 weeks after the last menstrual period. Thus, it is important to establish the exact stage of the pregnancy using an ultrasound examination. After 7 weeks, an elective surgical abortion must be used.

Medicines used for a medical abortion include:

• methotrexate (i.e., Rheumatrex, Trexall) , a medicine approved by the U.S. Food and Drug Administration (FDA), for cancer treatment. Methotrexate is most often given as a shot, but it also can be taken by mouth. Methotrexate, when taken during the first few weeks after conception, stops the embryo from growing in the uterus.
• mifepristone (i.e., Mifeprex), known as RU-486, has been approved by the FDA for medical abortions. Mifepristone works by blocking the female hormone progesterone. As a result, the lining of the uterus breaks down and is passed out of the uterus, along with the unborn child, through the cervix.
• misoprostol (i.e., Cytotec), which is taken a few days after the woman takes either methotrexate or mifepristone. Misoprostol is given by tablets that are either swallowed or inserted into the vagina. It causes the uterus to contract and expel the unborn child through the vagina.

To prepare for an abortion, a pelvic exam is done to confirm the size of the uterus. Lab studies will rule out anemia, determine the woman's Rh factor, and screen for sexually transmitted infections. The woman should be taught what to expect during and after the procedure, and psychological support should be given as needed.

What happens right after the procedure?

A medical abortion can take from 3 days to 3 to 4 weeks. After the first medicine (methotrexate or mifepristone) is given for a medical abortion, the woman can go home. Some women will have vaginal bleeding after the first medicine. The bleeding can range from light to heavy.

The woman should return to the doctor for a second visit to take the misoprostol. The uterine cramping caused by this medicine might result in the unborn baby being expelled right away while at the doctor's office. In other cases, the abortion occurs later at home. Many women will have cramps for several hours and pass blood clots as they are aborting.

Most of these symptoms should start to taper off after the abortion occurs. Bleeding can last for 1 or 2 weeks more. Headache, nausea, vomiting, and diarrhea can also be caused by misoprostol. Finally, a third visit will be made so that the doctor can check to be sure that the abortion was complete. Of the women who take methotrexate, 80% to 85% will abort within 2 weeks.

A woman who takes longer may need more misoprostol. With mifepristone, 95% to 97% of the women will expel the unborn child and placenta within 2 weeks. About 5% of the women who choose to have an elective medical abortion require a surgical abortion because the medicine does not work.

After any abortion, a woman with Rh negative blood should be given an injection of Rh immune globulin unless the father is also known to have Rh negative blood. Pain medicines may also be prescribed. Sometimes antibiotics are needed to help prevent infection.

What happens later at home?

Once she is home, a woman should:

• call the healthcare professional if there are any new or worsening symptoms, such as fever, severe or lasting abdominal distress, or heavy vaginal bleeding
• be aware of the possible emotional effects of abortion. Some women have depression similar to postpartum depression after an abortion. Some may experience guilt, or anger at an individual who may have influenced her to have the abortion. Other women may experience anxiety, depression or other mental health issues after an abortion. These issues may persist for months or years and require sensitive counseling.
• avoid using tampons or having sex for at least 2 weeks
• slowly resume daily activity as she is able

If a woman has no physical problems after the abortion, it is likely that she will be able to get pregnant again later. A follow-up visit with a healthcare professional should include a pelvic exam to be sure the uterus shrinks in size. This office visit is also a good time for a woman and her healthcare professional to discuss birth control, so she can choose a method that will work well for her.

What are the potential complications after the procedure?

Any type of abortion can cause heavy bleeding that might require a D&C or blood transfusion. Use of RU-486 in conjunction with misoprostol has been linked to possible increased risk for septic abortion and death. Long-term complications have not been linked with the medicines used for medical abortion.