Medication Abortions with Mifepristone
What will happen at the clinic?
Your first visit may last as long as 3 hours. You need to come in to our office at least twice and possibly 3 times to be sure everything is safe, and worked well.
On the first appointment, you will fill out some forms and we will collect a urine sample. You will then see the doctor, have a vaginal ultrasound and see a counselor to review the procedure. We will do some blood work (finger poke) and give you a package of medications to take home with you.
If the doctor has been unable to see anything on the ultrasound you may need to go to the lab for an extra blood test and we will have to book you to come back the next day.
When and where does the abortion actually happen?
You will take the mifepristone when you are ready. 24 – 48 hours after taking the mifepristone, you will insert misoprostol tablets into your cheeks or into your vagina. The misoprostol tablets make the uterus cramp, you should bleed heavier than a period and the pregnancy will come out. You may experience some side effects from the medication. This only happens to a small percentage of patients and usually goes away within a few hours.
How well do the drugs work?
95% of patients will be done after taking the misoprostol. This will be confirmed at your follow up visit in one week. If the abortion is not complete you may be given more medications and asked to return in another week.
About 0.5% of abortions with mifepristone fail and require surgery because the pregnancy is still growing. About 2% of patients request surgery because they don’t want to wait for the bleeding to start (a delayed reaction).
What about side effects?
There are few side effects from the mifepristone. After the misoprostol you can expect bleeding, cramping and some patients get flu-like symptoms such as nausea, diarrhea, headache, fever and chills. Many patients have few or no side effects.
What are the costs?
If you have BC medical (MSP), your office visits for the medication abortion is covered in British Columbia. The cost for the Mifepristone is also covered by the government. There will be a fee of $25.00 to cover the cost of the pain medications we will give you and in office blood testing if required. If you do not have BC medical the cost is $400.00 for the office visits and $325.00 for the medications.
There may also be extra fees (for example, for lab tests when necessary). We accept out of province medical (except Quebec) for the office visits but the cost of the medication will not be covered. The fee for the medication will be $325.00.
If you live more than 2 hours away from us, please check our medication abortion at a distance page.
How can we know if the abortion is completed?
Your follow up visit will be about a week later and will last about 15-20 minutes. For most patients, this will be their last visit. If the ultrasound shows that there is still tissue left in your uterus, you may be given more misoprostol and asked to return to our office for another ultrasound.
This is called a delayed reaction and we will watch your progress until the ultrasound shows an empty uterus.
If it is difficult for you to come back to our clinic, we can follow the progress of the abortion with blood tests instead of ultrasounds and arrange skype/facetime follow up visits.
What if it doesn’t work?
In about 1% of patients this procedure will not work and a surgical abortion will be required. We will make the arrangements for you at a local clinic. Another 2% of patients choose surgery because they are having delayed reactions to the medication and don’t want to wait. Less than 1% have complications such as infection or serious bleeding.
What are the possible complications?
Mifepristone and misoprostol have been formally studied and used safely. The risk of excessive bleeding or serious infection is very low. Rarely, patients may be allergic to the medications.
Are there emotional issues specific to this method?
Some patients are anxious waiting for the abortion process to complete. Viewing the pregnancy tissue can also be difficult for some.
What are the advantages of Medication Abortions?
Effective and safe for very early pregnancies. Avoids anesthesia, instruments or vacuum aspiration, unless it fails (however, blood work and a vaginal ultrasound are required. An injection may also be needed if your blood type is RH negative). Induces a miscarriage-like process, so if you need someone in your life to think it is a miscarriage, this may be the best option. Being at home instead of a clinic during the actual abortion may seem more comfortable and private.
What are the disadvantages of this method?
It is not completely predictable – there is more uncertainty about when you will bleed and pass the pregnancy. Bleeding can be heavy and last longer than with a surgical abortion. Cramping can be strong and last longer than with the surgical abortion. At least two visits are required, sometimes more. Failure rate is higher than with surgical abortion.
Who should not use this method?
If it is more than 10 weeks from your last period, you are on blood thinners, have an allergy to the medications, blood clotting problems, porphyria, severe anemia or uncontrolled seizures.
Are there any long term effects?
The medications leave your body within one week and will not affect future pregnancies or general health.