Types of abortion

There are two types of abortion procedures: medical and surgical abortion

There are two types of abortion procedures: medical and surgical abortion. Medica abortion is when you take tablets to have an abortion. A surgical abortion is when you have a surgical procedure to remove the contents of your womb. For each person, the preferred or most effective method for abortion will be different, depending on a range of circumstances, including your stage of pregnancy.

Medical abortion

In South Africa, medical abortion is generally available up until 10 weeks after your last period. In some settings, doctors provide medical abortions until 13 weeks, or even up until 18 weeks after your last period, depending on different provincial and hospital protocols. 

Medical abortion requires the use of two drugs: mifepristone and misoprostol. Mifepristone is an antiprogestin taken orally.  It blocks receptors of the hormone progesterone. As a result, the lining of the uterus can no longer sustain the growing embryo. The drug also increases prostaglandin levels and dilates the cervix, facilitating abortion. Misoprostol is a prostaglandin analog that is marketed worldwide in over 60 countries for treatment and prevention of gastric ulcers. It is widely used “off-label” for a number of reproductive health indications.

One tablet of mifepristone is swallowed first, causing the embryo to stop growing. Two days later, you take misoprostol, causing contractions of the uterus and expelling its contents. The timing, dose, and route of administration of misoprostol often vary slightly. Studies have shown that these drugs effectively terminate more than 9 out of 10 pregnancies in the early first trimester.

The drugs that induce medical abortions cause birth defects. A person 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 to make sure that the abortion has been effective.

  • You have a confirmed pregnancy
  • The first day of your period was up to 56 days ago
  • You are willing to have a surgical abortion if the medical abortion does not work
  • You are willing to return to the clinic 10 – 14 days later for a follow – up visit.

Yes! There are a few circumstances when medical abortion should not be used. The doctor or nurse will advise you if there is a reason why you cannot choose this option.

  • You have an Ectopic pregnancy (a pregnancy which lies outside the uterus)
  • Your adrenal glands do not function normally
  • You are on long-term corticosteriods (eg. for the long – term treatment of asthma), you are taking blood-thinning medication, or have a history of a bleeding disorder.
  • You are allergic to any of the components of the medication.
  • You have severe, uncontrolled asthma.
  • You have a disease called porphyria.
  • You have an intra-uterine contraceptive device (IUCD) in your uterus
  • You have serious cardiovascular problems or severe high blood pressure
  • You cannot return for a follow-up visit to the clinic 14 days after the medical abortion has taken place
  • You cannot get to an emergency medical clinic / hospital during the treatment (in case of emergency)

Medical abortion is extremely safe. The medicines used in medical abortions have been widely studied and have been used by millions of pregnant people in other countries for the past ten years. The South African Medicines Control Council also approves them. Of every 100 pregnant people who have a medical abortion, 1 will have very heavy bleeding that does not stop and requires a surgical abortion.

Medical abortion is successful in about 95% of cases. This means that out of every 100 pregnant people taking both of the medicines for a medical abortion, about 5 will not have a complete abortion. In this case, a surgical abortion will need to be done to complete the process. Surgical abortion usually involves removing the pregnancy by suction. Once a medical abortion has started, it needs to be completed, because of the damage to the foetus.

Step 1: At the clinic

When you come to the clinic, the doctor or nurse will explain the process and answer questions. After your medical history has been reviewed and you have been examined, and a pregnancy test and a sonar has been performed, you will be given the first medicine to be swallowed at the clinic. You may experience some cramps and bleeding in the days after taking the first medicine, but very few people will have a complete abortion before taking the second medicine.

Step 2: Two days later, at home

Unless the doctor or nurse says that the abortion is complete, two days after your visit to the clinic, you will place 2 to 4 tablets of the second medicine under your tongue at home. This is usually done in the morning before you have had anything to eat or drink. Within two hours, you can have breakfast and something to drink. You should then take pain medication, because you will probably start to experience strong cramps and bleeding. The bleeding can be heavier than an ordinary period. 

You can expect to bleed or spot for about two weeks after taking the tables. You may also see blood clots and tissue coming from the uterus. This is an expected part of ending the pregnancy. The heaviest bleeding will happen while the abortion occurs, usually within the first 6 hours after taking the second medicine.

Step 3: 10-14 days later, follow-up visit to the clinic

The medicine causes bleeding and cramping. These symptoms mean that the treatment is working. However, sometimes you can get cramping and bleeding and still be pregnant. This is why it is very important to return to the clinic 10 – 14 days after taking the first medicine to make sure that the pregnancy has ended. If you are still pregnant after taking the medicine, you will have a surgical procedure to end the process.

Read more about what to expect when having an abortion here!

What are the possible side effects of a medical abortion?

Bleeding and cramping are a normal part of the process and show that the medicines are working. Cramps generally last a few days. Bleeding is heavier at first but some bleeding or spotting may continue for as long as 12 days.

You may also experience some nausea, vomiting and diarrhoea on the days that you take the medicines.

Occasionally, some people also experience headaches, dizziness, chills or fever. These symptoms usually last a short time and can be reduced by taking pain medicines or anti-nausea medicines.

Can I go to work after taking the medicine? How should I prepare for taking the second set of tablets?

On the day you take the second set of tablets, it would be best for you to take the day off if you can. Let your work know you will be taking sick leave that day. Ideally, prepare to make sure you are in a safe place on the day you take the second set of tablets, close to a flushing toilet and your comforts. In preparation, make sure you have stocked up on sanitary pads, and have with you anything that makes you feel comforted, such as a hot water bottle, your favourite snacks, and pain medication. You should expel the foetal sac that day. Snuggle in bed with a hot water bottle, take your pain medication, and change your pad regularly.

The following day you can go back to work, but do continue to care for yourself, changing your pads, and taking pain medication if needed.

Surgical abortion

Surgical abortion by vacuum aspiration or dilatation and curettage has been the method of choice for early pregnancy termination since the 1960s. Medical abortion became an alternative method of first trimester pregnancy termination with the availability of prostaglandins in the early 1970s and anti-progesterones in the 1980s.

Manual vacuum aspiration (MVA) is a safe and effective method of uterine evacuation that involves the use of a hand-held plastic aspirator. The aspirator provides a vacuum source attached to a cannula (thin tube), and is manually activated to suction the contents of the uterus. 

Electric vacuum aspiration involves the use of an electric pump or suction machine connected via flexible tubing to a plastic or metal cannula. It typically is used in centralised settings with higher caseloads, and is less appropriate for settings with intermittent electrical supply.

Dilatation and evacuation or dilatation and curettage are methods used after 15 weeks. This method might be used if some products of conception have been retained following an earlier MVA, or if the procedure is done in a very late stage of pregnancy.

Read more about what to expect when having an abortion here!