Abortion pill: all you need to know about how it works

In theory, the abortion pill is the molecule used to terminate a pregnancy as part of a voluntary medical pregnancy termination (at home or in the hospital). However, in practice, we cannot reduce this protocol to a drug, because the success of the abortion (complete abortion without the need for surgery) is only possible thanks to a sequence of two molecules, namely:

• Mifepristone (or Mifégyne®) is the drug that will truly chemically block pregnancy. It is therefore he who could be considered strictly speaking as the main abortion pill. This synthetic steroid inhibits the action of progesterone, one of the main pregnancy hormones. It thus allows the detachment of the embryo, the dilation and the opening of the cervix;
• Misoprostol (or Gymiso®) is an analogue of prostaglandin, this hormone which promotes contractions at the end of pregnancy. Its role in medical abortion: to cause contractions and the expulsion of the embryo generally within 4 hours after taking it (in some cases later, up to three days after taking it).

These abortion pills are only indicated if you want to terminate a pregnancy by medication, up to

Note: until now, medical abortion was authorized up to 7 WA at home and treatment in hospital up to 9 WA. However, since April 2021, the Haute Autorité de Santé has recommended medical abortion “in town to be possible up to 9 weeks as well, due to the state of health emergency”. Do not hesitate, as such, to take stock with the health professional who follows you. He can advise you according to your case and the latest recommendations from health authorities.

Taking the abortion pill is part of a follow-up protocol in several stages:

• it begins with a first consultation with a health professional (city or hospital midwife or gynecologist), scheduled within 5 days of your call to make an appointment. This period is recommended by the HAS to ensure that the abortion is as simple and quick as possible. During this consultation, the practitioner will ensure give you all the necessary information about the procedure and what it may involve, in particular in the event of side effects. He will also tell you the (minimal) risks of continuing pregnancy and give you written documentation to promote your informed consent;
• define the progress of the pregnancy (or gestational age) by asking yourself a few questions and performing a physical examination. He may also recommend, if necessary, the performance of a pelvic ultrasound;
• offer you to do an information, support and listening interview (the psychosocial interview) with qualified professionals (psychologists, etc.). This interview is only mandatory if you are a minor, but do not hesitate to schedule it if you feel the need.

A second consultation is then scheduled to obtain your written consent, discuss your upcoming contraception and, on the advice of your practitioner, perform a possible screening for sexually transmitted infections such as chlamydia.

Note: there are no longer any legal reflection periods between these two consultations since the law to modernize our health system (JO January 27, 2016). The only constraint: you must respect a period of 48 hours of reflection, following your psychosocial interview, if you have decided to provide for it or if the law commits you to it.

After this consultation phase, the pills will be delivered to you either in the pharmacy (in case of teleconsultation), or by the practitioner. You will then have to take:

• a dose of mifepristone, usually in the presence of your doctor or midwife, who will recommend the appropriate dosage depending on the progress of the pregnancy. He / she will also prescribe analgesics in case of pain;
• a dose of misopostrol (in consultation or at home), within 24 to 48 hours after the first dose.

In addition, if you have a rhesus negative, your doctor may recommend treatment with anti-D immunoglobins to avoid any rhesus incompatibility. This injection (intravenous or intramuscular) must be done within 72 hours of the medical abortion.

The abortion pill is 95% effective, slightly less than the instrumental abortion method, which has a success rate of 99,7%. If the medical abortion fails, your practitioner will help you organize hospital care for endo-uterine aspiration. But again, be sure to reassure yourself: medical abortion is very effective and very rarely requires such consequences.

There are two types of side effects associated with taking abortion pills:

• Metrorrhagia (bleeding) may appear immediately after taking mifepristone, but are more generalized after taking prostaglandins (misopostrol). They can occur within 3 or 4 hours or up to several days later and can last for up to ten days. Sometimes impressive, this blood loss is normal. However, if you have excessive bleeding for more than 2 hours after taking this last molecule, it is recommended to consult an emergency room (number indicated by your practitioner during consultations prior to the abortion). The sign to watch out for: you must change your sanitary napkin (maximum size) every 30 minutes or more.
• Abdomino-pelvic pain: due to the contractions induced by the abortion pills, these pains (similar to menstruation pains, sometimes stronger) are almost systematic. They usually go away on their own after a few hours and are alleviated by taking painkillers. However, if your pain persists despite analgesics, be sure to consult your practitioner.

The abortion pill and emergency contraception have nothing in common and are used in very different situations. Thus, emergency contraception is intended to block ovulation as well as to modify cervical mucus to slow down the passage of sperm. Taking it, up to 72 hours after risky intercourse, aims to prevent pregnancy (no ovulation, no pregnancy).

However, be sure to keep in mind that the further the intake is away from the report, the less effective the contraception (95% within 24 hours, 48% within 48 to 72 hours)

On the contrary, the abortion pill is indicated when the pregnancy is already installed. Ovulation and fertilization have already taken place. The method is therefore not preventive, but rather curative.

Termination of pregnancy with pills

Dear women, remember that there is no 100% absence of the risk of complications with any method of abortion! The best alternative to abortion is the birth of a new life, this is an incomparable feeling of happiness and fullness of life!

But … if an unexpected pregnancy turned out to be unwanted, and the woman made an independent decision or together with her partner to terminate the pregnancy, then you should only contact qualified gynecologists.

Experienced doctors of the NARUS Medical Center perform artificial termination of pregnancy – medical abortion (abortion with pills).

Abortion is, unfortunately, one of the most common interventions in the practice of an obstetrician-gynecologist. Worldwide, approximately 46 million women have abortions every year. In those countries where abortion is not prohibited by law, this medical manipulation is safer for health, and the risk of complications is minimized. In places where abortion is illegal or of low quality and in violation of the necessary rules, women often resort to dangerous methods of terminating unwanted pregnancies, which are accompanied by a high rate of complications, detrimental consequences and even death.

There are two types of artificial termination of an unwanted pregnancy: mechanical (surgical abortion, vacuum aspiration, or mini-abortion) and pill abortion – hormonal (medical abortion, pharmaceutical abortion). With the mechanical method, the embryo is forcibly separated from the inner lining of the uterine cavity (endometrium), which can cause severe bleeding (sometimes even uterine perforation occurs) or infectious complications, which subsequently have to be treated for a long time, and in some cases therapy is unsuccessful.

Termination of pregnancy by changing the hormonal background is a medical abortion. With this exposure, under the influence of pharmacological agents (abortion pills), a significant hormonal shift occurs, resulting in the rejection of the products of conception (fetal egg) from the inner wall of the uterus. This is a much less traumatic way to get rid of a pregnancy than a mechanical abortion.

Medical abortion is a modern alternative to surgical intervention that allows you to terminate a pregnancy with the least possible consequences for a woman’s health.

Abortion with pills (medical abortion) is a method of terminating a pregnancy in the early stages (up to 6 weeks) – the procedure resembles the onset of a delayed menstruation. The ancestor of this method, the authors of the know-how are the French, so they often say “French tablets”.

Medical abortion is gaining increasing recognition and popularity among women of reproductive age. However, it should be borne in mind that artificial termination of pregnancy, carried out in any way, does not benefit health. Despite the apparent safety and simplicity of medical abortion, gynecologists warn that this manipulation can also pose a threat to women’s health.

Abortion pills – a way to artificially terminate an unwanted pregnancy at an early stage, no later than 6-7 weeks, without the use of surgical intervention. The maximum safety and effectiveness of this procedure is noted in terms of up to 4 weeks: at this point, the embryo does not yet have time to firmly attach to the endometrium, and besides, the hormonal restructuring of the female body, aimed at creating optimal conditions for bearing a child, is still minimal.

Most often, with the medical method of artificial termination of an unwanted pregnancy, abortion pills containing the pharmacological agent Mifepristone (Mifegin, Mifepristone, Mifolian, Mifeprex, Pencrofton) are used. It blocks the action of progesterone (this is the female sex hormone necessary for the successful development of pregnancy). With the sudden cessation of the influence of the female hormone progesterone, rejection of the endometrium (the mucous membrane lining the uterine cavity) occurs. Due to the high content of prostaglandins, the cervical canal opens, uterine contractions appear, pushing out the fetal egg. Sometimes these uterine contractions are not enough for an abortion to take place. If they need to be strengthened, since the contents of the uterine cavity are not rejected 2 days after the woman has taken mifepristone,

It should be borne in mind that medical abortion (abortion with pills) has both many advantages and a diverse range of various complications.

Benefits of medical abortion:

• its high efficiency and safety
• no need for surgery
• minimal chance of developing complications (minimal risk of ascending infections)
• virtually no damage to the uterine cavity
• rapid recovery of the menstrual-ovarian cycle (occurs after 1 month)
• Possibility of early termination of pregnancy
• the risk of infertility is minimized, which is why medical abortion is a particularly preferred method for young nulliparous women.

Complications and negative effects of medical abortion include:

• pain in the lower abdomen, nausea, vomiting, uterine bleeding, in some cases, the further development of pregnancy (when an incomplete abortion occurred). Sometimes allergic reactions, increased blood pressure, and other side effects are noted.

Medical abortion (abortion with pills) is carried out in 2 stages:

At the 1st stage of the pharmacotherapy , a drug is given that gradually causes detachment of the fetal egg within 36-48 hours. During this period, you can lead a normal life, with minor restrictions.

Stage 2   – directly pharmacological miscarriage, occurs every other day in the clinic under the supervision of a doctor and under ultrasound control.

An indispensable rule: the drug is taken only in the presence of a gynecologist in order to take appropriate measures in time in the event of any complications. After taking the drug, a woman should be under medical supervision for at least 2 hours. After 36-48 hours, you need to undergo an ultrasound.

8-14 days after medical abortion, a follow-up examination and ultrasound are required to establish the complete expulsion of the embryo from the uterine cavity!

And yet … we never forget that there is no 100% absence of the risk of complications with any method of abortion! The best alternative to abortion is the birth of a new life, this is an incomparable feeling of happiness and fullness of life!