Medical Abortion Services at CHOICES

A medical abortion (or what some call, "the abortion pill") is one that is brought about by taking medications that will end a pregnancy.

A medical abortion usually is done without surgery. Either of two medications, Methotrexate or Mifepristone (RU486), can be used for medical abortion. Each of these medications is taken together with another medication, Misoprostol, to induce an abortion.

The alternative is surgical abortion. Go to our First Trimester Abortion page for more information.

Determination of Length of Pregnancy

Before any abortion can be done, a medical professional must confirm that a woman is indeed pregnant and determine exactly how long she has been pregnant.

The length of a pregnancy is usually measured by the number of days that have passed since the first day of the woman's last menstrual period (abbreviated as LMP). Medical abortions can be performed as early as a pregnancy can be confirmed. In fact, the shorter the time that a woman has been pregnant, the better the medications will work. Because they do not work as well later in pregnancy, medical abortion is often not an option after nine weeks (or 63 days) LMP. After that, surgical abortion may be the safest and best option.

How the Medications Work

Methotrexate: Methotrexate has been used in the US since 1953, when it was approved by the FDA to treat certain types of cancer. Since that time, medical researchers have discovered other important uses for the drug. One of these uses is to end unintended pregnancies. Although the FDA did not consider methotrexate for this specific purpose, clinicians may prescribe (and are now prescribing) methotrexate for early abortion.

This medication is usually is given to a pregnant woman in the form of an injection, or shot, although it can be taken orally. Methotrexate stops the ongoing implantation process that occurs during the first several weeks after conception.

Mifepristone: Mifepristone, also called RU486, is a newer medication that was developed and tested specifically as an abortion inducing agent. It has been used by over 500,000 women in Europe and millions of women worldwide, especially in China.

Mifepristone is taken in the form of a pill. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy.

Misoprostol: A few days after taking either methotrexate or mifepristone, a second drug, misoprostol, is taken. Misoprostol tablets, can be taken orally or put into the vagina.

Methotrexate and Mifepristone work in different ways, and so they will have slightly different effects on a woman's body. One of our gynecologists can help a woman decide whether medically induced abortion is the right option for her, and which of the two drugs she should use.

How Long Do Medical Abortions Take?

Medical abortion can take anywhere from 3 days to 4 weeks, and requires a minimum of two visits to the abortion clinic or medical office.

The return visits are very important since there is no other way to be sure that the abortion has been completed. With methotrexate, 80-85% of women will abort within two weeks. Some will take longer and may need more doses of misoprostol. With mifepristone, 95-97% of women will abort within two weeks. About 1 in 20 women who try medical abortion will later need to have a surgical abortion because the medication does not work for her.

What to Expect from Medical Abortion

The most common side effects of medical abortion are caused by misoprostol, the medication taken after the methotrexate or mifepristone. The side effects may include: cramps similar to those with a heavy menstrual period, headache, nausea, vomiting, diarrhea, and heavy bleeding.

The abortion provider may have the woman stay at the clinic for several hours after taking the second drug (misoprostol). The uterine contractions caused by this medication may lead to immediate cramping and bleeding, thus ending the pregnancy. A high proportion of women, however, will experience the effects of the abortion after they have left the medical facility. A woman considering medical abortion will need to be prepared for this possibility. Our OB-GYN specialists and clinic staff can answer questions about what to expect.

The amount of bleeding that a woman has will be greater with medical abortion than with surgical abortion. Most women have cramps for several hours, and many pass blood clots as the medical abortion is taking place. Bleeding continue to last for one to two weeks after the medical abortion.

Some women report that their first regular menstrual period after a medical abortion is heavier, or longer, or in some other way different from normal for them. By the second period after the abortion, their cycles should be back to normal.

Possible Complications

Medical abortion is irreversible once the mifepristone or methotrexate has been taken.

Deciding to continue the pregnancy to term is not an option at any point after taking the first medication. If the embryo is not expelled after using these medications, a surgical abortion may be required. See First Trimester Abortion and Second Trimester Abortion pages.

The most common immediate complication of a medical abortion is heavy bleeding. For this reason, a woman must have access to a telephone and transportation in case emergency treatment is needed. Rarely, just like with surgical abortion, treatment for very heavy bleeding might require a D&C or a blood transfusion.

There do not appear to be any long-term complications associated with use of these drugs to induce a medical abortion.

Follow-up Care

Because there is no way to know for sure that the abortion is complete without an examination by a health care professional, keeping appointments with our clinic in Jamaica for follow-up care is very important!

In addition, a woman must report any problems she has during the medical abortion to a health care professional.

Choices Women's Medical Center in Queens, NYC, is committed to providing the highest quality reproductive healthcare in a safe, nonjudgmental, patient-centered environment. By offering 2nd trimester abortions, we are continuing our tradition of fulfilling the needs of women from all five boroughs of New York City, and beyond, through our Out of Town Program.