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A medical abortion, also known as an abortion with pills or a medication abortion, is a non-surgical method of abortion administered using the pharmaceutical drugs mifepristone and misoprostol (combi-pack) or misoprostol alone.
For women who are 10 weeks pregnant or less, most doctors recommend using the medications mifepristone and misoprostol for a medical abortion. However, misoprostol alone is often more accessible and can be highly effective by itself in the first 10 weeks.
The accessibility of misoprostol from pharmacies in low- and middle-income countries has expanded access to medical abortion in many restrictive settings. However, medical abortions should always be administered with sufficient guidance on safe use and access to follow-up care.
To assist with this, Howtouseabortionpill.org, also known as pinkshoes, has developed a simple guide on using abortion pills safely. Although the guide was developed with women looking to self-administer in mind, much of the content is relevant for providers too. The guide covers information on how medical abortion should be administered, what can be expected during and following a medical abortion, and when women should seek follow-up care due to potentially concerning symptoms. In addition, the guide would make a useful resource to provide to clients, to share further information on what to expect from a medical abortion procedure.
The guide provides instructions for administration of both the combi-pack medications (mifepristone and misoprostol together), as well as administration for misoprostol only.
The guide details that the World Health Organization recommends that you need to access follow-up care only if:
- Sickness or pain is not getting better after two or three days
- Pregnancy symptoms persist two weeks after taking the abortion pills
- Bleeding is heavy and not getting lighter after two weeks.
To share with women and providers about signs of complication, the guide also shares the following details on risk of complication:
- Heavy bleeding: If 2 regular pads are soaked per hour for 2 hours in a row after the pregnancy is predicted to have passed, this is defined as very heavy bleeding. The guide defines soaking as completely soaked through with blood, front-to-back, side-to-side, and through-and-through. In this case, medical help should be sought.
- Intense pain: If a woman experiences extreme pain that does not get better even after ibuprofen or another pain killer is taken, it could imply that there is a complication related to their pregnancy and medical help should be sought.
- Feeling very sick: It is normal to have a fever, nausea and vomiting the day misoprostol is taken. However, this should go in the following days. If sickness continues, or increases, medical attention should be sought.