Pregnancy options
Understanding abortion options
Medication abortion
Medication abortion ends a pregnancy with medicine and without surgery. Medication abortion is an available option up to 9 weeks after your last menstrual period began.
If you choose medication abortion, you will receive two different types of medication. The first (either mifepristone, given orally, or methotrexate, given as an injection) causes the pregnancy to end, by blocking the production of hormones or enzymes needed to maintain a pregnancy. The second medication (misoprostol, taken orally) causes the uterus to contract and empty, causing vaginal bleeding. Bleeding usually begins within 24 hours of taking the misoprostol and will likely continue for about a week. Most women feel that a medication abortion feels like an early miscarriage. You may bleed as if you are having a heavy period and feel strong cramps. You may also have other side effects like temporary abdominal pain, dizziness, fever and/or chills. Over-the-counter medications can reduce these symptoms.
You will return to your clinician for a follow-up appointment about two weeks after your initial visit to make sure the abortion is complete. Depending on the medicines used, medication abortion is between 90-97% effective. Mifepristone and methotrexate can cause serious birth defects if pregnancy continues. So, if they don't work, vacuum aspiration must be done.
Vacuum aspiration
Vacuum aspiration is a way to end pregnancy by emptying the uterus with suction. The two most common methods are manual vacuum aspiration and dilation and suction curettage.
Manual vacuum aspiration (MVA) can be done up to 10 weeks after your last menstrual period began. A hand-held instrument gently empties the uterus through a tube inserted through the cervix. You may be given pain medications before and after this procedure.
Dilation and suction curettage (D&C) can be performed after the first month of pregnancy and throughout the first trimester. A tube is inserted through the cervix into the uterus, and this tube is attached to a suction machine. When the suction machine is turned on, the uterus is emptied by gentle suction. Then a curette (a narrow metal loop) may be used to clean the walls of the uterus. You may receive pain medication before and after this procedure, and you can choose to be sedated during the procedure if you wish. Those who are awake during the procedure say the pain they feel is similar to strong menstrual cramps. After a vacuum aspiration, you will rest in a recovery room for about an hour before receiving after-care and emergency instructions.
Surgical abortion
Surgical abortion, usually called dilation and extraction (D&E), is usually the method used when a pregnancy is terminated later than 14 weeks after a woman’s last menstrual period. Fewer than 10 percent of abortions in the United States happen during this time. D&E is a two-part procedure. First, the cervix is slowly opened, and then the procedure is completed by emptying the uterus using a combination of suction and medical instruments. There are more risks involved with having a surgical abortion than having an earlier medication abortion or vacuum aspiration. Therefore, it is best to schedule the procedure you prefer as soon as you have chosen to have an abortion.
Note:
The Duke Student Health Center provides all-options pregnancy counseling through the Office of Health Promotion. Call 681-WELL (919-681-9355) to schedule an appointment with Lindsey Bickers Bock, MPH, to discuss pregnancy options. The counselor will help you make your own decision about what is right for you at this point in your life.
Information last reviewed June 2009