According to a research published Tuesday in the journal BMJ Sexual & Reproductive Health, many women are taken aback by the level of pain they endure during a medication abortion.
Medication abortions, in which a woman takes two medications, frequently at home, to terminate a pregnancy, account for more than 60% of abortions performed in the US. According to the study, which polled women in the United Kingdom, many of them don’t feel ready for the level of agony they would experience during the surgery.
Although some women may feel taken aback by the information they received from medical professionals, pain does not indicate that the treatment is hazardous.
Dr. Alyssa Colwill, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine, who was not involved in the new study, stated that there is currently some reckoning in the field of gynecology regarding the pain that patients are going through during procedures.
Researchers examined survey answers from over 1,600 women in the United Kingdom who had had medication abortions and then responded to questions about their experiences. Half of them had never given birth, and the majority were between the ages of 20 and 39.
About half of the respondents stated that the pain was more than they had anticipated, and over 90% gave their agony at least a 4 out of a possible 10. On a pain rating of 8 to 10, about 40% of respondents reported having severe pain.
In the U.S. and the U.K., women are frequently advised to anticipate discomfort during a medication abortion that is similar to severe menstruation cramps. Some respondents indicated they felt unprepared and that the agony associated with medication abortion was minimized or sugar-coated, while others thought that was a fair assessment.
According to one lady who answered the survey, the pain was so much worse than menstrual discomfort that it seemed like labor contractions. I’ve given birth three times, and each time the pain was essentially the same—a cramping contraction.
According to another, it’s important to reassure them that just because pain is described as severe, it doesn’t always mean that it will be. I worried about the potential negative effects for longer than was necessary!
The researchers came to the conclusion that women wanted general anticipatory advice and comprehensive, realistic pain counseling, including first-hand accounts that showed the range of suffering that women might experience following medication abortion.
The study’s primary author, Hannah McCulloch, an assessment researcher at the British Pregnancy Advisory Service, stated in an email that it’s critical to recognize that each person’s experience of agony during a medical abortion will be unique. To deliver effective patient-centered care, it’s critical to be truthful about what women go through during medical abortion.
Two tablets are taken during a medication abortion. The first, mifepristone, inhibits progesterone, a hormone essential to the continuation of pregnancy. The person takes a second medication, usually misoprostol, one or two days after taking mifepristone. This medication causes the uterus to relax and cramp, and the cervix to dilate so the pregnancy can end, usually within 24 hours after taking misoprostol, according to Colwill.
The uterus’s need to cramp and expel the pregnancy will inevitably create pain, she added, adding that each person’s level of pain is influenced by a variety of circumstances.
According to Colwill, women who have undergone labor or given birth vaginally, as well as those who suffer from intense monthly menstrual cramps, such as those who have endometriosis, may report less discomfort with a pharmaceutical abortion.
She continued by saying she was not surprised to learn that many women did not feel they were sufficiently prepared to manage pain during a medication abortion and that knowing these past experiences, as well as things like how they experience Pap smears and vaginal exams, can help us better support patients to be prepared for how pain may be for them.
Abortion with medication is a very safe operation. According to the drug’s label, less than 0.5% of persons taking Mifeprex, the brand-name form of mifepristone, experience serious adverse effects, and since the Supreme Court reversed Roe v. Wade in 2022, more women are handling their own abortions.
Patients must be given sufficient information about what to anticipate and what is known about pain management. According to Dr. Daniel Grossman, a professor of obstetrics and gynecology and the director of establishing new standards in reproductive health at the University of California San Francisco, pain is minimized in medicine generally and in women’s health and obstetrics and gynecology specifically.
According to Grossman, people should still receive counseling on how to manage the severe pain and nausea that may occur during the surgery, even if they obtain abortion drugs via telehealth. He stated that taking a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen, concurrently with misoprostol is his best recommendation for managing discomfort during a medical abortion. He advises using an anti-nausea drug, such as the prescription drug metoclopramide, if at all possible.
Acetaminophen, widely known as Tylenol, is another choice, but NSAIDs are more effective at inhibiting this particular discomfort, according to Colwill.
According to Grossman, using a heating pad, a hot water bottle, or over-the-counter trans-electrical nerve stimulation pads to the lower abdomen can also assist to confuse nearby nerves and reduce discomfort.
He said that it’s critical to know what constitutes normal discomfort and when to seek medical attention, particularly when people are at home.
For instance, pain in the center of the lower abdomen is common, but pain that is higher up or that is limited to one side may indicate a serious illness, such as an ectopic pregnancy, a potentially fatal condition in which a fertilized egg implants outside the uterus.
According to Grossman, people should visit the ER if they have excruciating discomfort on one side of their abdomen or pelvic. They may attempt to speak with a physician over the phone first if they experience mild to moderate pain on one side. However, he cautioned, they should visit an emergency room if they have any questions.
Ultrasounds can identify ectopic pregnancies, but many individuals have medication abortions without one, and an ultrasound may even miss it, according to Grossman.
The Food and Drug Administration states that medication abortion will not be effective for an ectopic pregnancy.
According to him, pain that persists for more than 24 hours after the end of a pregnancy, particularly if the patient is also experiencing fever or vomiting, may indicate an infection.
He went on to say that women shouldn’t undervalue the significance of moral support, saying that having someone there and feeling supported also makes a significant difference.
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