Information & Support
This information contains an outline of each stage involved in a medication abortion. It is intended as a general guide only If you have any questions or want more detail, call a medication abortion provider directly. Providers can be found by clicking the Find a Service button at the bottom of this page.
Medication abortion: a step by step guide
Medication abortion, sometimes also called medical abortion, is the use of drugs to end an early pregnancy. In Australia, the drugs used for this (mifepristone and misoprostol) are licensed by the Therapeutic Goods Administration (TGA) and marketed as MS 2-Step. Medication abortion is generally available in Australia for terminations of pregnancies less than nine weeks gestation (that is, less than 63 days from the first day of your last period).
How medication abortion works
Mifepristone blocks the hormone progesterone, which is needed to sustain a pregnancy. This changes the lining of the uterus and causes the pregnancy to detach from the uterine wall. It also softens and opens the cervix. Mifepristone is used in combination with another medication, misoprostol, which causes the uterus to contract and the cervix to further soften, which results in the pregnancy tissue being expelled from the uterus.
Possible side effects of medication abortion
Side effects, such as pain, cramping, and vaginal bleeding, are expected with a medication abortion, similar to an early miscarriage. Other side effects of the medications may include nausea, vomiting, diarrhoea, chills or fever. Side effects from the mifepristone will generally be less than those experienced with the misoprostol. Complications are rare but may include excessive vaginal bleeding requiring transfusion (occurs in approximately one in five hundred cases), incomplete abortion or ongoing pregnancy which requires a surgical abortion.
The doctor prescribing the medication for you should talk you through the possible side effects and how to respond to them. You should also be provided with a 24/7 phone number staffed by nurses for you to call in case you have any questions or concerns as the medication takes effect.
First appointment and pre-testing
In this first appointment your medical history will be taken, you will have clinical exam, blood test and ultrasounds performed you will then have a consultation with the doctor.
These tests and your medical history are taken to ensure there are no reasons for not proceeding with the medication, and to confirm the gestation of the pregnancy (how many weeks since the first day of your last period). The doctor will also talk you through what is involved in the procedure, make sure you are comfortable with your decision, that it is your decision and you are not being forced or coerced into ending the pregnancy by someone else. This is sometimes called ‘counselling’ by medical professionals but it is for the purpose of getting your informed consent for the procedure. This is not counselling in the sense of helping you make a decision. If you’re unsure about your decision or you’d like to talk it through with someone, you can contact Children by Choice or ask the service to refer you to an all options counselling service.
If you’re going through a private clinic, all of this will be done at the clinic during your first appointment.
If you’re going to a GP, you will be referred to a pathology service for blood tests and an ultrasound. Some GPs will arrange for the referral at the time you make your appointment, others will only give you a referral after you’ve had the first consultation with them and they’ve discussed your decision and taken your medical history. Either way, your ultrasound and blood tests will be done at a separate appointment.
Taking the first medications
This step is taking the first medication, the mifepristone, and is generally done with the doctor providing the abortion.
If you’re at a clinic this is done at the clinic during your first appointment, after your clinical exam and ultrasound.
If you’re going to a GP, this might be done at a second appointment, after you’ve had an initial consultation with the GP, had your blood tests and ultrasound done, and the GP has reviewed the results.
Taking the second medications
The second lot of medication, the misoprostol, is taken 24 to 48 hours after the mifepristone. Misoprostol tablets are placed between the cheek and the gum to be absorbed in the mouth.
This step generally happens at home regardless of whether you go to a clinic or a GP. Your doctor will give you instructions on how and when to take the misoprostol. If you have concerns about the possible physical discomfort involved with this stage of the process, talk to your doctor about pain relief.
Some GPs include a consultation approximately three or four days after the taking of the misoprostol. At this time the doctor may gather information about levels of pain, blood loss and the size of any clots that have passed to determine if the process is progressing well. If you would like this consultation can also offer emotional support.
This step takes place between 11 days to 3 weeks after the first medications have been taken.
The doctor evaluates you to confirm that all of the pregnancy tissue has been expelled and you are no longer pregnant. This step is essential. Even if there has been significant pain, loss of blood and passing of clots this is not enough in itself to confirm that the process has successfully ended the pregnancy. You must return to the clinic or GP to confirm that the abortion is complete. For women and pregnant people having to travel some distance to access a clinic or prescribing doctor, arrangements may be made for the follow up to be done by their local GP.
If there is an ongoing pregnancy a surgical abortion should be performed but this is usually at additional cost.
If the abortion wasn’t successful and some tissue still remains in the uterus the clinician will discuss possible treatment options with you. These may include waiting and re-evaluating for complete abortion in a number of days or performing a surgical abortion.