ABORTION OPTIONS
A person-centered approach to discussing medication versus aspiration abortion includes discussing timing of completion, amount of bleeding, instrumentation, and need for privacy/discretion. These may impact external factors like childcare, work/school schedule, housing situation and are important in determining the best option for their abortion.
ABORTION OPTIONS COMPARISON Adapted from, RHAP 2022
| Medication Abortion with Mife/Miso | Aspiration Abortion | |
|---|---|---|
| Quick Summary of Options | “Both work very well, are safe, and do not change your chances of having a safe and healthy pregnancy in the future if that is something that you’d want.” | |
| “You take one pill first, then 4 additional pills later, which will cause cramping and bleeding. The pregnancy will usually pass within a few hours of the second pills. People experience this method differently; we can give you additional pills to help with pain and side effects.” | “This is a 5-10 minute procedure in the office where we use gentle suction to empty the uterus. There are several options for reducing procedure-related pain that I can review with you.” | |
| Gestational Duration | Up to 11-14 weeks in many U.S. practices and guidelines; > 14 weeks in some settings | Aspiration to 14-16 weeks Dilation and Evacuation beyond 14-16 weeks |
| Advantages | More control over where abortion takes place Avoids procedure 96-98% of the time More personal support options possible Often perceived as natural, like EPL Options to personalize the experience May be able to avoid clinic spaces |
Procedure takes 5-10 minutes Usually less post-procedure bleeding Options for different levels of sedation Able to leave the office visit not pregnant Clinic staff for support No routine follow-up needed |
| Disadvantages | Process takes 1-2 days (or longer) May have heavier, longer bleeding and cramping, less control of duration May see fetal tissue at higher gestations May require follow up |
Requires in-person clinical setting Risks of instrumentation Risks of sedation/anesthesia, if used Will need a driver if using anesthesia May have fewer options for personal support Suction device may be audible |
| Protocol | Take meds at home/private space or office | Procedure in office or hospital |
| Effectiveness | < 9 w, 95-99% ( see Ch 4 Table) 9-12 w 99.6% with 2nd miso dose > 12 w 97.6% with repeat miso doses If fails, need repeat dosing or aspiration |
Over 99% If fails, will need repeat aspiration |
| Duration | One to several days to complete | One visit (unless mandatory wait periods); 5-10 minute procedure |
| Symptoms | After taking Miso – mild to strong cramps lasting hours to days, nausea, diarrhea, vomiting, fever lasting hours | Mild to strong cramps during and just after the procedure. Nausea if anesthesia is used. |
| Bleeding | Possible heavier bleeding with clots Bleeding, possibly with small clots, can persist on and off for 1-2+ weeks | Heaviest bleeding during procedure Light bleeding can persist for 1-2+ weeks; may also pass clots during this time |
| Pain management | Oral pain medication | Options include: Oral pain medication Local anesthesia Moderate or deep sedation (may require travel or $) |
| Safety | Used safely for > 25 years Many times safer than staying pregnant |
Used safely for > 45 years Many times safer than staying pregnant |