Adapted from, 2014 RHAP/RHEDI, and Management of Unintended and Abnormal Pregnancy

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.

Medication Abortion with Mife/Miso Aspiration Abortion
Quick Summary for Patient “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 take 4 different pills later which will cause cramping and bleeding. The pregnancy will usually pass within a few hours. Different people experience this method differently; we can give you some pain pills to help with any discomfort you might feel.” “This is a 5-10 minute procedure in the office where we empty the contents of the uterus. There are several options for reducing procedure-related pain that I can review with you.”
Gestational Age Up to 11 weeks in most U.S. practices
Beyond 11 weeks in some countries
Aspiration to 14-16 weeks
Dilation and Evacuation beyond 14-16 weeks
Advantages Patient has control over where the abortion takes place
Avoids procedure 96-98% of the time
More support options possible
May be perceived as more natural, like a miscarriage
Options for personalizing the experience
Procedure takes 5 -10 minutes
Usually less post-procedure bleeding
Options for mild, moderate or deep sedation
Able to leave the office visit not pregnant
Medical and nursing staff are there to support with patient
No routine follow up needed
Disadvantages Process takes 1-2 days (sometimes longer)
May experience heavier and longer bleeding and cramping
Less control over the time during which bleeding and cramping occurs
May see fetal tissue
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 be fewer options for personal support person(s) during procedure
Suction machine may be audible
Protocol Take medication at home/private space or clinic Procedure in office or hospital
Effectiveness < 63 days, 95-99% (See Chap 4 Table)
64-77 days, with 2nd miso dose 99.6%
71-77 days, with 2nd miso dose 97.6%
If fails, will need repeat dosing or aspiration
Over 99%
If fails, will need repeat aspiration
Duration One to several days to complete One visit (with the exception of mandatory waiting periods); 5-10 minute procedure
Pain Mild to strong cramps after taking the 2nd misoprostol, lasting a few hours or days Mild to strong cramps during and just after the procedure
Bleeding Possible heavier bleeding with clots
Bleeding, possibly with small clots, can persist on and off for 1-2 weeks or more
Heaviest bleeding during procedure
Light bleeding can persist for 1-2 weeks or more; 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 more $)
Safety Used safely for > 25 years
At least 10-fold safer than continuing a pregnancy to term
Used safely for > 45 years
At least 10-fold safer than continuing a pregnancy to term


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