'Medical Abortion' Regimen Is Not a Simple One
In any case, all patients are expected back for a follow-up appointment two weeks later to make sure the pregnancy is actually over -- something that is verified with an ultrasound.
As for what the misoprostol expels, at seven weeks into a pregnancy -- which is the latest time at which a medical abortion is now recommended -- the embryo is about the size of a marble.
Mifepristone's effectiveness wanes beyond that seven-week period because the placenta -- not the uterus -- begins secreting progesterone, and at levels that are potentially too high for mifepristone to block. But Creinin says there are plenty of data to justify the use of mifepristone nine and even 10 weeks into a pregnancy -- if the follow-up dose of misoprostol is inserted into the vagina rather than taken by mouth.
Other possible alterations to the regimen include reducing the number of mifepristone tablets and shortening the interval between the two drugs. "There are tons of studies showing one tablet is effective" instead of the recommended three, Creinin says, adding that "if you could shorten the regimen, the woman has less time for the whole process to conclude, and less time to have side effects."
Moore says there is little doubt of the regimen's safety. "The level of confidence comes from the French experience. It's now been used for more than 10 years [in France]. ... There have been no serious adverse events reported."
Still, there is one adverse event women need to consider with a medical abortion: the possibility that it won't work. This happens in about 5% of cases, according to Saporta, leaving abortion providers with two options: "If it's incomplete you could give a follow-up dose of misoprostol or complete with a surgical [abortion] procedure."
And then there is the possibility some women might take the first drug, but not the second. Creinin says it could happen, but will likely prove a rare occurrence. "We're talking about human beings," he says. "They have the right to start down a path and change their minds. It happens very, very infrequently. Part of it is that women who go through medical abortions are very well counseled."
Medical abortion is not for everyone, Trupin tells WebMD. Women who live in remote or rural locations, more than 50-75 miles from the provider, are not candidates. Neither are those with certain medical conditions, including severe anemia; adrenal disease; severe pulmonary, liver, or kidney disease; clotting disorder, heart disease; ectopic pregnancy; or glaucoma, Trupin says.
At some point in the counseling process, patients will also be apprised of the cost for a medical abortion. And they may be surprised. "In an ideal world, there would be no difference in cost compared with surgical abortion," Creinin says.