by Many women are surprised by the amount of pain they experience during a medication abortion, according to a study published Tuesday in the journal BMJ Sexual & Reproductive Health.
More than 60% of abortions in the US are medication abortions, meaning someone takes two medications, often at home, to end a pregnancy. The study, which surveyed women in Britain, found that many feel unprepared for the amount of pain they may feel during the procedure.
Pain does not mean the procedure is unsafe, but some women may feel overwhelmed based on the information given to them by health care providers.
“There is a reckoning right now in the world of gynecology and the pain patients experience during procedures,” said Dr. Alyssa Colwill, associate professor of obstetrics and gynecology at Oregon Health and Science University School of Medicine. ‘not involved in the new investigation.
In the study, researchers looked at survey responses from about 1,600 women in Britain who had had a medication abortion and then answered questions about the experience. Most were between 20 and 39 years old and half had never given birth.
More than 90% of respondents rated their pain at least a 4 out of a maximum of 10, and about half said the pain was more than they expected. About 40% said their pain was severe, between an 8 and a 10 on the pain scale.
Women are often told to expect cramps similar to strong menstrual cramps during a medication abortion, both in Britain and the US. While some respondents felt this was an accurate description, others said they felt unprepared and that the pain aspect of medication abortion “had been “sugar-coated” or downplayed.
One woman who responded to the survey said: “Pain was so much stronger than period pain, it was like having contractions during childbirth. I gave birth three times and the pain was actually not much different from that pain, the cramping contraction pain.”
Another said: “I think it’s worth reassuring people just because it is [pain] If it is declared serious, it does not necessarily mean that it will be so. I spent more time worrying about the possibilities of side effects than I should have!”
The researchers concluded that women wanted detailed, realistic pain counseling and general preparatory advice, including details from first-hand experiences that illustrate the extent of pain women can experience during medication abortion.
“What is important here is the recognition that everyone’s experience of pain during a medical abortion will be different,” the study’s lead author, Hannah McCulloch, an evaluation researcher at the UK Pregnancy Advisory Service, wrote in an email. “It is important to be realistic about what women experience during medical abortion in order to provide meaningful patient-centered care.”
Medication abortions involve taking two pills. The first, mifepristone, blocks the hormone progesterone, which is crucial for continuing a pregnancy. One or two days after taking mifepristone, the person takes a second medication — usually misoprostol — which contracts and softens the uterus and dilates the cervix so the pregnancy can pass, usually within 24 hours of taking misoprostol, Colwill said.
“That process, where the uterus has to contract and expel the pregnancy, is inherently going to cause pain,” she said, adding that many factors play a role in the amount of pain each person feels.
Women who may report less pain with a medication abortion include those who have experienced childbirth or given birth vaginally and women who have painful menstrual cramps every month, such as those who have endometriosis, Colwill said.
“Understanding these past experiences, and things like how they experience Pap smears and vaginal exams, can help us better support patients to be prepared for what pain can be like for them,” she added, noting that she wasn’t surprised to see that many women did. do not feel they are adequately prepared to deal with pain during a medication abortion.
Medicinal abortion is an extremely safe procedure. Serious side effects occur in less than 0.5% of people who use Mifeprex, the brand-name version of mifepristone, according to the drug’s label, and the number of women who self-arrange abortions has increased since the Supreme Court ruled on Roe v. Wade. has destroyed. 2022.
“Patients need to be adequately informed about what to expect and told what we know about how to manage the pain. Pain is downplayed in medicine in general and especially in women’s health care, obstetrics and gynecology,” said Dr. Daniel Grossman, professor of obstetrics and gynecology and director of Advancing New Standards in Reproductive Health at the University of California in San Francisco.
Even if someone is accessing abortion medications through telehealth, Grossman says people should still receive counseling about what to expect and how to manage the intense pain and nausea that can occur during the procedure. His best advice, he said, for managing pain during a medication abortion is to take a nonsteroidal anti-inflammatory drug, or NSAID, such as ibuprofen at the same time as misoprostol. If possible, he recommends also taking an anti-nausea medication, such as metoclopramide, which requires a prescription.
Colwill said acetaminophen, or Tylenol, is also an option, but NSAIDs can block this specific pain better.
Placing a heating pad, hot water bottle or over-the-counter transelectric nerve stimulation pads on the lower abdomen can also help “confuse” the nerves in the area and relieve pain, Grossman said.
He said it’s also important to understand what pain is “normal” and when it’s time to seek medical care, especially in situations where people are at home.
For example, pain in the center of the abdomen is normal, but pain higher up or pain on one side can be a sign that something is wrong, such as an ectopic pregnancy, a life-threatening condition in which a fertilized egg implants. outside the uterus.
If someone experiences severe pain on one side of the abdomen or pelvis, they should go to the emergency room, Grossman said. “If they have mild to moderate pain on one side, they can try talking to a doctor on the phone first. But if there is any doubt, they should go to the emergency department,” he added.
Ectopic pregnancies are detected on ultrasounds, but “many people have medication abortions without an ultrasound and it can even be missed on an ultrasound,” Grossman said.
According to the Food and Drug Administration, medication abortion will not work for an ectopic pregnancy.
Pain for more than 24 hours after a pregnancy has ended, especially if the person also has a fever or is vomiting, could be a sign of infection, he said.
Women should also not underestimate the importance of moral support, he added: “Feeling supported and having someone there also makes a big difference.”
