Medical/Non-Surgical/Chemical/Abortion by Pill or Instrument-Free Abortion (3 to 24 weeks)
There are many ways to describe Medical Abortions. The different names used are Abortion by Pill, early non-surgical, chemical or instrument-free abortion. It is a procedure that has been frequently performed in the United States since the year 2000. This was the first time the FDA approved a medication specifically for terminating pregnancies without the use of surgery. Prior to the year 2000, Non-Surgical Abortion procedures were performed in the United States using medications that were found to stop the growth of early pregnancies. They were used “off label” which means that the medications are FDA approved for other indications besides abortion. In several European countries, nearly 50% of women choose to undergo abortion using the Non-Surgical Abortion process. Early abortions both surgical and medical are very safe and effective when supervised and performed by an experienced, skilled Physician.
Different medications are used to carry out a medical abortion procedure which include RU486 (Mifeprex, Mifepristone, Mifegyne, Abortion Pill, Early Option Pill, French Pill), Methotrexate, or Tamoxifen. RU486 is the only medication approved by the Food and Drug Administration (FDA) to use specifically for medical abortion in the United States. The other two medications are FDA approved for other medical indications, but were also found to be highly effective in terminating pregnancy.
Our Women’s Centers have been performing abortion using the medical abortion procedure from 3 to 24 weeks in 24 hours or less using RU486 and Misoprostol for nearly 14 years. We are able to perform the medical abortion procedure in 24 hours or less in 99% of cases in a highly effective, efficient and safe manner. Surgery is not required in over 99% of the time. For those patients who wish to have the medical abortion (Abortion Pill) procedure performed and cannot find a physician or family planning facility to perform the medical abortion process past 10 weeks from their last period, please know that we are able to perform this service and provide the care you deserve. Women come from all over the country and throughout the world to have our one day early, first trimester, second trimester and late term abortion pill procedure performed.
There are two options for performing the early medical abortion for women who are generally no more than 10 weeks pregnant. How the medical abortion pills are taken depends on multiple variables.
1) First Option: During the first appointment you will receive the Mifepristone or Tamoxifen tablets which are taken by mouth, or Methotrexate which can be taken by injection or by mouth. 48 to 72 hours later, in the privacy of your own home, you will insert Cytotec (Misoprostol) tablets into your vagina, which causes contractions resulting in a miscarriage. The Cytotec (Misoprostol) tablets can be inserted later than 72 hours if your schedule does not permit the tablets to be inserted vaginally before then. When used in combination, there is a 90 to 98% rate of success. The success rate decreases with the further number of gestational weeks. There is close to a 99.9% success rate for patients 6 weeks or less from their last menstrual period.
2) Second Option: Same Day (One Day): A combination of medications or a single medication can be taken which will result in completion of the abortion process within 24 hours or less in 99% of patients. There is less than a 1% chance for surgical instruments to be required. Less complications and side effects have been found with our same day option and as a result more women prefer this shortened abortion pill procedure because it eliminates the potential for a longer drawn out process.
Use of Abortion Pills (RU486) and Misoprostol (Cytotec) In the First Trimester (3 to 10 weeks) and Second Trimester (14.1 to 24 weeks) to Terminate Pregnancy in One Day
Our Clinics have been performing first trimester, second trimester and late term abortions using the Medical Abortion Pill Procedure (Non-Surgical, Chemical) for many years. There is no other facility in the State of Florida or in the U.S. with this vast knowledge and experience. The techniques used are highly efficient, effective and safe. We are able to start and complete the process within 24 hours or less in 99.9% of cases with minimal to no complications.
Medical Abortion Pill Dosages, Frequency and Route of Administration for RU486 (Misoprostol, Mifepristone, Mifegyne), Cytotec (Misoprostol), Tamoxifen, Methotrexate for usage in the First Trimester, Second Trimester, Late Term and Third Trimester of Pregnancies:
The result of extensive research has been reported in medical literature regarding the use of using a single abortifacient alone or in combination for terminating pregnancies. The type of medication given, the dosages, frequency and route of administration all vary with 1) how early in pregnancy the procedure is being performed, 2) patient allergies to the medication, 3) any contraindications the patient may have to a particular medication, 4) the side effects that a patient may have while taking a particular medication during the abortion process. An example of this would be the use of Cytotec (Misoprostol). Cytotec may be taken vaginally, rectally, placed between the cheek and gum (buccally), sublingually (placed underneath the tongue) and swallowed. Medical studies indicate that it can be used as frequently as once per hour. It may be used alone as an abortifacient or in combination with RU486, Tamoxifen or Methotrexate for terminating pregnancy. More side effects result by taking Cytotec sublingually and less occur when administered vaginally. The route of administration and how frequently Cytotec is given is significant regarding the success or failure of the abortion process. Adjustments have to be made regarding dosages, frequency and route of administration depending on the number of weeks of pregnancy. A physician must possess the appropriate knowledge and experience required to safely and effectively perform the abortion pill procedure. Dosages, route of administration and the frequency of when and how the medication is given must be carefully considered because they may vary greatly from one patient to the other. What is best for one patient may not necessarily work for another.
What occurs at the first visit?
At the first appointment to our office, a medical history is obtained to alert the staff and physician of any medical problems you may have. This is very important to determine if you meet the criteria for undergoing the abortion using the non-surgical procedure method. Lab tests will be performed to verify the pregnancy, check the blood count and determine your Rh factor.
Each patient will undergo counseling and the abortion procedure will be explained in detail. The risks, benefits and alternatives to the abortion procedure will also be explained. More importantly, it will be determined if having an abortion is the right thing for you at this time. The decision to have an abortion is one of the most difficult decisions a woman may have to make in her lifetime. The decision is based on age, family, religious, ethical, moral, financial, social, and personal values. No one truly wants to have an abortion. The question is whether or not it’s the right time to become a mother.
A sonogram will be performed to confirm that the pregnancy is 10 weeks or less from the last menstrual period. If more than 10 weeks and a patient would still like the option of undergoing a medical abortion procedure, arrangements can be made to do so.
What to Expect
Upon taking the initial medication at our offices, there is a chance that bleeding may begin and a 1% chance of a miscarriage occurring before taking the second medication (Misoprostol) 48 to 72 hours later. Most women do not experience any bleeding until taking the Misoprostol. Misoprostol can be taken later than 72 hours if your schedule does not permit it to be taken before. Once the Misoprostol is inserted, you can expect to experience lower abdominal cramping, with a range in bleeding from very light, to the same as a normal period. Some women experience very heavy vaginal bleeding but this is not common. Nausea, vomiting, and diarrhea can occur. The bleeding and cramping can begin as soon as 20 minutes after taking the Misoprostol tablets. Most women miscarry within 6 to 8 hours of taking the Misoprostol pills. Bleeding usually lasts between 6 days and 2 weeks. A small percentage of patients can have bleeding for up to 30 days.
It is necessary for the patient to return in one week for a sonogram to make sure that the medical abortion procedure was successful and complete. A small percentage of patients have an incomplete passage of tissue and usually request taking the Misoprostol tablets again. Upon returning in one week, if the patient is still pregnant, then a surgical procedure is performed. The surgical procedure will be carried out in our offices without an additional fee.
Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications, such as continuous, profuse blood loss that may require a blood transfusion, or continuing a pregnancy with severe birth defects. The patient is given a 24 hour emergency number to call if there are any problems or questions. A medical staff person is always on call.
With the recent use of the non-surgical regimen to end the pregnancy, how long will the pregnancy test remain positive? Is there a possibility of still being pregnant?
The follow-up visit is extremely important. You must return to the office 7 to 14 days after taking the Mifeprex, Tamoxifen or Methotrexate to be certain the pregnancy has ended. To verify this, a sonogram will be performed. If the pregnancy has not ended, there is a chance of fetal birth defects. Therefore, in all cases, there must be an additional insertion of the Misoprostol or a surgical procedure performed to end the pregnancy. A pregnancy test can remain positive up to 4 to 6 weeks after the procedure is complete in 3 to 6% of the patients.
Common Side Effects and Risks Associated with RU486 (Mifegyne, Mifeprex, Mifepristone), Non-Surgical, Chemical, Abortion Pill and Misoprostol (Cytotec)
Cramping and bleeding are an expected part of ending a pregnancy. It is rare, but serious and potentially life-threatening bleeding, infection, or other problems can occur following a miscarriage, surgical abortion, medical abortion or childbirth. Prompt medical attention is needed in these circumstances. Serious infection has resulted in death in a very small number of cases in which Misoprostol was used in the vagina. There is no evidence indicating vaginal use of Misoprostol caused these deaths.
If you have any questions, concerns or problems, or if you are worried about any of the side effects or symptoms, you should contact our office immediately.
Be sure to contact our office immediately if you have any of the following:
Bleeding enough to soak through two, full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (Surgical Abortion/D&C) to stop it.
Blood Transfusion may be required 0.1 to 0.2% of the time due to the possibility of heavy or continuous vaginal bleeding. Symptoms of hypovolemic shock are rapid heart rate (100 beats per minute), inability to sit, stand or walk, excessive weakness and blurred vision.
Abdominal Pain or “Feeling Sick”
If you have abdominal pain or discomfort, or you are “feeling sick,” including weakness, nausea, vomiting or diarrhea, with or without fever, more than 24 hours after taking Misoprostol, you should call our office without delay. These symptoms may be a sign of a serious infection or other problem (including ectopic pregnancy, a pregnancy outside the womb).
In the days after treatment, if you have a fever of 100.4F or higher that lasts for more than 4 hours, you should contact us immediately. Fever may be a symptom of a serious infection or other problem (including an ectopic pregnancy).
Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications such as continuous, profuse blood loss that may require a blood transfusion, or continuing a pregnancy with severe birth defects. All patients are given a 24 hour emergency number to call if there are any problems or questions. A medical staff person is always on call.
Long Term Side Effects and Risks Associated with RU486 (Mifegyne, Mifeprex, Mifepristone), Non-Surgical, Chemical, Abortion Pill and Misoprostol (Cytotec)
Chronic Pelvic Pain: A rare percentage of patients who have a pelvic infection can develop chronic pelvic pain.
Pelvic Inflammatory Disease (PID): Pelvic Inflammatory Disease is commonly caused by untreated Gonorrhea, Chlamydia, Bacterial Vaginosis and other rare bacteria.
Infertility: 10 to 11% of patients who develop PID may become infertile. Over 33% of women who develop PID a second time have more than a 30% chance of becoming infertile.
Psychological Problems: In the past, abortions were thought to increase the chance of developing psychological problems in the long term. This is no longer thought to be the case. Patients who have no support or who have a history of psychological problems possess a higher chance of developing them after the abortion process is complete.
Maternal Death: Maternal death is rare. It occurs in 1:100,000 abortions. It is 10 times safer to have an abortion than it is to have a full term vaginal delivery. Maternal death is due to a rare bacterium (Clostridium Sordelli) which migrates into the blood stream and may lead to multiple organ failures and death.
Eligibility for Medical Abortion
- You must be 10 (ten) weeks or less from your last menstrual period
- You must have reliable transportation and a support person to take you to the hospital or bring you back to our medical offices if necessary
- You must live no more than an hour away from the hospital or our medical offices
- You must be able to make the follow-up appointments (possibly 2 or more)
- You must agree to have a surgical procedure performed if the medical abortion fails
The Medical Abortion is contraindicated in patients with the following problems:
- Severe anemia
- Blood clotting problem or currently taking anticoagulant medication
- Possible ectopic pregnancy
- Have a mass in the tubes or ovaries or ectopic pregnancy (pregnancy outside the uterus)
- Inherited porphyria
- Intrauterine Device (Must be removed before having a medical abortion procedure)
- Unable to get emergency medical help in the two weeks after taking the medications
- Allergy to Misoprostol or other prostaglandins, Mifeprex, Tamoxifen or Methotrexate
Other Options For Early Abortion (3 to 6 weeks)
If you are found to be 6 weeks or less by sonogram, and there is a contraindication for you to undergo the Non-Surgical Abortion, then a surgical abortion is still an option for you. The advantage of the early surgical procedure is that the abortion procedure is quick and over within a matter of minutes, and the pregnancy symptoms of nausea, vomiting, bloating, and breast tenderness can end within a few hours after the abortion procedure is performed.
Early Abortion: Choosing Medical or Surgical
Because our Physicians are highly trained to perform the early abortion procedures surgically and medically, both are equally safe and effective. More women are choosing the medical abortion method because they feel it is more natural and there are no instruments used in the procedure. Most women are very satisfied with the outcome of either method.
We encourage all women to start birth control on the day of the surgical procedure or the day of the follow- up visit of the medical abortion procedure. You can become pregnant two weeks after having the procedure performed.
When can I have sex?
With the medical abortion procedure, you can have sex at any time. For the early abortion procedure, (6 weeks or less) we suggest you wait 24 hours before having sex again.
Abortion Pill (RU486, Mifegyne, Mifeprex, Mifepristone), Cytotec (Misoprostol) Fees/Costs/Prices
The cost of the Medical Abortion Pill Procedure in the first trimester of pregnancy ranges from $300.00 to $1,500.00. The cost of a second trimester abortion (14.1 to 24 weeks) using the Abortion Pill Procedure may range from $500.00 to $7,500.00. The cost of the procedures can be significantly reduced for patients who meet our qualifications.
From time to time our Women’s Centers are able to provide the abortion pill procedure at no cost with the exception of the fee required for the State mandatory sonogram (ultrasound).
As previously indicated, all Abortion Pill Procedures (3 to 24 weeks) can be performed in 24 hours or less in 99% of cases with minimal to no complications. Surgery is not required in the majority of patients.
Please contact our office today to have your questions answered and to schedule an appointment.
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