What Are The Various Methods of Abortion?
In the United States, abortion is a well-established and generally safe medical procedure used to end a pregnancy.
Understanding the different abortion methods can help patients make informed decisions about their reproductive healthcare.
The most common methods of abortion include the following:
1) Menstrual Extraction:
Some consider this method a termination of pregnancy when it actually is not. There is no pregnancy test performed to diagnose if a woman is pregnant.
Thousands of Menstrual Extraction Clinics are set up around the world to perform these procedures in countries where abortion is illegal. Without confirmation of pregnancy menstrual extraction allows a woman’s menses return to normal.
It is not uncommon that an instrumental Surgical Dilation and Curettage is performed to determine if there is uterine pathology responsible for a woman not having her menses.
Women who have missed their menses from 3 to 8 weeks around the world undergo a surgical (Dilation and Curettage) or medical pill evacuation (Cytotec/Misoprostol) of the uterine lining in order to return their menses to normal.
The surgical procedure is commonly performed with a handheld manual suction device along with an attached sterile curette. It is gently inserted through the cervix and the tissue inside the uterus is removed by a manual or electrical suction device.
When a Menstrual Extraction is performed, the tissue is not examined or sent to pathology.
Cytotec may be taken orally (by mouth), buccally (between cheek and gum), sublingually (under the tongue) or vaginally to cause uterine contractions and passage of the tissue in the uterine cavity.
The contraction, cramps and bleeding is similar to a heavy menses. Most women do not need medication to control the pain or discomfort. Approximately 40% of women take Tylenol, Motrin or Advil to control their discomfort.
A very small percentage of women require narcotics for pain control.
If menstrual extractions are performed at 4 weeks or less, the dosage required to pass the Uterine tissue is less and the success rate is greater.
The woman’s menses generally returns in 3 to 6 weeks.
2) Dilation and Curettage (D&C):
This procedure is performed in the first trimester (3 to 14 weeks gestation) or early second trimester of pregnancy (14.1 to 16.4 weeks).
What distinguishes an early second trimester abortion from a late second trimester abortion is that surgical instruments (forceps) are not required to manually remove (extract) the pregnancy tissue from within the Uterus.
The patient electively receives IV Sedation, Deep Sedation, Advanced IV Sedation, or General Anesthesia.
After the patient is placed on the exam table in the position as having a Pap Smear performed, a vaginal speculum is placed inside the vagina. This is used to maintain the opening of the vaginal walls so that the cervix may be visualized.
The cervix is anesthetized with Lidocaine and dilated (opened) with sterile dilators (rods) followed by insertion of a sterile curette (the size of a straw) inside the uterus and the pregnancy tissue is gently removed.
The procedure is a 3 minute pain free safe abortion.
3) Dilation and Evacuation (D&E):
Dilation and Evacuation (D&E) is a surgical abortion procedure most commonly performed during the second trimester of pregnancy, generally beginning at approximately 14 weeks.
It may also be performed later in pregnancy when medically appropriate and legally permitted, including at 16.5 to 24 weeks or beyond in specialized healthcare settings.
In the United States, D&E is one of the most commonly used methods of second-trimester surgical abortion. In other parts of the world, medication-induced abortion, sometimes referred to as the late-term abortion pill method, is also used.
This approach typically involves Mifepristone and Misoprostol (Cytotec), although Misoprostol alone may be used in certain medical circumstances.
Before performing a D&E, the cervix must be adequately prepared to allow the physician to complete the procedure safely.
Cervical preparation involves gradually softening and dilating the cervix using osmotic dilators, such as Laminaria, and/or medications, including prostaglandins such as Misoprostol. Mifepristone may also be used as part of cervical preparation in selected circumstances.
Depending on the stage of pregnancy and the patient’s medical history, cervical preparation may begin several hours before the procedure or require one or more appointments over multiple days.
During the procedure, an experienced physician uses specialized medical instruments and suction to remove pregnancy tissue from the uterus.
Pain management options may include local anesthesia, intravenous sedation, or deeper anesthesia, depending on the patient’s medical needs, the stage of pregnancy, and the healthcare facility’s protocols.
Ultrasound guidance may also be used during the procedure to help the physician evaluate the uterus and support safe, complete treatment.
The duration of the procedure varies depending on the gestational age and individual medical circumstances.
4) Medical Abortions (Abortion Pill):
Early Medical abortions are generally performed between 3 to 28 weeks gestation.
The most common medications used are RU 486 (Mifepristone, Mifeprex, Mifegyne) and Cytotec (Misoprostol).
Other ways of performing medical abortions are with Methotrexate and Cytotec or Cytotec alone.
Late Medical Abortions can occur between 11 to 28 weeks. In essence; second trimester and late term abortions can be performed using the Abortion Pill Method.
The medications stimulate uterine contractions and cervical changes, allowing the pregnancy to end without a surgical evacuation procedure in many cases.
The process can be started and completed within 24 hours or less 99% of the time with less than 1% chance of complications or side effects.
Medical abortion provides an effective alternative to surgical abortion for many patients.
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