Medical abortion – up to which week of pregnancy is a medical abortion possible

A medical abortion is a significant step and a deeply personal decision – it allows a pregnancy to be ended at home with medication, without surgery. For many women, it can offer a confidential, safe and effective option at a moment of great vulnerability.

Every woman experiences this situation differently. That makes being well informed all the more important: what exactly is a medical abortion, how does it work, how do you prepare for it and how do you cope with the symptoms afterwards? We cover all of this in today's article.

What is a medical abortion? 

A medical abortion is a method of ending a pregnancy by taking a combination of two medicines – mifepristone and misoprostol. In the case of an unwanted pregnancy, a patient can opt for a medical abortion without surgery, even in the privacy of her own home. It is a safe method, with studies showing effectiveness of up to 98%.

Medical vs surgical abortion – what's the difference? 

Unwanted pregnancies can be ended in two ways: medically or surgically. The key difference is that a surgical abortion requires an operative procedure, whereas a medical abortion does not – here, taking tablets is sufficient.

Beyond this clear distinction, there are other aspects that set the two methods apart. One is location. A medical abortion can take place either at the doctor's surgery or at home. A surgical abortion is only possible in a medical facility.

Another significant difference is the gestational age at which the abortion can be carried out. In the UK, early medical abortion (abortion pills) is normally used up to 10 weeks of pregnancy and, in England and Wales, can be done at home after a remote consultation. Medical abortion can also be used later in a clinic or hospital, up to the 24-week legal limit. If the pregnancy is further advanced, it can only be ended effectively by surgical means.

And naturally, the process itself differs, as do the symptoms that may occur during or after each procedure. Cramping and bleeding can last longer and be heavier after a medical abortion, while a surgical abortion is carried out under anaesthetic and generally results in lighter bleeding afterwards.

Medical abortion – how does it work? 

A medical abortion takes place over several days and consists of two steps, corresponding to the two medicines taken: mifepristone and misoprostol.

Taking the first medicine  

The first step of a medical abortion is taking a tablet containing mifepristone. This active substance stops the production of progesterone – the hormone that stimulates the thickening of the womb lining to support the development of the pregnancy. Without progesterone, the womb lining thins and the embryo cannot remain implanted.

Taking the second medicine  

Around 24 to 48 hours after taking the first medicine, the second step follows. This involves taking a misoprostol tablet orally or using it vaginally, which triggers contractions of the womb so that bleeding begins and the pregnancy is expelled. Most patients notice the first signs shortly after using misoprostol.

When is a medical abortion possible?

In the UK, medical abortion is always arranged through a regulated provider (the NHS or an approved independent provider such as BPAS or MSI Reproductive Choices), with medical support available throughout. If the pregnancy is further advanced, it can only be ended surgically.

Up to which week is a medical abortion possible? 

As a rule, a medical abortion is possible up to week 8 to 10 of pregnancy. In certain cases, mifepristone and misoprostol can be used up to week 12, though with closer medical monitoring. If the procedure takes place before week 7, the symptoms are usually easier to manage.

How do you know which week of pregnancy you're in? 

The most common method of calculating gestational age is based on your last period. As the exact moment of conception cannot be determined, gestational age is calculated not from conception but from the first day of your last period.

For women with a regular cycle, the first day of the last period counts as day 1 of the pregnancy. If, for example, the first day of your last period was 6 weeks ago, the pregnancy is considered to be 6 weeks along.

Your doctor can also measure the hCG level in your body and determine the size of the embryo during an ultrasound scan in order to assess the weeks of pregnancy more precisely.

How do you prepare for a medical abortion? 

Even though no surgery is involved, a medical abortion is a carefully planned process that requires good preparation. That means being sure of your decision, being correctly informed and taking all the steps needed to ensure safety and avoid complications. This preparation is both physical and emotional.

Medical examination and confirmation of pregnancy 

The first step is confirming the pregnancy. A pregnancy test shows whether you are indeed pregnant, and an ultrasound allows the doctor to determine the gestational age precisely.

Once confirmed, you'll be talked through the available options, as well as how the procedure works, the associated risks and possible complications. At this stage, medical contraindications are also ruled out, such as an ectopic pregnancy or pre-existing conditions.

Why is emotional preparation so important with a medical abortion? 

An abortion – even a non-invasive one such as a medical abortion – can bring up intense and conflicting emotions. It may unsettle you, make you doubt or regret your decisions, or leave you feeling relieved and sad at the same time.

Emotional preparation is therefore just as important in order to cope with what can be an overwhelming experience.

It's a good idea to have someone you trust nearby to support you and help if needed, to choose a place where you feel safe, to set aside a free day, and to have light snacks, comfortable clothing and large pads ready for the bleeding to come.

When is a medical abortion not recommended?

Like any other procedure, a medical abortion is not suitable in certain situations or with certain conditions. That's why it's important for your doctor to assess your medical history and state of health before deciding whether this option is safe for you.

A medical abortion is not recommended:

• in the case of an ectopic pregnancy (a pregnancy developing outside the womb)
• in the case of an advanced pregnancy of more than 9 to 10 weeks
• if you have a blood clotting disorder
• if you have anaemia
• if there is an allergy or contraindication to mifepristone and misoprostol
• if you are taking certain medicines (e.g. corticosteroids)

• if you have untreated infections or pelvic inflammatory disease

  

Possible symptoms and side effects after a medical abortion 

As a rule, symptoms begin shortly after using misoprostol:

• After around 1 to 4 hours, bleeding and abdominal cramps begin as the womb contracts to expel the pregnancy.
• The cramps intensify, and over the following hours blood is passed along with clots of tissue.
• Some women experience accompanying symptoms such as fever, chills, diarrhoea, nausea, vomiting, headaches, dizziness and fatigue.

Bleeding after a medical abortion 

Bleeding is one of the key signs after a medical abortion, as it is how the pregnancy is expelled. It is normal and can last 7 to 14 days, but should be monitored closely.

The bleeding is heaviest in the first few hours after using the second medicine – highly absorbent pads are recommended here. After that, the flow should gradually ease.

Over the following days, period-like bleeding may continue, and during this time you can use the organic pads you'd normally use during your period. Finally, only light to moderate bleeding remains for 1 to 2 weeks.

Possible complications after a medical abortion 

A medical abortion is considered a safe and effective procedure, and complications are rare when all medical advice is followed.

However, deviations such as taking the second medicine late or not at all, or any other failure to follow medical instructions, can lead to complications:

• incomplete abortion (a surgical procedure involving suction and curettage may be required)
• heavy bleeding (persistent, very heavy bleeding)
• womb infections (an unpleasant odour in the intimate area and a fever lasting more than 24 to 48 hours can be signs of an infection)
• Large blood clots (larger than 3 cm; these can indicate an incomplete abortion)

Recovery after a medical abortion 

The abortion itself is a different experience for every woman – and recovery is just as individual. Every woman recovers from such a procedure at her own pace.

Some women can return to their usual activities after just 1 to 2 days; for others it may take a few weeks until the bleeding stops and the whole process is complete.

During this time, it's important that you:

• keep an eye on any symptoms.
• watch out for any signs of complications.
• follow your doctor's advice.
• speak to a professional if you need support in processing your feelings and your experience.
• get plenty of rest to give your body the time it needs to recover.
• avoid heavy lifting and intense physical exertion in the first few days.
• drink enough fluids and nourish yourself well with a balanced, nutrient-rich diet.
• avoid sexual intercourse for around 2 weeks or as advised by your doctor, as the risk of infection is higher while the womb is still sensitive.
• don't use tampons, but rather organic pads with suitable absorbency, until the bleeding stops.

How long after a medical abortion does your period return? 

After a medical abortion, menstruation usually returns after around 4 to 6 weeks. If your period hasn't arrived after these 6 weeks, speak to your doctor about it.

The first period after an abortion may be heavier or lighter than usual and may be accompanied by more intense cramping.

Frequently asked questions about medical abortion 

A medical abortion is a safe way to end a pregnancy in the first weeks – but an important prerequisite is being well prepared and correctly informed. Below you'll find short, clear answers to the most common questions on this topic.

Can you get pregnant after a medical abortion? 

Yes, ovulation resumes as early as 2 to 3 weeks after the abortion, and a new pregnancy can occur during the following cycles. If you don't want to become pregnant, speak to your doctor about choosing a suitable method of contraception.

Is a medical abortion possible after 9 weeks of pregnancy? 

As a rule, a medical abortion is possible up to week 8 to 10 of pregnancy. However, the further along the pregnancy is, the less effective the procedure becomes. From week 9 onwards, a medical examination is needed to determine whether a medical abortion is still possible or whether a surgical procedure is the safer option.

Is a medical abortion painful? 

You may feel cramping and discomfort similar to a heavy period, but the intensity varies from woman to woman. Alongside rest and a warm heat pad, your doctor can recommend painkillers if the pain is severe.

Is there a risk that a medical abortion won't work? 

A medical abortion is an effective method. In around 2 to 5% of cases, however, the abortion may be incomplete, meaning further procedures are needed. It's important to follow all medical advice carefully to avoid the procedure failing and to prevent complications.

How safe is a medical abortion? 

A medical abortion is considered a safe and effective method when carried out early in pregnancy and under medical supervision. Studies show an effectiveness of 95 to 98%.

Where can you have a medical abortion safely?

A medical abortion can be carried out at home following your gynaecologist's instructions – provided you can quickly reach a medical facility in an emergency. However, it's advisable to have the procedure arranged through the NHS or an approved provider such as BPAS or MSI Reproductive Choices, where you'll be supported by appropriately trained medical staff.

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