Early Options: Features of Medical and Surgical Abortion

Early Options - A Provider's Guide to Medical Abortion

After reading this page, you should be able to answer the following question:
Which features distinguish surgical abortion from medical abortion?

Many of the women who receive counseling and choose abortion will present early enough in pregnancy to be eligible for either medical abortion or vacuum aspiration. Practitioners need to explain the similarities of and differences between the methods clearly to enable women to make informed choices. Click here to view Figure 1.

Medical abortion is perceived by some women as less invasive because the "procedure" involves swallowing pills, inserting tablets into the vagina, or having an injection. Women who have a medical abortion usually avoid the instrumentation and anesthesia associated with vacuum aspiration.

The duration of the procedure and the number of visits required also differ. Early vacuum aspiration usually takes place during one visit and the procedure itself generally is completed in 5 to 10 minutes.

In contrast, medical abortion usually requires a minimum of two visits, depending on the protocol used. Medical abortion patients take medications on two separate occasions, and, although the majority of women will abort within 24 hours of taking the second medication (misoprostol), it may be a few days and sometimes a few weeks from the time the woman takes the first medication before she has confirmation from her health care provider that the abortion is complete.

The degree of patient participation and requirements for follow-up also differ between the two methods. The medical approach involves active participation by women throughout a multiple-step process and some women feel it gives them more autonomy. With vacuum aspiration, more control resides with the clinician who performs the procedure.

While vacuum aspiration does not require a follow-up visit in all cases, follow-up to ensure completion is essential with medical abortion. Practitioners should note that treatments involving methotrexate, vaginal misoprostol, and home administration of misoprostol are off-label, evidence-based uses not included in the FDA-approved medical abortion regimen.

Both medical abortion and vacuum aspiration are associated with high rates of success (95% to 99% and 99%, respectively) and both can be performed safely during early pregnancy.^2-4 However, some medical facilities may not offer vacuum aspiration before 7 weeks' gestation.⁵

The woman's perception of privacy is another feature that distinguishes medical abortion from vacuum aspiration. Some women may feel that, because medical abortion involves using medications, which may be taken at home, rather than undergoing a procedure in a medical facility, it affords greater privacy.

On the other hand, women may have difficulty concealing the fact that they are experiencing the equivalent of a (medically induced) miscarriage at home. When this is a concern, a vacuum aspiration performed during a relatively brief office visit may offer more privacy than a medical abortion.

Click here to check your understanding.

Proceed to Issues and Challenges of Abortion Counseling.

References for this module