medical abortion medical abortion a medical abortion, also known as medication abortion, occurs when drugs (medication) are used to bring about an abortion. medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage. medical abortions are more common than surgical abortions in most places, including europe, india, china, and the united states. not to be confused with plan b or other types of emergency contraception. medical abortionbackgroundabortion typemedicalfirst useunited states 1979 (carboprost),west germany 1981 (sulprostone),japan 1984 (gemeprost),france 1988 (mifepristone),united states 1988 (misoprostol)gestation3–24+ weeksusagemedical abortions as a percentage of all abortionsfrance76% (2021)sweden96% (2021)uk: eng. & wales87% (2021)uk: scotland99% (2021)united states53% (2020)infobox references mifepristone/misoprostolcombination ofmifepristoneprogesterone receptor modulatormisoprostolprostaglandinclinical datatrade namesmifegymiso, medabon combipackatc codeg03xb51 (who) legal statuslegal status ca: ℞-only uk: pom (prescription only) us: ℞-only eu: rx-only medical abortions are typically performed by administering a two-drug combination: mifepristone followed by misoprostol. when mifepristone is not available, misoprostol alone may be used in some situations. medical abortion is both safe and effective throughout a range of gestational ages, including the second and third trimester. in the united states, the mortality rate for medical abortion is 14 times lower than the mortality rate for childbirth, and the rate of serious complications requiring hospitalization or blood transfusion is less than 0.4%. medical abortion can be administered safely by the patient at home, without assistance, in the first trimester. starting with the second trimester, it is recommended to take the second drug in a clinic or provider's office. medical abortion should not be confused with emergency contraception, which typically involves drugs (such as levonorgestrel or "plan b") taken soon after intercourse to prevent a pregnancy from beginning. drug regimens 200 mg mifepristone and 800 μg misoprostol, the typical regimen for early medical abortion less than 12 weeks' gestation for medical abortion up to 12 weeks' gestation, the recommended drug dosages are 200 milligrams of mifepristone by mouth, followed one to two days later by 800 micrograms of misoprostol inside the cheek, vaginally, or under the tongue. the success rate of this drug combination is 96.6% through 10 weeks' pregnancy. misoprostol should be administered 24 to 48 hours after the mifepristone; taking the misoprostol before 24 hours have elapsed reduces the probability of success. however, one study showed that the two drugs may be taken simultaneously with nearly the same efficacy. for pregnancies after 9 weeks, two doses of misoprostol (the second drug) makes the treatment more effective. from 10 to 11 weeks of pregnancy, the national abortion federation suggests second dose of misoprostol (800 micrograms) four hours after the first dose. after the patient takes mifepristone, they must also administer the misoprostol. failure to take the misoprostol may result in any of these outcomes: the fetus may be terminated, but not fully expelled from the uterus (possibly accompanied by hemorrhaging) and may require surgical intervention to remove the fetus; or the pregnancy may be successfully aborted and expelled; or the pregnancy may continue with a healthy fetus. for those reasons, misoprostol should always be taken after the mifepristone. if the pregnancy involves twins, a higher dosage of mifepristone may be recommended. self-administered medical abortion in the first trimester, self-administered medical abortion is available for patients who prefer to take the abortion drugs at home without direct medical supervision (in contrast to provider-administered medical abortion where the patient takes the second abortion drug in the presence of a trained healthcare provider). evidence from clinical trials indicates self-administered medical abortion is as effective as provider-administered abortion; however additional research is required to confirm that safety is equivalent. the procedure used to administer the two drugs depends on specific drugs prescribed. a typical procedure, for 200 mg mifepristone tablets, is: take the mifepristone take the misoprostol between 24 hours and 48 hours after the mifepristone the pregnancy (embryo and placenta) will be expelled through the vagina within 2 to 24 hours after taking misoprostol, so the patient should remain near toilet facilities at that time. cramps, nausea and bleeding may be experienced while the pregnancy is being expelled, and afterwards to avoid infection, the patient should not use tampons or engage in intercourse for 2 to 3 weeks the patient should contact their provider 7 to 14 days after the administration of mifepristone to confirm that complete termination of pregnancy has occurred and to evaluate the degree of bleeding after 12 weeks' gestation medical abortion is safe and effective in the second and third trimesters. the who recommends that medical abortions performed after 12 weeks' gestation be supervised by a generalist medical practitioner or specialist medical practitioner (in contrast to first trimester, where the patient may safely take the drugs at home without supervision). for medical abortion after 12 weeks' gestation, the who recommends 200 mg of mifepristone by mouth followed one to two days later by repeat doses of 400 μg misoprostol under the tongue, inside the cheek, or in the vagina. misoprostol should be taken every 3 hours until successful abortion is achieved, the mean time to abortion after starting misoprostol is 6–8 hours, and approximately 94% will abort within 24 hours after starting misoprostol. when mifepristone is not available, misoprostol may still be used though the mean time to abortion after starting misoprostol will be extended compared to regimens using mifepristone followed by misoprostol. alternative drug combinations the mifepristone-misoprostol combination is, by far, the most recommended drug regimen for medical abortions, but other drug combinations are available. misoprostol alone, without mifepristone, may be used in some circumstances for medical abortion, and has even been demonstrated to be successful in the second trimester. misoprostol is more commonly available than mifepristone, and is easier to store and administer, so misoprostol without mifepristone may be suggested by the provider if mifepristone is not available. if misoprostol is used without mifepristone, the who recommends 800 μg of misoprostol inside the cheek, under the tongue, or in the vagina. the success rate of misoprostol alone for terminating pregnancy (93%) is nearly the same as the mifepristone-misoprostol combination (96%). however, 15% of the women using misoprostol alone required a surgical follow-up procedure, which is significantly more than the mifepristone-misoprostol combination. a rarely used drug combination for uterine pregnancies is methotrexate-misoprostol, which is typically reserved for ectopic pregnancies. methotrexate is given either orally or intramuscularly, followed by vaginal misoprostol 3–5 days later. the methotrexate combination is available through 63 days. the who authorizes the methotrexate-misoprostol combination but recommends the mifepristone combination because methotrexate may be teratogenic to the embryo in cases of incomplete abortion. the methotrexate-misoprostol combination is considered more effective than misoprostol alone. access to medical abortion both drugs – mifepristone and misoprostol – are no longer covered by drug patents, and hence are available as generic drugs. over-the-counter availability the requirements for a prescription vary widely between countries. many countries make the medical abortion drugs available over the counter, without a prescription, such as china, india, and others. other countries require a prescription (canada, most of western europe, the united states, and others). some countries require a prescription but are lax about enforcing that requirement (russia, brazil, and others). telehealth access telehealth includes access to medical services that the person can perform at home, without in-person visits to clinic or provider offices. people who have used telehealth report being satisfied with the access it provides to abortion services. however, those who might need the service the most (those who are incarcerated, unhoused, or live on low income) are often inhibited from accessing it. telehealth options for people in the u.s. seeking medical abortion include: aid access, plan c, hey jane, choix, just the pill, carafem, and abortion on demand. clinic-to-clinic access in this model, a provider communicates with a patient located at another site using clinic-to-clinic videoconferencing to provide medication abortion. this was introduced by planned parenthood of the heartland in iowa to allow a patient at one health facility to communicate via secure video with a health provider at another facility. this model has expanded to other planned parenthoods in multiple states as well other clinics providing abortion care. direct-to-patient access the direct-to-patient model allows for medication abortion to be provided without an in-person clinic visit. instead of an in-person clinic visit, the patient receives counseling and instruction from the abortion provider via videoconference. the patient can be at any location, including their home. the medications necessary for the abortion are mailed directly to the patient. this is a model, called telabortion or no-test medication abortion (formerly no-touch medication abortion), being piloted and studied by gynuity health projects, with special approval from the u.s. food and drug administration (fda). this model has been shown to be safe, effective, efficient, and satisfactory. complete abortion can be confirmed via telephone-based assessment. in the united states further information: abortion in the united states by state