A study published Tuesday in the journal BMJ Sexual and Reproductive Health found that many women were surprised by the amount of pain they experienced during medical abortions.
More than 60% of abortions in the United States are medication abortions, which involve taking two drugs (often at home) to end a pregnancy. The study of women in the UK found that many women felt unprepared for the level of pain they might feel during surgery.
Pain does not mean the procedure is unsafe, but some women may be caught off guard based on the information given by their health care provider.
Dr. Alyssa Colwill, associate professor of obstetrics and gynecology at the Oregon Health & Science University School of Medicine, said, “There is some recognition in the gynecology world right now that patients feel pain during surgery.” Not involved in new research.
For the study, researchers looked at survey responses from around 1,600 women in the UK who had undergone medical abortions, answering questions about their experiences. The majority were between 20 and 39 years old, and half had never given birth.
More than 90% of respondents ranked their pain at least 4 out of 10, and about half said their pain was greater than they expected. About 40% said their pain was severe, with a score between 8 and 10 on the pain scale.
In both the UK and the US, women are often told to expect pain similar to strong menstrual cramps during medical abortions. Although some respondents felt this was an accurate description, they felt unprepared and the pain aspect of medical abortion was “sugar-coated” or downplayed.
One woman who responded to the survey said: “The pain was so much stronger than period pains, it felt like I was having labor contractions.” It wasn’t much different than normal labor.”
Another said: “I think it’s worth reassuring people that just because they say[the pain]is bad doesn’t necessarily mean it will be.” I spent more time than that.”
Researchers believe that women should receive detailed, realistic pain counseling and general preparation advice, including details from first-hand experience that demonstrate the range of pain women can experience during medical abortions. I concluded that I wanted it.
“It’s important to acknowledge that everyone experiences pain during a medical abortion differently,” the study’s lead author, Hannah McCulloch, an evaluation researcher at the British Pregnancy Advisory Group, wrote in an email. . “To provide meaningful, patient-centered care, it is important to be realistic about what women experience during medical abortions.”
In a medical abortion, you take two tablets. The first, mifepristone, blocks the hormone progesterone, which is essential for the continuation of a pregnancy. Colwill says that if you take mifepristone and then take a second drug (usually misoprostol) a day or two later, your uterus will cramp and soften, causing your cervix to dilate and prevent pregnancy. It is possible to pass, usually within 24 hours after taking misoprostol.
“That process of the uterus spasming and expelling the pregnancy is inherently painful,” she says, adding that many factors play into how much pain each person experiences. Ta.
Colwill said women who report pain relief from medical abortion include those who have gone into labor or had a vaginal birth, or those with endometriosis or other conditions that cause monthly painful periods.
“Understanding these past experiences and how they experience pap smears and vaginal exams can help patients better support what pain is like for them,” she says. added that they did not feel adequately equipped to deal with pain during medical abortions, which they noted was not surprising to see many women doing so.
Medication abortion is a very safe procedure. According to the drug’s label, fewer than 0.5% of people who take Mifeprex, the brand-name version of mifepristone, experience serious side effects and are less likely to have an abortion on their own since the Supreme Court struck down Roe v. Wade. The number of women managing is increasing. 2022.
“Patients need to be fully informed about what to expect and taught what we know about how to manage pain. “It’s neglected in human medicine,” said Dr. Daniel Grossman, professor of obstetrics and gynecology and director of the New Standards in Reproductive Health initiative at the University of California, San Francisco.
Grossman said that even if abortion pills are available through telemedicine, women should receive counseling about what will happen during the abortion and how to treat the severe pain and nausea that can occur during the abortion procedure. Ta. She says the best advice for managing pain during a medical abortion is to take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, at the same time as misoprostol. If possible, you may also want to take an anti-nausea medication, such as metoclopramide, which is available by prescription.
Colwill said acetaminophen, or Tylenol, is an option, but NSAIDs are better at blocking this particular pain.
Placing a heating pad, hot water bottle, or over-the-counter transelectrical nerve stimulation pads on the lower abdomen can “confuse” the nerves in the area and relieve pain, Grossman said.
He said it was also important to understand what pain was “normal” and when to seek medical help, especially in situations where people were homebound.
For example, pain in the center of the lower abdomen is normal, but pain in the lower abdomen or on one side only can be a sign that something is wrong, such as an ectopic pregnancy or a life-threatening condition when the fertilized egg implants. There may be. outside the uterus.
If you experience severe pain on one side of your abdomen or pelvis, you should go to the emergency room, Grossman says. “If you have mild to moderate pain on one side, you might try to talk to a clinician over the phone first, but if you have any questions you should go to the emergency department,” he added. .
Although ectopic pregnancies can be detected by ultrasound, “many people have medical abortions without ultrasounds, and they can even be missed by ultrasounds,” Grossman said.
According to the Food and Drug Administration, medical abortions are not effective for ectopic pregnancies.
She said pain that occurs more than 24 hours into the pregnancy could be a sign of an infection, especially if you have a fever and vomiting.
She added that women should not underestimate the importance of emotional support. “Feeling supported and having someone there for you makes a huge difference.”
