Most women determine that they are pregnant if they are sexually active and have missed a period. Nausea, breast soreness, and fatigue are also common symptoms in early pregnancy. Ultrasound or pregnancy tests are the only ways to immediately be sure that a woman is pregnant.If an ultrasound is performed, the doctor can tell a woman exactly how long she has been pregnant. The doctor can also estimate the length of the pregnancy without using ultrasound. A pregnancy test cannot provide this information.
A woman can also make a reasonable calculation of about how long she has been pregnant. She must figure out when the first day of her last menstrual period was, include that day and start counting up until today.
more scientific information:Studies show that women are capable of doing this on their own.A study was carried out to see if women in the United Sates and India could calculate how long they had been pregnant. The women were given calendars and worksheets to help them do the calculations. 98 out of every 100 women in the study group in the U.S. and 87 out of every 100 women in the study group in India were able to estimate how long they had been pregnant. Approximately 9 out of 10 women could estimate the lengths of their pregnancies accurately enough to use mifepristone and misoprostol on their own. The researchers concluded, “The vast majority of women seeking first-trimester abortion in this study could accurately calculate pregnancy duration within a margin of error clinically inconsequential for safe use of unsupervised medical abortion. Most of the women’s estimates were within 1 week of the actual length of their pregnancy. This was “well within the documented margin for safe and effective medical abortions
How many weeks into your pregnancy can you do a medical abortion?
You can do a medical abortion treatment until the 9th week of your pregnancy.
More scientific information:Medical abortion was first offered for terminating pregnancies in the early first trimester (some regulations required pregnancies to be seven weeks or less, and others required nine weeks or less). It has now been shown to be effective through the first trimester (12 weeks) and has been successfully used during the second trimester 13 . In 2004, “The Royal College of Obstetricians and Gynaecologists evidence-based clinical guidelines stated that the medical regimen using Mifepristone in combination with Misoprostol would be a safe and effective alternative to surgery for women undergoing abortion at 9-13 weeks’ gestation 20 .
After 9 weeks, women who have medical abortions have a higher risk of complications. The 9 week limit is also supported by other health professionals worldwide. An official statement issued at an international conference on medical abortion in 2004 said, “For abortions up to nine weeks, the pills can be provided through primary health care services and women can safely use the method at home or in a clinical setting, according to their own preferences and personal circumstances. Medical abortion after nine weeks and in the second trimester can be carried out in a health centre or hospital 4 .
What will happen if you do a medical abortion after the first 9 weeks?
If you have been pregnant for longer than 9 weeks and do a medical abortion anyway, the medicines still work and cause an abortion. However, the risk of complications increases and it is more likely that you will need to receive treatment from a doctor afterwards (See the table below on complications to determine the exact amounts of increased risk.) If you have no other means, doing the medical abortion is still much safer than dangerous methods for causing an abortion, such as inserting sharp objects into the vagina, ingesting toxic chemicals such as bleach, or punching the abdomen. You should never use these dangerous methods!What if you are not pregnant but take the medicines anyway?
Your health will not be harmed if you are not pregnant but take the medicines anyway.
What are hCG levels during pregnancy?
hCG levels in weeks from Last Menstrual Period :
3 weeks LMP: 5 - 50 mIU/ml4 weeks
LMP: 5 - 426 mIU/ml5 weeks
LMP: 18 - 7,340 mIU/ml6 weeks
LMP: 1,080 - 56,500 mIU/ml7 - 8 weeks
LMP: 7, 650 - 229,000 mIU/ml9 - 12 weeks
LMP: 25,700 - 288,000 mIU/ml13 - 16 weeks
LMP: 13,300 - 254,000 mIU/ml17 - 24 weeks
LMP: 4,060 - 165,400 mIU/ml25 - 40 weeks LMP: 3,640 - 117,000 mIU/ml
These numbers are just an indication, every woman’s level of hCG can rise differently.
Most women can expect their levels to return to a non-pregnant range about 4 - 6 weeks after an abortion.
What if I have a RH - bloodtype?
Usually doctors advice women who have an (surgical) abortion or miscariage or delivery to take an injection with anti D globuline. The reason is that if the fetus has a positive bloodtype and if there is an exchange in blood the woman can make antibodies in her blood that can affect the next born baby. However research with early medical abortion and first trimester (first 12 weeks) spontaneous abortions have shown that no or very little exchange in blood between the woman and the fetus takes place and that the a woman does not make any significant amount of antibodies that could affect the next fetus (62). So we do not advice you to get an injection with anti-d globuline. But if you feel unsure, you should to a doctor or hospital shortly after having the medical abortion, say you had a miscarriage and that you are rhesus -, the doctor might decide or not that he thinks he should give anti-d globuline anyway depending on his opinion.
There is minimal evidence that administering Rh immune globulin for first trimester vaginal bleeding prevents maternal sensitization or development of hemolytic disease of the newborn. The practice of administering Rh immune globulin to Rh-negative women with a first trimester spontaneous abortion is based on expert opinion and extrapolation from experience with fetomaternal hemorrhage in late pregnancy. Its use for first trimester bleeding is not evidence-based (62).
When should you not use the medicines?
you should not use the medicines if:
someone is forcing you to end your pregnancy.
you are not sure about wanting to end your pregnancy.
the first day of your last menstrual period was more than 9 weeks ago.
you have an allergy to Mifepristone, Misoprostol, or prostaglandins
you have one of the following diseases: Chronic adrenal failure, Hemorrhagic disorders or bleeding disorders/diseases, Inherited porphyries. (It is highly unlikely that you have one of these diseases and do not know it yet.)
you have is an intrauterine device (IUD). This must be removed before using the medicines.
you have an ectopic pregnancy (a pregnancy outside the womb).
you cannot get to a hospital or first aid centre within an hour.
you are alone. You should ask a partner, friend or other trusted person to stay with you while you use the medicines.
What is a contraindication and how do you know if you have one?
Why shouldn't you be alone when you do a medical abortion and what if you do it alone anyway?
You are strongly advised to use the medicines in the presence of someone you trust. However, if you choose to do the medical abortion alone, it is not necessarily hazardous. Make sure you are near a phone or some way of contacting medical professionals. You should consider telling someone (a neighbor, a family member, or someone who is nearby) that you are not feeling well and you are going to rest. You can ask them to check on you later in the day after you use the Misoprostol. This way someone will know if you are experiencing complications and can help you, but they do not have to know that you have done a medical abortion. You can say that you think you have had a miscarriage.
Why should you be within 60 minutes of a hospital or first aid centre when you do the abortion?
It is absolutely necessary to be within one hour of help, in case you lose too much blood. This is also the case when a woman miscarries or gives birth. It is not necessary for you to live in an urban area medical abortion. Almost all areas with internet access will also have a basic first aid centre nearby.Hospitals and first aide centres must have basic medical equipment and staff. This equipment and expertise is the same that is required to care for women who have complications related to miscarriage or birth.
You can use Paracetamol (acetaminophen) or Aspirin (salicylic acid) or NSAID’s like Ibuprofen, Naproxen and Diclofenac. Please read the patient instructions of the package of painkillers you obtained for the maximum dosis you can use.
How should you use the medicines?
To end a pregnancy the medicines should be used in the following way:
First you should swallow one tablet of Mifepristone. This medicine blocks the effects of progesterone, the hormone that is necessary to maintain the pregnancy.
24 hours later you should put 4 tablets of Misoprostol in the space between gum and cheek (the buccal cavity) and keep there there for at least 30 minutes, until the tablets are dissolved. You can swallow your saliva. After 30 minutes you can swallow the remains of the tablets.
4 hours after using the first dose of Misoprostol, you should use 2 more tablets of Misoprostol in the space between gum and cheek (the buccal cavity).
Why should you use Misoprostol buccally, in the space between the gum and cheek?
We strongly advise you to use Misoprostol in the space between your gum and cheek. This way, no remains of the pills can be found in the event that you need to go to a hospital. There are no blood tests that can show that you have taken Mifepristone or Misoprostol, so there will be no way to prove that you tried to do an abortion.
In countries where women can be prosecuted for having an abortion, it is not necessary to tell the medical staff that you tried to induce an abortion. You can say that you had a spontaneous miscarriage. The doctor CANNOT see the difference. The treatment is also the same. The treatment is curettage, also known as vacuum aspiration, during which a doctor will remove remaining tissue from the womb. Doctors have the obligation to help in all cases.
What happens if you do not use Misoprostol in time?
The doctor advises you to use the Misoprostol 24 hours after swallowing the Mifepristone tablet. However it can also be used earlier or later, from 12 hours to 72 hours after swallowing Mifepristone.
What if you take the Mifepristone and then decide not to take the Misoprostol?
If, for some reason, you take the Mifepristone and then decide you will not take the Misoprostol part of the medical abortion regimen, there are a few things that could happen.
1-You might experience a complete abortion without ever taking Misoprostol.
2-You might experience a missed abortion, which means that the fetus is no longer viable, but the products of pregnancy (blood, tissue) do not leave your body. This has to be treated with a vacuum aspiration.
3- It is also possible that your pregnancy might continue. If you decide you want to keep the pregnancy at this point, it is unlikely that the Mifepristone will cause later fetal malformations.
Can you use Mifepristone and Misoprostol if you are still breastfeeding?
It is better not to breastfeed during the first 5 hours after taking Mifepristone and after using Misoprostol. It is best to throw away the milk produced in the first 5 hours.
THE ABORTION PROCESS
After using Misoprostol you should expect bleeding and cramps. Bleeding usually starts within four hours of using the pills, but it sometimes starts later. If you do not start bleeding within the first 4 hours, you should apply another 2 tablets of Misoprostol. Bleeding is often the first sign that the abortion has begun. If the abortion continues, bleeding and cramps become more severe. Bleeding is often heavier than a normal menstruation, and there can be clots. The longer the pregnancy has developed, the heavier the cramps and the bleeding will be. If the abortion is complete, the bleeding and the cramps diminish. The moment of abortion can be noticed with a peak of heavier abortion can be noticed with a peak of heavier blood loss and more pain and cramps.Normally the bleeding will continue lightly for one to two weeks after the abortion, but times may vary. The normal menstrual period usually returns after four to six weeks
Can you see the products of the abortion (placenta, embryo, blood) and what should you do with them?
What are the side effects of the medicines?
More scientific information:Most women will experience pain and cramping during the medical abortion, in particular after using the Misoprostol 26 . In most of the scientific studies on the topic, the majority of women describe the pain as only a little bit worse than the pain they experience during a menstrual period 26 .Some women will experience nausea, vomiting, or diarrhea, but it is thought that this is an effect of early pregnancy as much as it is due to Mifepristone or Misoprostol 26 . Usually these side effects go away by themselves and do not require medical attention 26 . Headache, mild dizziness, fever and hot flashes are symptoms that also should go away by themselves.
What is a complete, successful abortion and how do you know you've had one?
How do you know if you have complications and what should you do?
These are the possible complications, their symptoms and treatment:
Heavy bleeding (occurs in less than 1% of medical abortions)
Symptom: Bleeding that lasts for more than 2 hours and soaks more than 2 maxi sanitary pads per hour. Feeling dizzy or light-headed can be a sign of too much blood loss. This is dangerous to your health and must be treated by a doctor.
Treatment: a vacuum aspiration (curettage.) Very rarely (less than 0.2%) a blood transfusion is needed.
Symptoms: heavy or persistent bleeding and/or persistent severe pain.
Treatment: a vacuum aspiration (curettage)
Symptom: If you have a fever (more than 38 degrees Celsius) for more than 24 hours, or you have a fever of more than 39 degrees, there might be an infection that needs treatment.
Treatment: antibiotics and/or vacuum aspiration.
The symptoms are exactly the same and the doctor will not be able to see or test for any evidence of an abortion, as long as the pills have completely dissolved. If you took the pills buccally, between the gums and the cheek as our protocol recommends, the pills should have dissolved within three hours of taking them. If you took the pills vaginally, you must check with your finger to make sure that they are dissolved. Traces of the pills may be found in the vagina up to four days after inserting them.
Less than 1% of women experience ongoing pregnancy. This can be determined by a pregnancy test after 3 weeks or an ultrasound after 10 days. If the medical abortion treatment failed, there is a slight increase in the risk of birth defects such as deformities of the hands or feet and problems with the nerves of the fetus. To treat an ongoing pregnancy you must repeat a medical or surgical abortion.
More scientific information:
Research has shown that very few serious complications result from medical abortions compared to the number of women who experience successful medical abortions. 16 17 20 21 22 . In the few cases that a surgical intervention such as a curettage (vacuum aspiration) is needed, this can be managed by the same health care facilities that care for women who have had miscarriages.
Legnth of pregancy
% of women who needed further medical care
0- 49 days (0-7 weeks) 2 %
40-63 days (7-9 weeks) 2.5%
64-70 days (9-10 weeks) 2.7%
71-77 days (10-11 weeks) 3.3%
77-84 days (11-12 weeks) 5.1%
85-91 days (12-13 weeks) 8%
(Further medical care consists of vacuum aspiration for a continuing pregnancy or an incomplete abortion.)
How do you know if you have a post-abortion infection?
Infections following medical abortions are very rare. If you feel weakness, nausea, vomiting, diarrhea, fever, pain in your belly, if your belly feels sore or tender, if you bleed a lot or for a long time, or if you have vaginal discharge that smells bad, you might have an infection and you should go to a doctor immediately. The infection should be treated with antibiotics.
Medical abortion is a safer alternative in places where surgical methods are dangerous for a woman’s health, or in places where the availability of safe abortion is restricted. The risk of infection is greater when a woman has a child than when she has a medical abortion.
An incomplete abortion is an abortion that has only been partially successful. The pregnancy has ended— no fetus will develop, but your body has only expelled part of the tissue and products of pregnancy. If you have prolonged bleeding, too much bleeding (much more than a regular menstrual period), pain in your belly that does not go away after a few days of taking the Misoprostol, pain that is unbearable, fever, continued bleeding after three weeks, or pain when pushing on your belly, you may have an incomplete abortion. You must go to a hospital or a doctor to complete the abortion if you have any of these symptoms. This is absolutely necessary because the tissue and blood that remains in the body can cause heavy bleeding or an infection. The treatment of an incomplete abortion is legal everywhere.In countries where women can be prosecuted for having an abortion, it is not necessary to tell the medical staff that you tried to induce an abortion; you can that say that you had a spontaneous miscarriage. There are no tests that can show that a woman has done a medical abortion. It is extremely important to treat an incomplete abortion. The treatment for incomplete abortion is called a vacuum aspiration, or “curettage." Any clinic that can deal with complications of miscarriage can also help women with incomplete abortions, because the symptoms are the same.
How do you know if you have a continuing pregnancy?
What are the chances that the fetus will be malformed if you have an ongoing pregnancy?
If you have an ongoing pregnancy after using Misoprostol, the risk of having a baby with fetal malformations is increased. However, this risk is still small, less than 1 in 1000. This risk is smaller than the normal risk of having a baby with Down Syndrome.
We advise women with ongoing pregnancies to undergo surgical or medical abortions to terminate the pregnancy in order to entirely avoid the risk of having a malformed fetus.
AFTER ABORTION CARE
Most women do not need any psychological help after an abortion. Feelings of regret after abortion are rare. Indeed, the most common emotional response after abortion is relief. Transient feelings of guilt, sadness, or loss are common but most women can overcome negative feelings that might affect them. It is normal to feel emotional after an abortion. While you may experience sadness or sadness or grief, these feelings usually go away after a few days. But in countries where the taboo and social stigma is big, it is more common for women to suffer feelings of guilt and shame.If you are not sure if a medical abortion treatment is right for you, we encourage you to discuss it with a trusted friend.How do women feel after an abortion?
Every woman is unique in how she feels after an abortion. Most women report feeling a sense of relief that they have made the best decision under the circumstances. This is the most common response. For some women, however, abortion can raise a number of emotional responses including sadness, guilt, rage, shame and regret. Some women feel bad about themselves because they don’t feel guilty about having an abortion, but think they should feel guilty. In general, understanding your emotional pain can help you to begin to let go of the grief, guilt, rage or shame you may be feeling. It is important to acknowledge that you are hurting and to take good care of yourself if you are experiencing difficulty.
You are not a bad person because you had an abortion. You are also not alone in having chosen abortion. Many women are surprised to learn that about 46 million women worldwide have abortions each year.
What kinds of things might contribute to a woman feeling distress after an abortion?
You might feel very divided inside about your decision to have an abortion. It may not have been clear to you that abortion was the right decision in your circumstances.You may feel abandoned and alone. Maybe your were hoping the man who got you pregnant would want to have a baby with you. Maybe he was not willing to do that, contributing to your sadness.Perhaps you have low self-esteem and often feel bad about yourself.Other parts of your life may be very stressful — school, your job, your kids etc.
You might fear that you will never again be able to get pregnant. If this is a worry to you, be assured that a safe medical abortion does not cause infertility in the future.
Is it normal to feel depressed after an abortion?In rare cases, women may become clinically depressed after having an abortion. If your feelings are overwhelming and do not seem to be resolving or you are suffering symptoms of depression, you should consult a professional.
There are some factors which are known to contribute to the risk of depression after abortion, including having a history of depression, anxiety or panic. Depression is a very serious illness. It is extremely important that you seek help from a professional such as a doctor, counsellor or therapist if you believe you are depressed.
What is “Post-abortion Syndrome"?
Reliable, unbiased studies have shown that, although psychological disturbances do occur after abortion, they are uncommon and generally mild and short-lived.Most psychiatric experts doubt the existence of “post-abortion syndrome and point out that abortion is not significantly different from any other stressful life experience that might cause trauma in some people.
What can I do to help myself heal after an abortion?
After an abortion, there are concrete things you can do to help you come to terms with your decision. The following suggestions can help you accept and deal with your feelings, make your feelings of sadness go away and help you reach some "closure" to your abortion experience.
Remind yourself that you are brave -- you made a difficult decision.
Remind yourself why you made the decision to have an abortion.
Ask yourself, if you hope to have a planned pregnancy some day, how would it differ from the situation you have just been in?
Write your feelings down in a journal or special book which no one else will see.
Think about things you can do which will make you feel good. Write them down and try to do several of these each day.
Remind yourself of the future. Make a list of things you are looking forward to doing.
Consider creating an "end" to your relationship with your pregnancy by writing a good-bye letter and keeping it in a safe place or burning it.
Practice relaxation exercises to help deal with stress.
Different women have different feelings about and experiences with abortion. Psychological studies show that women do not suffer for prolonged periods of time due to abortions they choose to have. These studies show that women can overcome negative feelings that might affect them. “Multiple studies have demonstrated that feelings of regret after abortion are rare. Indeed, the most common emotional response after abortion is relief. Transient feelings of guilt, sadness, or loss are common, but no evidence indicates that routine counseling is essential or even beneficial in coping with these feelings 1 . Evidence suggests that most women do not need counseling after an ABORTION.
Does medical abortion increase the risk of breast cancer?
No, having an induced abortion does not increase a woman’s chance of developing breast cancer.
Will you be able to get pregnant and have children after a medical abortion?
More scientific info:The results of one study suggest that if a woman who has never given birth has an early medical abortion using Mifepristone, it will not cause problems during a future wanted pregnancy 23 .
A publication intended to help doctors understand induced abortion states, “Induced abortion does not harm a woman’s reproductive capacity. Premature birth, infertility, ectopic pregnancy, spontaneous abortion, and adverse pregnancy outcomes are not increased in frequency after abortion 30 . There is disagreement among researchers as to whether induced abortion increases the chance that a woman will experience the problem of placenta previa in a later pregnancy. Placenta previa is a condition in which the placenta covers all or part of the cervix, or implants at the edge of the cervix. Some studies have shown an increased risk of placenta previa, but others have not 30 .
When can you get pregnant again after doing the medical abortion?
You can get pregnant again immediately after doing the medical abortion. It is very important to start using contraceptives as soon as possible. The contraceptive pill can be started on the first day of the first normal menstruation after having the medical abortion (and after that as well of course) . Condoms can be used immediately. An IUD can also be put in place by a doctor during the first normal menstruation after the medical abortion. (and after that as well of course).
How can you prevent a future unwanted pregnancy?
About 85% of sexually active women who do not use contraceptives become pregnant within a year. A woman can become pregnant while breastfeeding, from about 10 days after childbirth, and even during her menstruation. Withdrawal of the penis prior to ejaculation and periodic abstinence does not prevent pregnancy or spread of sexually transmitted diseases. Here you can read more about several forms of contraceptives.
You can prevent an unwanted pregnancy with:1- Total Abstinence2- Use of contraceptives
If you are sexually active and do not want to get pregnant, always use contraception.
Methods of Contraception:No method of contraception gives 100% protection.The male latex condom is the only contraceptive method considered highly effective in reducing the risk of sexually transmitted diseases (STD's). Birth control pills, Implant and IUDs do not protect against STD infection.
For the Woman
DIAPHRAGM is a rubber disk with a flexible rim that covers the cervix and must be used together with spermicide. It is available by prescription only and must be fitted for size by a health professional. The diaphragm protects for six hours and should be left in place for at least six hours after intercourse but not for longer than a total of 24 hours.
ORAL CONTRACEPTIVES protect against pregnancy by the combined actions of the hormones estrogens and progestin. The hormones prevent ovulation. The pills have to be taken every day as directed and do not work after vomiting or diarrhoea. Side effects of the pill can be nausea, headache, breast tenderness, weight gain, irregular bleeding, and depression.
DEPO-PROVERA is a hormonal contraceptive injected into a muscle on the arm or buttock every three months. The injection must be repeated every 3 months. The menstruation can become irregular and sometimes even absent.
IMPLANTS (such as Norplant or implanon) are made up of small rubber rods, which are surgically implanted under the skin of the upper arm, where they release the contraceptive steroid levonorgestrel. Their protection lasts from 3 to 5 years. Side effects include menstrual cycle changes, weight gain, breast tenderness and loss of bone mass.
IUD is a T-shaped device inserted into the uterus by a health-care professional. The IUD can remain in place for 5- 10 years. IUD’s have one of the lowest failure rates of contraceptive method. Sometimes the IUD can be expelled and a woman has to check each month after her period with her finger if she can still feel the threads of the IUD. Other side effects can include abnormal bleeding and cramps, but this usually only occurs during and immediately after insertion.
FEMALE STERILIZATION is done surgically. The tubes are ligated, preventing the egg-cells from encountering the sperm cells and preventing any future pregnancies. It is a permanent form of contraception.
EMERGENCY CONTRACEPTION must be taken within 72 hours of unprotected sex in order to prevent an unplanned pregnancy. A woman must take 1 Norlevo and a second pill 12 to 24 hours later. Beside Norlevo, most combination (estrogens and progesterone) birth control pills can also be used. Take within 72 hours of unprotected sex. One dose
100 µg ethinylestradiol + 500 µg levonorgestrel (2-4 birth control pills), 12 hours later a second dose.MORNING-AFTER IUD must be inserted within 5 days of unprotected intercourse. The IUD can stay for 5 to 10 years.
For the Man
CONDOMS are usually made from latex rubber and can be used only once. Some have spermicide added to kill sperm. They act as a mechanical barrier, preventing direct vaginal contact with semen, infectious genital discharges, and genital lesions. Condoms are the most effective method for reducing the risk of infection from the viruses that cause AIDS and other sexually transmitted diseases (STD’s). It is important to put a condom on properly before intercourse
MALE STERILIZATION also known as vasectomy, is a quick operation performed under local anaesthesia with possible minor postsurgical complications, such as bleeding or infection. The ability to get an erection and an ejaculation does not disappear. The sperm cells are just a very small part (1%) of the fluid and a man will not notice any difference in ejaculation. The body will absorb the sperm cells
If you do want to become pregnant again after doing a medical abortion, it is also better to wait until after the first normal menstruation, so please use contraceptives until then.