Recent changes to Australian laws now make it possible for all GPs to prescribe the abortion pill (aka a medical termination or medical abortion) and all community pharmacies to dispense it from August 1, 2023. To find out more, we asked General Practitioner Dr Claire Mohr who provides non-directive pregnancy counselling and abortion care, to explain how a medical abortion works.
What is the abortion pill?
“The abortion pill is actually a set of two different medications,” Dr Mohr says. “Step one is mifepristone which stops a pregnancy from progressing. Step two is misoprostol which causes the pregnancy to be expelled from the uterus.”
In Australia, mifepristone and misoprostol are available as a combined composite pack with the brand name MS-2 Step, available on prescription for dispensing from a community pharmacy or via an abortion provider.1-2 Together, these medications will induce a medical abortion and may only be used during the first 63 days (nine weeks) of pregnancy.
What are the advantages of a medical termination over a surgical abortion?
More widely available and less costly than a surgical abortion, a medical abortion allows the procedure to happen at home rather than in a healthcare setting. “A medical abortion provides some advantages over a surgical abortion,” Dr Mohr says. “A medical abortion is typically cheaper and quicker to access, means you can have your abortion in the comfort of your own home, and avoids having to have an anaesthetic. It also means that for a lot of women they no longer have to travel to a major city for their abortion care as they can access care via telehealth.”
How do I get the abortion pill in Australia?
“The abortion pill in Australia can be prescribed by a GP or a gynaecologist,” Dr Mohr says. “While any GP can prescribe the medication, some may not feel comfortable prescribing it if they are not familiar with all the details, however they should be readily able to refer you on to a colleague who is able to prescribe. Some women choose to access their medical abortion through a dedicated termination clinic.”
Once you have the prescription, you take it to a community pharmacy for dispensing. The pharmacist can provide additional counselling to make sure you know how to take the medication and answer any questions.
How much does the abortion pill cost in Australia?
“The cost of an abortion varies greatly depending on who is providing the service,” Dr Mohr says. “Your local GP may charge $150 to $300 out of pocket for the appointments associated with having a termination.”
The combined mifepristone and misoprostol (MS-2 Step) composite pack is available from pharmacies on the PBS.
“The medication cost is $30 [or $7.30 for concession card holders],” Dr Mohr says. “You also need to take into account the cost of an ultrasound and any supportive medications such as anti-nausea medication and pain relief. If you do not have access to Medicare then costs can be much higher.”
Do I need to have an ultrasound before having a medical termination?
“An ultrasound is essential prior to having a medical abortion,” Dr Mohr says. “It is necessary to confirm that the pregnancy is at the right stage and is located within the uterus. The earliest that an USS [ultrasound scan] can detect an intrauterine pregnancy will be at around 5 weeks and 4 days of gestation. Most abortion clinics and a few GPs will have an ultrasound in their clinic.”
Can anyone take the abortion pill?
“There are very few reasons why someone cannot take the abortion pill,” Dr Mohr says. “Contraindications include having a known bleeding disorder, being on blood thinners, having chronic adrenal failure, or having a disease requiring regular long term oral steroids.”
When should it be prescribed and taken?
“Step one, mifepristone, can be taken up to and including 63 days (or 9 weeks) of pregnancy, calculated from the first day of the last menstrual period,” Dr Mohr says. “Step two, misoprostol, is then taken 36 to 48 hours later.”
How is the abortion pill taken?
It’s essential to take both medications in the correct order, as prescribed. First, you take mifepristone, a single 200mg tablet.1-2 “The step one tablet is swallowed with a glass of water,” Dr Mohr says.
Then, 36 to 48 hours later, you take the second medication, misoprostol, which comes in the pack as four 200mcg tablets.2 “For step two, the four tablets are placed between the cheek and lower gums (two on each side) and allowed to dissolve over 30 minutes,” Dr Mohr says. “Any remaining remnants of these tablets are then washed down with a glass of water.”
What happens after taking the abortion pill?
“The abortion pill is a two-step process, with the first step (mifepristone) blocking the progesterone production that is required to support a pregnancy,” Dr Mohr says. “The second step (misoprostol) softens and dilates the cervix and causes the uterus to contract to expel the pregnancy products.”
Is a medical termination painful?
“Having a medical abortion will be painful for most women, and is typically more painful than a painful period,” Dr Mohr says. “However, it can be effectively managed with prescription pain medication from your GP when they prescribe your abortion pill. You can also use heat packs and a hot shower to manage symptoms.” Some women prefer to have a support person with them during a medical abortion.
How long is the recovery following a medical termination?
“It is recommended you stay at home on the day of taking step two of the medication (misoprostol),” Dr Mohr says. “Typically you will pass the products [of pregnancy] within a few hours of taking the medication and then bleeding will gradually slow down after this. Many people are ready to resume normal activities in about 24 hours, however some may need an extra day or two to recover. Bleeding can continue for up to four to six weeks post a medical abortion, however after the first two weeks it should be very light and manageable.”
Why is it necessary for me to be able to access emergency medical care?
“There are some complications that can develop in the two weeks following a medical abortion, including severe or prolonged bleeding and pelvic infection, therefore ready access to medical care is important,” Dr Mohr says.
What follow up care is required?
“Follow up is essential to ensure the abortion was successful,” Dr Mohr says. “Bleeding on its own is not confirmation that there is no longer a progressing pregnancy. Typically, your doctor will arrange some form of follow up pregnancy hormone test (either a blood test or a special urine pregnancy test). Follow up can be done via telehealth in most circumstances. Ultrasound for follow up is not required unless there is a concern about complications.”
Is the morning after pill and the abortion pill the same thing?
The abortion pill is prescribed to pregnant women seeking to terminate a confirmed pregnancy up to nine weeks since the first day of the last menstrual period. In contrast, the morning after pill is taken by a non-pregnant woman. Taken after unprotected sexual intercourse but before ovulation, the morning after pill is designed to stop pregnancy from occurring.3 “The morning after pill is dose of progesterone that delays ovulation which allows the sperm in the genital tract to die off and therefore prevent conception,” Dr Mohr says. “It only works if it is taken prior to ovulation.”
Is the morning after pill abortion?
No. The morning after pill is only effective at preventing pregnancy before ovulation occurs.3 It does not cause a medical abortion if pregnancy has already occurred.
Will taking the abortion pill impact my fertility in future?
“No, if pregnancy is desired at another time there is no impact upon fertility after using the abortion pill,” Dr Mohr says. “In fact, fertility returns incredibly quickly and therefore it is recommended to think about your contraceptive requirements prior to resuming sexual intercourse.”
Talk to your GP about starting contraception at the same appointment you discuss the abortion pill abortion. Some hormonal contraception options including the combined oral contraception (COC) or progestogen-only pill can be taken from the day after starting a medical abortion and become effective immediately if the first active pill is taken within five days of mifepristone.2
How soon after a medical abortion can I have sex?
To reduce risk of infection after taking the abortion pill, wait at least one week before sexual intercourse.
“It is recommended to not put anything in the vagina for the seven days after passing the products of the pregnancy, this includes having intercourse, using tampons or menstrual cups, swimming or having a bath,” Dr Mohr says.
What are the side effects?
“The abortion pill will give some side effects such as diarrhoea, nausea or vomiting and fever or chills for the 24 hours after taking step two (misprostol),” Dr Mohr says. “Otherwise, there are minimal side effects from the medication itself. Most side effects are related to the passing of the pregnancy (pain, cramping, bleeding), or residual effects of pregnancy such as breast tenderness which can take a few days to settle down. There is no long-term impact to reproductive health.”
Is the abortion pill available to under 18s?
“The abortion pill can be prescribed to anyone who is pregnant, including patients who are under 18,” Dr Mohr says. “Depending on the state in which you live there may be different rules that the GP must abide by when it comes to prescribing the abortion pill regarding the type of consent required and who needs to be notified.”
Where can I get support after a termination?
Contact your GP or access the MSI Australia 24-hour aftercare telephone service on 1300 888 022
References
1. NPS Medicinewise. Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for terminating early pregnancy. February 16, 2015. Accessed July 14, 2023. https://www.nps.org.au/news/mifepristone-mifepristone-linepharma-followed-by-misoprostol-gy-miso-for-terminating-early-pregnancy
2. Therapeutic Guidelines. Medical abortion. July 2021. Accessed July 14, 2023. https://tgldcdp-tg-org-au.eu1.proxy.openathens.net/viewTopic?etgAccess=true&guidelinePage=Sexual%20and%20Reproductive%20Health&topicfile=medical-abortion&guidelinename=Sexual%20and%20Reproductive%20Health§ionId=toc_d1e1302#toc_d1e1302
3. Black KI, Hussainy SY. Emergency contraception: oral and intrauterine options. Australian Family Physician. 2017. Accessed July 14, 2023. https://www.racgp.org.au/getattachment/2e03346b-631e-4bab-9e7d-256fecfcd77c/Emergency-contraception-Oral-and-intrauterine-opti.aspx
