Overview of medical abortion in primary care
This topic may be relevant for any person who can conceive; this includes cis women, trans men and nonbinary people.
Medical abortion is achieved by a combination of oral mifepristone (a progesterone receptor blocker) and buccal misoprostol (a prostaglandin analogue), available as a composite pack (mifepristone and misoprostol [MS-2 Step]; see Medical abortion regimen). This regimen induces the miscarriage of an intrauterine pregnancy by:
- preventing progesterone from supporting the pregnancy
- softening and dilating the cervix
- increasing uterine contractility.
In the primary care setting, medical abortion is only approved by the Australian Therapeutic Goods Administration (TGA) for intrauterine pregnancies of up to 63 days’ (9 weeks’) gestation, also termed ‘early medical abortion’. This topic does not cover medical abortion for later gestations.
Very early medical abortion refers to medical abortion when an ultrasound has not shown definite evidence of an intrauterine pregnancy. The drug regimens used are the same as for gestations of up to 63 days (9 weeks). Very early medical abortion should only be offered by experienced practitioners, because of the increased risk of an undiagnosed ectopic pregnancy. Alternatively, abortion can be deferred until ultrasound confirms that the pregnancy is intrauterine.
Nondirective counselling about pregnancy options may be beneficial for some individuals, particularly those at increased risk of distress, to assist their decision on whether to proceed with an abortion. It can be undertaken by a suitably trained GP, psychologist, social worker or nurse.
Risk factors for heightened distress associated with abortion include:
- coercion
- personal, family or cultural values conflicting with abortion
- extreme ambivalence about the decision
- lack of support identified by the individual
- underlying issues such as mental health or domestic violence
- a previously wanted pregnancy and changed circumstances.
In making a decision to proceed with a medical abortion, an individual needs an understanding of how it compares to a surgical abortion (outlined in Comparison of potential advantages of medical and surgical abortion) and a realistic expectation of what is involved; see also Regulatory and legal requirements for medical abortion.
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Medical abortion |
Surgical abortion |
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usually avoids invasive procedures and potential surgical complications (eg uterine perforation, anaesthetic risk) [NB1] may be safer for individuals with obesity or distortion of the uterine cavity may be more widely accessible usually less costly usually allows abortion to take place at home seen by some individuals as a more natural and less medical process |
less likely to require subsequent evacuation of retained products [NB1] requires only one appointment and is usually performed under sedation causes less pain; bleeding resolves in a few days rather than weeks less risk of severe bleeding and access to emergency care not usually required avoids potential distress of seeing the gestational sac |
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Note: NB1: In 3 to 5% of medical abortions and less than 1% of surgical abortions, subsequent surgical evacuation of retained products of conception is required.
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Individuals undergoing abortion (medical or surgical) have an increased risk of future unplanned pregnancy. It is important to discuss contraception as part of the management plan. Contraception may be started at the consultation in which medical abortion drugs are prescribed, or considered at the follow-up consultation. See Contraception after medical abortion for more information.