What’s the difference between medical abortion and surgical abortion?

In Australia, around one in four people who are able to get pregnant will have a medical or surgical abortion in their lifetime.

Both options are safe, legal and effective. The choice between them usually comes down to personal preference and availability.

So, what’s the difference?

What is a medical abortion?

A medical abortion involves taking two types of tablets, sold together in Australia as MS2Step.

The first tablet, mifepristone, stops the hormone progesterone, which is needed for pregnancy. This causes the lining of the uterus to break down and stops the embryo from growing.

After taking mifepristone, you wait 36–48 hours before taking the second tablet, misoprostol. Misoprostol makes the cervix (the opening of the uterus) softer and starts contractions to expel the pregnancy.

It’s normal to have strong pain and heavy bleeding with clots after taking misoprostol. Pain relief including ibuprofen and paracetamol can help.

After two to six hours, the bleeding and pain usually become like a normal period, although this may last between two to six weeks.

Haemorrhage after a medical abortion is rare (occurring in fewer than 1% of abortions). But you should seek help if bleeding remains heavy (if you soak two pads per hour for two consecutive hours) or if you have have signs of infection (such as a fever, increasing abdominal pain or smelly vaginal discharge).

Do I have to go to hospital?

It is legal to have a medical abortion outside of a hospital up to nine weeks of pregnancy.

Depending on state or territory law, the medication can be prescribed by a qualified health-care provider such as a GP, nurse practitioner or endorsed midwife. These clinicians often work in GP surgeries or sexual and reproductive health clinics and they may use telehealth.

Medical abortions also occur after nine weeks of pregnancy, but these are done in hospitals and overseen by doctors alongside nurses or midwives.

Medical abortions after 20 weeks are done by taking medications to start early labour in a maternity unit. Often, medications are first given to stop the foetal heartbeat so it is not born alive. Then, other medications are given to manage pain.

These types of abortions are very rare. They may be used when an obstacle has prevented someone accessing an abortion abortion earlier, continuing with the pregnancy is dangerous for the pregnant person’s health or if there is a serious problem with the foetus.

What is a surgical abortion?

Surgical abortions are performed in an operating unit, usually with sedation, so you will not remember the procedure. Surgical abortions are sometimes preferred over medical abortions because they are quicker. But the decision should be between you and your health-care provider.

In the first 12–14 weeks of pregnancy, a surgical abortion takes less than 15 minutes and patients are usually discharged a few hours after the procedure.

Medications may be given before surgery to soften and open the cervix and to ease pain. During the procedure, the cervix is gently stretched open and the contents of the uterus are removed with a small tube. This procedure is carried out by trained doctors with the assistance of nurses.

Surgical abortions after 12–14 weeks are more complex and are performed by specially trained doctors. Similar to medical abortions, medications may be given first to stop the foetal heartbeat.

It is normal to experience some cramping and bleeding after a surgical abortion, which can last about two weeks. However, like medical abortion, you should seek help for heavy bleeding or signs of infection.

Do I need an ultrasound?

It used to be common before an abortion to have an ultrasound scan to check how far along the pregnancy was and to make sure it was not ectopic (outside the uterus).

However, this is no longer recommended in the early stages of pregnancy (up to 14 weeks) if it delays access to abortion. If the date of the last menstrual period is known and there are no other concerning symptoms, an ultrasound scan may not be necessary.

This means people can access medical abortion much sooner, even from the first day of a missed period, without waiting for the embryo to be big enough to be seen on an ultrasound scan. This is called “very early medical abortion”.

Before and after care

Before having an abortion, a health-care provider will explain common side effects and when to seek urgent medical attention. For people who want it, many types of contraception can be started the day of abortion.

Even though the success rate of medical abortion is very high (over 95%) it is routine to make sure the person is no longer pregnant.

This is usually done two to three weeks after taking the first tablet mifepristone, either by a low-sensitivity urine pregnancy test (which you can do at home) or a blood test.

In the rare case a medical abortion has not worked, a surgical abortion can be done.

Sometimes after a medical or surgical abortion, tissue is left behind in the uterus. If this happens you may need another dose of misoprostol (the second tablet) or a surgical procedure to remove the tissue.

Some people may also seek support-based counselling or peer support to help them work through the emotions that might accompany having an abortion.

Understanding the differences and similarities between medical and surgical abortions can help individuals make informed decisions about their reproductive health.

It’s important to speak with an unbiased health-care provider to discuss the best option for your circumstances and to ensure you receive the necessary follow-up care and support.