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Medical Abortion

What is a Medical Abortion?

A pregnancy that is terminated through the use of medicines or pills is known as a medical abortion. It sounds simple, but it is important to know that abortion pills are not 100% effective, that you will need to know exactly how far along you are, that you will need to suffer a miscarriage - which may not always end well. Some 10% to 15% of such miscarriages may end up with complications – necessitating more traumatic womb surgery to clean retained pieces of the pregnancy.

How Does a Medical Abortion Work?

In Singapore, a medical abortion has been possible for decades with the use of a medication called misoprostol (Cytotec). This medicine has been approved for use to treat and prevent stomach ulcers – not for abortions. It has a side effect of causing spasms of the womb – which proves to be useful for pregnant women wanting abortions – so please note that it is an ‘off label’ use of the drug. When used alone for abortion, it is a much more painful method of causing a miscarriage since it essentially causes the womb to go into contraction to literally ‘squeeze’ the pregnancy out of your womb. Since it is low cost, it is widely used around our region for abortion purposes.

More recently, a much more specific abortion medication which can directly target pregnancy cells has been made available. However, it is much more costly. It is called Mifepristone, but also known as RU-486 or Mifegyne.

For best results, both medicines need to be taken in combination. The ‘gold’ standard needs a regimen of up to 13 tablets taken in combination, over an 8-hour period. However, such a combination can be rather expensive and can cost up to $1,000. Requests for lowering of costs can be done – but the result also means that abortions are less likely, less successful or even incomplete

Can I buy the tablets for Medical Abortion without seeing the doctor?

Those who think that one can just go to any doctor to buy these tablets have completely the wrong concept of abortion in Singapore. It's not a matter of buying the medicines and then taking the medication by yourself without any consultation, examination or counselling. You need to be properly assessed by qualified specialists who are licensed to practise abortions, and go through the same counselling process with the mandatory two-day waiting period. Next the entire process needs to be properly supervised - otherwise you could end up with many more problems and complications.

Cramping and vaginal bleeding are the most common side effects after having a medical abortion. These are normal and should stop after a few days or weeks. However, do not assume that having these two symptoms means that a miscarriage has occurred. Many women with ongoing pregnancies can also experience such symptoms. If symptoms such as a fever, vomiting, diarrhoea, persistent headaches, heavy bleeding, and abdominal and back pain are present, immediate medical attention should be sought.

What happens after I take the tablets for Medical Abortion?

Compared to a surgical aspiration of your womb which can be performed painlessly, after which you can go home confident that the doctor has cleansed your womb, a medical abortion requires you to come back repeatedly to see the doctor to (1) ensure that the abortion pills has been successful, (2) that assess that your miscarriage has been successful, and (3) that you do not suffer from complications like incomplete miscarriage, retained placental tissues or infections.

What is the price of the tablets for Medical Abortion?

The price of an abortion pill in Singapore is determined by many factors, especially the type of drug combination taken. Single drug regimens (especially in lower doses) can reduce the price, but also the success. However, even taking the optimal combination of two drugs in the best doses will not guarantee success. The type of clinic or hospital (private or public) you go to, the doctor’s professional fee, the length of pregnancy and so on also influence the price. Most of all, if you suffer any complications from taking the pills – like if it simply doesn’t work for you or if there are incomplete miscarriages, then the resulting corrective surgery required may mean much more costs and complications than just having the surgical cleansing done directly in the first place. So, the price can vary from $1,000 to $4,500 depending on whether you respond to the pills, and whether there are any complications from the miscarriage and therefore treatment needed for these complications.

The cost of a medical abortion therefore depends on your response to the abortion drugs and your ‘luck’. It could be less, but it could also be much more. An early surgical abortion would cost about $2,000 whilst a simple medical abortion would cost about half that amount. However, one needs to be prepared that the medicines do not work, and also to suffer the pain and stress of a miscarriage. Having more follow-ups adds to the costs. Also, if the medicines do not work (as in 10% of cases) or if there is prolonged bleeding, then surgical cleaning (D&C procedure) is needed – then this adds to the costs and you will end up paying much more than just a simple surgical procedure to start with. So, if you’re ‘unlucky’ – the method abortion route would be more complicated, expensive and stressful.

Why is Medical Abortion Performed?

Some patients prefer a medical abortion because the process can be done in the comfort of their home, and without having to undergo surgery. Some may also prefer how it feels more “natural”, as the experience is akin to a miscarriage. It is also less expensive as it does not require surgery or anaesthesia.

However, the above are ideal outcomes. The truth is that medical abortions are not without their downsides, which your doctor will explain to you and help you come to an informed decision. Miscarriages seldom end quickly and may result in many days and nights of pain and heavy bleeding. Trying to achieve such natural outcome in a miscarriage can often lead to more stress, more pain and more complications.

The best comparison is with childbirth – natural childbirth in a home setting versus a surgical birth in a hospital. Pain and stress are obviously much more at home, and a normal birth may not result with complications if they occur being much more dangerous. In comparison, a Caesarean birth is usually painless and complications better managed in the hospital.

Who Should Get a Medical Abortion?

A medical abortion is generally only given to women whose pregnancy is less than 7 weeks, counting from the first day of the last period, and not from the day of conception. If you are someone who has a fear of medical procedures and do not mind the stress and pain of a miscarriage then this is something to consider. However, please be aware of the greater supervision needed and surgery is still required if the pills fail to achieve success. In reality, a surgical abortion is a simpler procedure and less stressful than even having dental work by your dentist.

Who Shouldn’t Get a Medical Abortion?

A medical abortion is not for everyone. There are cases and risk factors that render a pregnant woman ineligible for the procedure. Some examples include:

  • Women who have an ectopic pregnancy or pregnancy outside their womb
  • Women who are too far into their pregnancy
  • Women who have serious anaemia or adrenal failure
  • Women who consume drugs or medications that can counteract the effect of abortion pills
  • Women who are allergic to abortion pills
  • Women who are afraid of the pain and stress of a miscarriage
  • Women who are not willing to be followed up and end up with complications of unsupervised miscarriages

What are the Potential Risks of Medical Abortion?

As with any medical procedure, a medical abortion comes with potential risks, including:

  • Incomplete abortion that may necessitate a surgical abortion
  • Infection and fever
  • Continuous and heavy bleeding
  • Digestive problems that include digestive pain and diarrhoea
  • Allergy to the medications
  • Ongoing pregnancy (unsuccessful abortion)

FAQs

Is medical abortion legal in Singapore?

Medical abortion (abortion pill) is legal in Singapore, especially when prescribed and overseen by a licensed medical specialist who is licensed to practise and counsel for abortions. You cannot just buy the abortion pills from any general practitioner.

How long does it take for misoprostol to work?

That really depends on the type of medication you have been give and the dosage. One or two types? How many tablets? What is your response? Medicines work differently for everyone.

How long does medical abortion take?

If you are lucky the medical abortion can be quick with the pain and heavy bleeding in the first few days, then less bleeding over a week. However, half may get pains lasting several days, with bleeding dragging on more than 7 and up to 14 days. A minority may still have bleeding after 2 weeks and these needs to be thoroughly assessed by the specialist for complicated or incomplete miscarriages.

Is medical abortion painful?

If you are just given Misoprostol alone then pain is a bigger factor. The bleeding and cramping can be quite heavy in roughly half the cases, whilst the uterus is contracting to expel the pregnancy tissues.

What is the success rate of medical abortion?

In eligible patients, it depends on the type of medical abortion regimen given and the size of the pregnancy. A medical abortion can have a success rate of over 90% is only to be found in the best-case scenarios, with many failing to reach this success rate. Patients should be seen by the attending gynaecologist multiple times to ensure that the abortion was indeed complete; and if it was not, an aspiration procedure will be necessary to complete the procedure urgently to prevent long term damage due to infection.

Will the abortion pill affect future pregnancies?

Yes, if you do not go back for supervision, and ignore symptoms of complications then long-term damage may occur. This usually occurs for patients who cannot afford the surgical procedure in the first place – and chose medical abortion as the cheaper and only option. They suffer in silence since they not have the financial option of paying to treat the complications of the medical route. If anyone wants to try the medical route, then they must be fully prepared to pay the extra costs of treating for possible complications – otherwise taking the abortion pill will have an effect on a woman’s fertility.

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