What Is Medical Abortion? A Complete Guide
Facing an unplanned pregnancy can be a strongly overwhelming experience. As you consider your next steps, it is important to understand your available options so that you can make informed decisions about what is right for yourself and your body.
In the event that you decide to terminate your pregnancy, there are multiple approaches that you could pursue. Medical abortion is one such option, serving as a non-invasive alternative to surgery.
This guide explains how a medical abortion works and the key details that can help you feel more at ease regarding the process.
How Does a Medical Abortion Work?
Medical abortion is a type of abortion procedure that uses two types of pills to terminate a pregnancy. Unlike surgical abortion, which involves a minor operation to remove tissue from the uterus, medical abortion does not require any instruments or invasive procedures.
The first medication, mifepristone, works by blocking hormones that are necessary to sustain a pregnancy. Once this medication is ingested and hormones are blocked, the lining of the uterus will begin to break down, preventing pregnancy from continuing.
The second medication, misoprostol, is taken 24–48 hours later. This medication causes the uterus to contract and expel the remaining tissue, thus terminating the pregnancy.
Medical abortion is generally chosen by women who prefer to avoid surgery and anaesthesia. It is most effective when performed in the first trimester of pregnancy, usually within 7–9 weeks of gestation.
What Are the Advantages of Medical Abortion?
Many women opt for medical abortion instead of surgical abortion for several reasons:
- Non-Invasive: There are no surgical instruments inserted into the uterus and no anaesthesia is required. This eliminates the risk and fear associated with surgery and sedation.
- Privacy and Comfort: After the initial clinic visit, where mifepristone is consumed under the supervision of a doctor, the actual process can take place in the privacy of one's home.
- Control and Support: Taking the medication gives individuals some control over the timing of the procedure within the recommended window. Being in a familiar, comfortable environment, with support from a partner or family member, can make the overall experience less stressful.
The Medical Abortion Process in Singapore
In Singapore, medical abortion is strictly regulated and must be carried out under the supervision of a qualified doctor. The process involves several stages to ensure safety, suitability and proper follow-up care.
Consultation and Assessment
Your gynaecologist will first perform an ultrasound to confirm the gestational age of the pregnancy. This helps determine whether medical abortion is a suitable option, as abortion in Singapore is only legally permitted up to the 24th week of pregnancy.
This assessment also helps to identify any potential safety concerns that could be associated with the procedure. Your doctor will also explain what to expect at each stage of the medical abortion procedure, including the timing of symptoms and how to manage them.
Once the consultation with a doctor is complete, patients must undergo a mandatory counselling session, followed by a 48-hour waiting period before any procedures can be performed.
First Medication
After the waiting period, the doctor administers the first medication, mifepristone, at the clinic. You will then be given the second prescription of misoprostol, along with detailed instructions on how and when to take it.
You may also be advised on pain relief options, what level of bleeding is expected and when to seek medical attention.
Second Medication
You will take the second medication 24–48 hours later. Depending on the clinic's protocol and your specific situation, you may take this at home or return to the clinic. The medication may be taken orally or inserted vaginally, according to the doctor’s instructions.
Patients are typically advised to rest, have access to sanitary products and ensure that they have support available if needed.
Physical Effect and Cramping
Within a few hours, heavy bleeding and strong, labour-like cramps usually begin as the uterus contracts to expel the pregnancy tissue. These symptoms are a normal part of the process and indicate that the medication is working.
Follow-Up Appointment
Your doctor will perform an examination or ultrasound to confirm that the abortion was successful and complete, ensuring there is no retained tissue or ongoing pregnancy. In the event that the abortion is incomplete, additional medication or a minor procedure may be required to safely complete the process.
This follow-up is an essential part of care, as it allows your doctor to monitor your recovery and address any potential complications early.
When is a Medical Abortion Not Suitable for a Patient?
While medical abortion is generally considered safe, it may not be suitable for certain individuals. Doctors may advise against it if any of the following conditions are present:
- An ectopic pregnancy, where the pregnancy occurs outside the uterus
- Bleeding disorders or current use of blood-thinning medication
- Severe anaemia
- A known allergy to the medications used for medical abortion
- The presence of an intrauterine device (IUD), which would need to be removed prior to the procedure
- Chronic adrenal failure, or if the patient is undergoing long-term corticosteroid therapy
What Are the Possible Risks of Medical Abortion?
Although medical abortion is generally safe, like any medical intervention, it carries potential risks:
- Incomplete Procedure: In some cases, the medication may not remove all pregnancy tissue. If this occurs, a follow-up procedure such as a dilation and curettage may be needed to empty the uterus.
- Heavy Bleeding: Bleeding after an in-clinic abortion is expected, and light bleeding may continue for up to two weeks. However, excessive or prolonged bleeding may require prompt medical review.
- Infection: There is a low risk of infection following the procedure. Signs include a fever lasting more than 24 hours, severe abdominal pain or foul-smelling discharge.
Your doctor will discuss these with you in detail before the procedure and explain how risks are minimised through appropriate assessment and follow-up care.
Seeking Out Safe Medical Abortion Procedures in Singapore
Abortion services need to be regulated and supervised in order to ensure that the patient is safe, well-informed regarding their own body, and provided with a high standard of care and support. If you are considering a medical abortion, it is important to seek out guidance from a qualified and licensed specialist, as well as to understand how the process is carried out.
Lien Clinic for Women provides comprehensive abortion services in Singapore, including safe medical abortion. Led by Dr Lien Lian Sze, a consultant obstetrician & gynaecologist, our clinic offers pre-abortion screening, counselling and tailored support during this vulnerable period of your life.
Contact us today to schedule a consultation and discuss your needs further.
Frequently Asked Questions (FAQs) About Medical Abortion
Is medical abortion painful?
Medical abortion can be painful. Most women experience strong cramping, similar to very heavy menstrual cramps, and some abdominal pain. Your doctor will typically prescribe pain relief medication to help manage this discomfort.
How effective is a medical abortion?
Medical abortion is highly effective when performed within the recommended gestational period. Success rates are generally above 95% in early pregnancy cases. In situations where the abortion is incomplete, additional medication or a minor procedure may be required to complete the process.
Can I purchase medical abortion tablets without a doctor’s consultation?
No. In Singapore, medical abortion tablets such as mifepristone and misoprostol are regulated medications and cannot be purchased over the counter. A licensed doctor must assess the pregnancy first to confirm that medical abortion is a suitable option.
Will undergoing a medical abortion affect future fertility/future pregnancies?
There is no evidence that a safe, uncomplicated medical abortion affects future fertility or pregnancy outcomes. However, complications like untreated infections can pose risks, which is why follow-up care is necessary for every patient.
About Our Abortion Specialist in Singapore
Dr Lien Lian Sze
Consultant Obstetrician & Gynaecologist
MBBS (Singapore), FRRCOG (London), FAMS, FICS (USA)
Dr Lien Lian Sze is an experienced senior gynaecologist dedicated to providing compassionate and professional healthcare for women. He supports patients who are facing the challenges of unplanned pregnancies, offering comprehensive care within a safe, confidential and respectful environment.
Beyond his expertise in abortion procedures, Dr Lien performs a range of gynaecological surgeries, including advanced laparoscopic methods. With a focus on understanding each individual’s needs, Dr Lien strives to ensure that patients feel supported and well-informed throughout their journey.