The abortion pill for an early medical abortion (EMA) is available in Australia as MS-2 Step. It consists of Mifepristone and Misoprostol. It is approved by the Therapeutic Goods Administration for use in terminating an intra-uterine pregnancy up to 63 days or 9 weeks in Australia.
In other countries, such as the United Kingdom, it is used well into the second trimester of pregnancy.
It is highly effective with a success rate of 98%. After 63 days or 9 weeks of pregnancy, the success rate starts to decline.
Successful advocacy by SPHERE Centre of Research Excellence has relaxed restrictions and MS-2 Step can now be prescribed by any doctor registered with AHPRA. Regrettably, only a small minority of doctors have completed training by MS-2 Step in the counselling surrounding the process of the EMA. This process involves confirming eligibility, reviewing tests results, checking for contraindications, discussing the risks involved, providing specific instructions on when and how to administer the medications, providing information on how to manage pain and other side effects, and making arrangements for follow up to check for complications.
The relaxed restrictions by the TGA has enabled MS-2 Step to be dispensed at any pharmacy, making it much more accessible.
If you require assistance with an early medical abortion, please book an appointment to discuss further.
Frequently Asked Questions
- Early Medical Abortion is 93-98% successful
- Chances of haemorrhage is less than 1 in 1000
- Chances of infection is less than 1 in 100
- Chances of having an incomplete abortion is 1 – 4 in 100
- Chances of an ongoing pregnancy is 1 in 200
- Most women will experience moderate to heavy bleeding (93.4% of women in Australian study).
- Most women will experience severe pain / cramps (78.4% of women in Australian study). This can be managed with pain medications that your doctor will prescribe. It is essential that you follow the instructions for the pain medications to effectively reduce the discomfort.
- Despite the above, most women felt that their overall experience was as expected or better than expected (90.3%) and would recommend it to others.
In the unlikely event that you have a haemorrhage (1 in 1000) chance, you need to be within 2 hours drive to the hospital to receive emergency care in timely manner.
- It is advisable to start the medical abortion only if you are extremely certain that you do not wish to keep the pregnancy.
- There is no evidence that Mifepristone causes malformations in the fetus, however, it blocks progesterone receptors in the uterus thus interfering with the requirements of a normal pregnancy. It increases the risk of miscarriage.
- Misoprostol in pregnancy is associated with malformations in the fetus. Please book an appointment so that your doctor can discuss the risks of complications and alternative options with you.
No. Early medical abortion does not impact your chances of falling pregnant in the future.
According to Therapeutic Guidelines, yes it is safe to take it while breastfeeding. Women do not need to “pump and dump” while taking the medication and can continue breastfeeding as normal.
- Here is a comparison of the pros and cons of medical vs surgical abortion
- The Royal Women’s Hospital https://www.thewomens.org.au/health-information/unplanned-pregnancy-information/unplanned-pregnancy-deciding-what-to-do has excellent resources to help with decision making.
- You can book an appointment with one of the doctors. Your doctor is trained in non directive pregnancy counselling and can assist with your decision making in an unbiased way.
| Medical abortion | Surgical abortion | |
|---|---|---|
| Costs | $$ | $$$$ |
| Privacy | At home and private | Some women are concerned about being seen entering and leaving abortion clinics. |
| Time off work | 1 – 2 days | 1 – 2 days |
| Number of appointments | 3 including follow up. Time required for ultrasound and blood tests. Repeat blood test required before follow up appointment. | Usually all completed on the same day. No follow up appointments provided. |
| Bleeding | +++ | ++ As women are under sedation, they will not experience it. |
| Pain | Moderate – severe | Moderate. Less pain experienced under sedation |
| Efficacy | 93 – 98% successful | 98 – 99% successful |
| Rate of incomplete termination | 1 – 4 in 100 | Less than 2 in 100 |
| Rate of ongoing pregnancy | 1 in 200 | Less than 1 in 200 |
| Risk of haemorrhage | 1 in 1000 | 1 in 1000 |
| Risk of infection | 1 in 100 | 1 in 100 |
| Risk of uterine perforation | None | 1 in 1000 |
| Risk of Asherman’s syndrome | None | Up to 13 in 100 |
| Risk of impact on future fertility | None | Yes. If develops Asherman’s syndrome |
It is required to track the decline of the beta hcg (pregnancy hormone level) to determine if the abortion is successful.
- If the tests were ordered by your regular GP are incomplete, you may be asked to complete the missing tests.
- If your beta hcg (pregnancy hormone level) was taken too many days before your appointment, you may be asked to repeat it. It is important that you do so, as we need to establish a baseline to track the decline of beta hg to determine if the abortion is successful.
Full blood count
- This helps to exclude pre-existing anaemia. It is dangerous to take the medication if you are already significantly anaemic and surgical abortion is the safer alternative.
Beta hcg
- The beta hcg is a pregnancy hormone. We use this to track the successful completion of the abortion.
Blood group and antibodies
- This information is In case you have a haemorrhage and require a blood transfusion at your nearest hospital.
First pass urine PCR for chlamydia and gonorrhoea
- If present, these bacteria reside at the cervix. An open cervix during the abortion will allow any bacteria present to enter the uterus and may lead to pelvic inflammatory disease. We screen for these to make sure if chlamydia or gonorrhoea infection Is present, we can treat it with antibiotics promptly.
- Preferably at > 6 weeks pregnancy. Ultrasounds performed earlier than 6 weeks may not be able to determine the location of the pregnancy and may have to be repeated.
- At least 2 days before your appointment to allow time for results to be ready.
- The blood and urine test should preferably be done on the same day as the ultrasound.
If your doctor has determined that your ultrasound result was unable to identify where the pregnancy is located and confidently exclude an ectopic pregnancy, your doctor will ask you to repeat the ultrasound.
An ultrasound is very Important and non-negotiable in order for us to exclude an ectopic pregnancy. The medications will be ineffective for terminating an ectopic pregnancy. The medications and the ongoing development of an ectopic pregnancy can cause life threatening internal haemorrhage. This is why we insist on the ultrasound.
Please advice your GP you will need the following
- Full blood count
- Beta hcg
- Blood group and antibodies
- First pass urine PCR for chlamydia and gonorrhoea
- 1st Trimester Dating Scan (ultrasound)
You must get a copy of your results and email it to us before your appointment in order for the process to be expedited for you. Occasionally, some GPs will say that we can call up to chase to results, but unfortunately, as we are an after hour service, pathology and radiology companies will not be open at that time to take our calls.
- No, a referral is not required.
- No. Your doctor can provide the necessary referrals at your first appointment.
- However, if you do manage to have an ultrasound and blood tests, and the results are forwarded to your doctor before your appointment, the process will be expedited for you.
- Please be aware that if your blood test results are incomplete or taken too many days before your appointment, you may be required to repeat some of them.