Abortion pills or procedure?

When deciding to end a pregnancy, you have choices as to how and where you do it. There is no “best” option. The best choice for one person may be different from another. Here, we outline some of the differences between the abortion pills and the in-office procedure, called manual uterine aspiration.

Medication Abortion

Medication abortion typically consists of taking the two medications mifepristone and misoprostol (there are also misoprostol-only protocols). Mifepristone blocks the hormone progesterone to prepare the uterus to release the pregnancy tissue. It also starts to soften and open the cervix. Twenty-four to 48 hours later, misoprostol is taken, a synthetic prostaglandin. Misoprostol causes the uterine muscles to contract and also softens the cervix, which helps to release the pregnancy tissue. This method is about 92-99% effective, with higher success rates when the pills are taken at earlier gestational ages.

Go through the entire process at home. This is one of the most common reasons people choose medication abortion. In California, typically no office visits are necessary* and the pills can be prescribed after a telemedicine visit. Some providers also offer “asynchronous” care, where an appointment isn’t required and all communication is done by email or text.
There is inherently more privacy if you do not need to go to a clinic. You have more control of your environment in the comfort of your home with the support people you choose to be present with you.
For some people, this method feels more “natural,” as taking the medications induces the pregnancy release.
There are very small risks of infection or heavy bleeding. The most common complication of the abortion pills is ongoing pregnancy. This includes ongoing ectopic pregnancy, or pregnancy outside of the uterus, which requires a different type of treatment to end. Note that neither method is known to affect fertility in the future.

*An in-office appointment may be necessary to check an ultrasound for folks who are unsure of the first day of their last menstrual period, or people who have risk factors for ectopic pregnancy.

Manual Uterine Aspiration (MUA)

MUA is a safe, non-surgical in-office procedure where a soft plastic tube called a cannula is inserted into the cervical opening. The cannula is attached to a large handheld syringe, which is used as a vacuum to create a gentle suction to remove pregnancy tissue from the uterus. This method is 98-99% effective.

Short procedure (~10 minutes).
Lower risk of incomplete abortion and success can usually be confirmed at the time of the procedure.
Patients typically experience less bleeding at home than they do with the pills.
Depending on the clinic, patients often have the choice to receive either local anesthesia or general sedation.
There are very small risks of infection or heavy bleeding. There is also a very low risk of injury to the cervix or uterus, in which case additional treatment may be necessary.'

Talk to your health care provider about your options for abortion pills versus MUA. There are very few contraindications for either of these methods, so most people have the choice between the two. What feels safest and most aligned for one person may be different from another.