Health News

Women prefer surgical abortion to pill in second trimester

NEW YORK (Reuters Health) - Women who undergo an abortion during the second trimester may often prefer a surgical procedure to the “abortion pill,” a small UK study suggests.

The study, of 122 women who were randomly assigned to either a surgical or medication-induced abortion during the second trimester, found that all women in the surgery group said they would opt for that form of abortion again, if necessary.

In contrast, only 53 percent of women in the medication group said the same, according to findings published in the obstetrics journal BJOG.

As a group, the study found, women who received a medical abortion reported more pain and had more vaginal bleeding than those who’d had surgery. And two weeks after the procedure, they had a higher average score on a standard measure of “intrusive” psychological symptoms -- such as unwanted thoughts or nightmares.

The findings, researchers say, suggest that when it comes to abortions done relatively later in pregnancy, many women would prefer the surgical approach.

Medication-induced abortions most often involve taking the drug mifepristone -- commonly referred to as the “abortion pill” -- followed by a hormonal medication called misoprostol, which causes the uterus to contract.

In the U.S., the abortion pill is approved for use within the first nine weeks of pregnancy. In the UK, it is approved for use up through the 24th week; however, most studies comparing the safety and effectiveness of medical and surgical abortions have focused on procedures performed in first trimester.

One reason is that recruiting women for clinical trials on the question is difficult. Most women, researchers have found, do not want to be randomly assigned to an abortion option, but prefer to make the choice themselves.

For the current study, Teresa Kelly and colleagues at Newcastle University in the UK followed 122 women who were seeking an abortion between the 13th and 20th weeks of pregnancy and agreed to be randomly assigned to either a medical or surgical abortion.

Women in the medication group took oral mifepristone, then returned to the medical clinic 36 to 48 hours later to receive several doses of misoprostol, until the abortion occurred.

Before the procedure and two weeks afterward, the women were asked to complete a standard questionnaire that measures the psychological response to stressful events. They also rated their physical symptoms during and after the procedure, and answered questions on general health and depression symptoms.

Only 60 percent of the women in the study completed that follow-up, however.

Of those women, the study found, those in the medical-abortion group reported more pain on the day of the abortion and in the days afterward. They also had more vaginal bleeding after discharge; 37 percent said their bleeding was heavier than a menstrual period, versus only 4 percent of women in the surgical-abortion group.

In addition, of women in the surgical group who completed the follow-up, none said the experience had been worse than they’d expected. In contrast, 53 percent of women in the medication group did feel that way.

And while the two groups did not differ in their overall scores related to psychological distress, the medical-abortion group had a higher average score when it came to intrusive thoughts.

Exactly what can made out of that finding is unclear. It’s not known, for instance, what percentage of women had “problems” due to intrusive thoughts, according to Kelly.

“The results therefore need confirming in a much larger study before the real clinical impact can be determined,” she told Reuters Health in an email.

A major limitation of the study, in general, is its small size and the low percentage of women who took part in the follow-up, Kelly and her colleagues note.

Still, what the results do suggest, Kelly said, is that women should have both the medical and surgical options available so that they can choose based on their personal preference.

In the UK, most of the facilities within the National Health Service that offer abortion services after the 13th week only provide medication-induced abortions, Kelly and her colleagues note in their report.

Kelly said their research suggests that medical abortions should not “replace” surgical ones, but that both options should be offered.

She also pointed to an earlier study she and her colleagues conducted that included women having an abortion before the 14th week of pregnancy. In that study, some women were randomly assigned to a surgical or medical abortion, while others were allowed to choose.

The researchers found that women were less likely to want a medical abortion the further along they were in pregnancy. They also found that among women who were allowed to choose their abortion option, there was no difference in psychological distress scores in the surgical and medical groups two weeks after the procedure.

That, according to Kelly, suggests that women having an abortion earlier in pregnancy tend to have better outcomes if they receive their preferred procedure. That could also be the case, she added, for women having later-term abortions.

In the U.S., the abortion pill is still controversial 10 years after its approval for early-term abortions. One current issue is the move by some abortion providers to use “telemedicine” technology to extend access to the medication to women who live far from clinics that offer abortion services.

A program in Iowa, for example, allows women seeking the abortion pill to go to a Planned Parenthood clinic, be examined by a nurse, undergo an ultrasound and then consult with a doctor via video teleconference. The doctor can remotely open a container to provide the patient with the pill.

Abortion opponents charge that the program poses a health risk to women because there is no face-to-face meeting with a doctor.

It’s estimated that nearly 1.4 million U.S. women have used the abortion pill since its approval, with the method currently accounting for about one-quarter of all abortions done in the first nine weeks of pregnancy and 15 percent of all abortions.

SOURCE: BJOG, online September 22, 2010.