Nearly half of abortion patients say they are surprised by the intensity of pain they experienced from medication abortions, according to a study published last week.
A survey from the National Health Service‘s British Pregnancy Advisory Service, published earlier this month in the British Medical Journal Sexual and Reproductive Health, found that 48.5% of respondents said they experienced more pain during their medication abortion than they were told to expect by healthcare providers.
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Most abortion providers in the United States and the United Kingdom tell medication abortion patients that the pain they are likely to experience is the equivalent of menstrual pain, but the survey indicates that most women experienced worse symptoms than they experience during a monthly period.
More than nine in 10 patients rated their pain as at least four out of a maximum of 10 on the standard pain scale, while four in 10 ranked their pain as severe, between eight and 10 on the pain scale.
“The results of the survey show that counselling on this aspect of medical abortion needs to improve,” said lead study author Hanna McCulloch. “For many respondents, using period pain as a reference point for what to expect was not helpful for managing expectations, or in line with their experiences.”
Medication abortion in the United States involves the combination of the abortion pills mifepristone and misoprostol. Abortion pills account for nearly two-thirds of all abortions in the United States, and it is also the most common form of abortion before 10 weeks of pregnancy in England and Wales.
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Mifepristone works by blocking progesterone receptors that are necessary for the developing fetus to receive nutrients from the mother. Misoprostol, taken between 24 and 48 hours after mifepristone, induces contractions to expel the pregnancy tissue.
Two-thirds of survey respondents said that they would choose medication abortion again if necessary in the future, but about one in eight patients, about 13% said they would opt for a surgical abortion.
Most of those who said they would prefer a surgical abortion in the future said that pain was the No. 1 factor in their decision.
McCulloch, evaluation researcher at BPAS, said that the survey has led to the development of new informed consent materials for patients and additional training protocols for staff, which the agency is in the process of evaluating.
“Women want more detailed, realistic information to make choices about treatment and to be prepared for medical abortion if that is their preference. And medical abortion is a very safe and effective choice,” said McCulloch.
The Food and Drug Administration‘s warning label for mifepristone indicates that between 2.9% and 4.6% of medication abortion patients will experience significant complications, including sustained severe bleeding or life-threatening infections.
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Access to mifepristone has been a highly politicized issue in the United States since the Supreme Court overturned Roe v. Wade in June 2022.
President-elect Donald Trump has promised not to ban abortion pills at the federal level during his next term despite fears from abortion advocates. Robert F. Kennedy Jr., his nominee for Secretary of Health and Human Services, is reportedly more open to imposing tighter safety regulations that would make accessing the medication more difficult.