Study says medical abortion was more painful than expected

Medical abortion is more painful than expected, says study | Image credit: © Vlyaks – © Vlyaks – Stock.adobe.com.

Women seeking medical abortions are often told that their pain is nothing more than menstrual cramps, according to a recent study published in . BMJ Sexual and Reproductive Health.¹

Medication abortion is performed by taking a pill up to the 10th week of pregnancy. This abortion method can be provided through telemedicine, eliminating the need for a clinic appointment and allowing patients to complete their abortion at home.

Data shows that medical abortions are common in England and Wales and are often performed at home. However, medical abortions are often painful, highlighting the need for appropriate pain management counseling. This information is necessary to enable patients to make informed decisions.

Researchers conducted a secondary analysis to evaluate counseling for patients undergoing medical abortion.² Patients undergoing medical abortion up to 10 weeks of pregnancy completed an anonymous online survey between November 2021 and March 2022.

This survey asked patients about their experiences with home medical abortion pain management. This included questions regarding future abortion methods and three optional open-ended questions. Descriptive statistics were used to summarize quantitative responses and compare mean pain scores based on prospective method preference.

Participants with at least one open-ended response were included in the analysis. The analysis was conducted by pain experts in abortion, endometriosis, chronic pelvic pain, and other gynecological procedures.

The final analysis included 1596 participants, one-third of whom had an abortion between eight and nine weeks pregnant. Unmarried status was reported by 48.7% of participants.

48.4% of participants reported experiencing more pain than expected and 92.2% experienced moderate to severe pain. 12.7% of participants said they would choose surgical abortion if they needed one in the future. Pain influenced this decision in 82.7% of cases.

Regarding future abortions, 65.6% said they would choose medical abortion, of which 42.7% cited pain as a deciding factor. Patients who chose future surgical abortion reported a mean maximum pain score of 8.5, compared with 6.2 for patients who chose medical abortion.

When reporting the severity of pain, patient responses include: “I had no pain at all,” “very mild,” “moderate,” “very strong, but not severe,” and “excruciatingly severe.” ' and 'This is the worst pain I've ever had.' Passed by. ” This shows that there is wide variation in the level of pain experienced.

There was also wide variation in how patients described the quality of their pain. This includes things like hurting, pulling, biting, stinging, twisting, and squeezing. Some patients described the pain as spasms or contractions.

When comparing their pain to the reproductive experience, some people describe the pain as similar to normal or severe menstrual cramps. However, many participants reported that the pain from medical abortion was worse than menstrual pain.

A comparison was also made with the pain experienced during childbirth. Some participants reported that the pain of abortion was worse than menstrual pain but better than labor pains.

For some participants, anticipated pain was similar to experienced pain. This indicated good preparation, in some cases using online forms, and in some cases sufficient counseling from reproductive health services.

Other participants experienced much more pain than expected. Patients report information about pain in discussions and flyers that are “swept away,” “downplayed,” and “sugarized,” and many have lowered their pain expectations to healthcare providers. It was based on the description from.

Although many participants were unprepared for the pain they would experience, several felt they needed emergency assistance during the abortion because they were not adequately prepared for the pain. Some said they would have chosen to have a surgical abortion if they had known the severity of the potential pain.

These results indicate that medical abortion pain counseling does not prepare many patients for the level of pain they will experience. The researchers recommended that further research focus on developing ways to manage pain anticipation.

References

1. Women often said that medical abortions were no more painful than menstrual pain. BMJ group. December 17, 2024. Accessed December 20, 2024. https://www.eurekalert.org/news-releases/1068226
2. McCulloch H, Perro D, Taghinejadi N, et al. Anticipation and experience of pain during home medical abortion: A secondary mixed methods analysis of a patient survey in England and Wales. BMJ Sexual and Reproductive Health. 2024.doi:10.1136/bmjsrh-2024-202533