In principle, it is possible to end an unwanted pregnancy with medication or surgery. Ideally, the unwanted pregnant woman has the choice between the two methods and can make an informed decision.
Medical Abortion
Termination of pregnancy with medication is possible up to the 9th week of pregnancy. The active ingredient mifepristone (trade name of the preparation: Mifegyne®) and a prostaglandin (known under the trade name Cytotec®) are used for this purpose. Mifegyne® is not available in pharmacies, but can only be obtained from doctors’ surgeries or clinics that are authorised to perform abortions.
Mifepristone: A progesterone antagonist that cancels the effect of the corpus luteum hormone (progesterone) and causes the uterine lining and the sac containing the embryo to detach. In some cases, the active ingredient already leads to the first opening of the uterine orifice, so that bleeding can (but does not have to) occur 24 hours after taking it. Mifepristone also increases the effect of prostaglandins on the uterus.
Prostaglandin: In addition, a prostaglandin (known under the trade name Cytotec®) is taken 36 to 48 hours later. The prostaglandin causes the uterus to contract and the cervix to open. Within a few hours, abortive bleeding occurs and the lining of the uterus and the amniotic sac with the embryo are expelled. In Germany, prostaglandin is administered in some practices under supervision; patients must then spend the first three hours after taking it in the practice. In some practices, so-called “home use” is offered, where the prostaglandin is taken at home.
The combination of mifepristone and prostaglandin leads to a complete termination of pregnancy in over 96 per cent of cases. Nevertheless, the success of the treatment should be checked after 10 to 14 days in a follow-up examination with a vaginal ultrasound. The abortion marks the start of a new menstrual cycle, during which effective contraception must be used from the day of the abortion.
Medication abortion does not require an anaesthetic and can be performed very early on in the pregnancy. It lasts several days and the woman concerned consciously experiences all phases. This can help some unintendedly pregnant women to come to terms with the abortion, as they feel involved and regain a certain amount of control over their situation. Others may find it stressful. However, the vast majority are satisfied with their choice of method.
The day of taking mifepristone is usually experienced without any discomfort. Occasionally there may be nausea or, in the course of the treatment, slight vaginal bleeding. On the day of taking prostaglandins, there is usually heavy bleeding over the course of the period, which can be accompanied by cramps, diarrhoea and circulatory problems. The severity of the symptoms varies greatly – while some people need neither painkillers nor sick leave, others feel as ill as if they had the flu. The symptoms usually subside after a few hours.
The psychological processing of what has happened depends on the personal attitude and the current life situation. Abortion can, for example, trigger a depressive mood or insomnia. However, relief is usually the predominant feeling after the termination. If psychological problems persist, psychotherapeutic treatment is recommended.
If the decision has been made in favour of a medication abortion, then MedAbb could be a useful aid for you – especially if the abortion is carried out as a “home use”, i.e. if you take the prostaglandins at home. The free app helps you to think about everything that needs to be considered during a medication abortion and provides important answers to questions that may arise. For example: What do I do if I feel nauseous? What do I do if I have pain? How heavy can the bleeding be?
The app is available in the Apple Store and on Google Play. It is currently being revised and will be available in an updated version in a few months.
Surgical Abortion
Surgical or instrumental abortion is the second, safe option for ending an unwanted pregnancy.
Clinics, day clinics and some practices usually perform surgical abortions on an outpatient basis. Patients can go home after a short period of rest. Surgical abortion can generally be performed under general or local anaesthetic; not every clinic offers both options. Local anaesthesia in particular is rarely offered in Germany, whereas it is very common in countries such as England and the USA.
Vacuum aspiration: The standard procedure is vacuum aspiration, also known as suction or suction curettage. A narrow, sterile tube is inserted through the vagina and the previously carefully dilated cervix. The uterine lining and the amniotic sac along with the embryo or foetus are aspirated through the tube located in the uterine cavity.
Before the procedure, an ultrasound is performed to determine the position of the uterus, the localisation and size of the pregnancy. A so-called ‘priming’ is usually carried out with a prostaglandin, which makes the uterine cavity softer and easier to stretch. After the procedure, another ultrasound is performed to ensure that the uterine cavity is empty. This prevents infections.
The procedure takes about fifteen minutes. Painkillers can be taken afterwards, but many patients manage without them. After the procedure, irregular bleeding sets in, which can last up to four weeks. A follow-up examination is recommended after two weeks. The abortion also marks the start of a new menstrual cycle, during which contraception must be used again from the day of the abortion.
Curretage: Unfortunately, > 11% of abortions in Germany are still performed using the so-called curette. (Source: Federal Statistical Office, 2021). This is a spoon-shaped instrument used to scrape out the uterus. This method is no longer recommended by the World Health Organisation (WHO) due to a higher complication rate (source: WHO Library Cataloguing-in-Publication Data).
A surgical abortion performed according to recognised methods, in a safe setting and by trained personnel is a very safe procedure. Complications are extremely rare. In the event of fever, heavy bleeding or persistent pain in the lower abdomen, a doctor must be consulted immediately; this happens in less than 2% of procedures.
A complication-free surgical abortion has no effect on fertility and subsequent pregnancies.
Some patients prefer a surgical abortion, as the procedure is over quickly and the pregnancy is safely terminated.
The psychological processing of what has happened depends on the personal attitude and the current life situation. Abortion can, for example, trigger a depressive mood or insomnia. However, relief is usually the predominant feeling after the termination. If psychological problems persist, psychotherapeutic treatment is recommended.
In figures and pictures
In Germany, 96.8% of all abortions take place before the 14th week of pregnancy (WOP). 42.4% of all abortions are performed up to the 8th week of pregnancy, 75.8% up to the 10th week of pregnancy. (Source: Federal Statistical Office, 2021)
Many people have a false idea of how advanced a pregnancy is at this stage. One of the reasons for this is that there are many frightening images circulating on the internet. That’s why we want to show realistic pictures of amniotic sacs.
When specifying weeks of pregnancy, it should be noted that this is calculated from the first day of the last menstrual period (p.m.). The first four weeks therefore include a ‘normal menstrual cycle’. An embryo only forms after about six and a half weeks. An embryo cannot be recognised with the naked eye until the 7th week of pregnancy. From the 8th week of pregnancy, the expelled embryo may be visible in rare cases during a medical termination of pregnancy. For those who would like to familiarise themselves with this in advance, we have therefore also illustrated an amniotic sac in the 8th week of pregnancy with a visible embryo below.