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\n \n Mifepristone<\/a>, one of two drugs used for medication abortions, can continue to be mailed to patients without an in-person visit with a doctor following the US Supreme Court rejection of a lawsuit<\/a> challenging regulation of the abortion pill.\n <\/p>\n \n \u201cWhile many women obtain medication abortion<\/a> from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,\u201d said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.\n <\/p>\n \n \u201cA growing body of research indicates that self-managed abortion is safe and effective,\u201d he said.\n <\/p>\n \n Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug is <\/a>approved to end a pregnancy through 10 weeks\u2019 gestation, which is \u201c70 days or less since the first day of the last menstrual period,\u201d according to the US Food and Drug Administration<\/a>.\n <\/p>\n \n In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades.\n <\/p>\n \n Together, the two drugs are commonly known as the \u201cabortion pill,\u201d which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute<\/a>, a research group that supports abortion rights.\n <\/p>\n \n \u201cSome people do this because they cannot access a clinic \u2014 particularly in states with legal restrictions on abortion \u2014 or because they have a preference for self-care,\u201d said Grossman, who is also the director of Advancing New Standards in Reproductive Health,<\/a> a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman\u2019s health<\/a>.\n <\/p>\n \n What happens during a medication abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.\n <\/p>\n \n CNN: What is the difference between a first-trimester medication abortion and <\/strong>a vacuum aspiration<\/strong><\/a> in terms of what a woman experiences?<\/strong>\n <\/p>\n \n Dr. Daniel Grossman:<\/strong> A vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic together with intravenous sedation, or what is called conscious sedation.\n <\/p>\n \n An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened up. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so, <\/strong>there\u2019s nothing in the tissue that would be recognizable as a part of an embryo.\n <\/p>\n \n The aspiration procedure takes just a couple of minutes. Then the person is observed for one to two hours until any sedation has worn off. We also monitor each patient for very rare complications, such as heavy bleeding.\n <\/p>\n \n A medication abortion is a more prolonged process. After taking the pills, bleeding and cramping can occur over a period of days. Bleeding is typically heaviest when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average people continue to have some mild bleeding for about two weeks or so, which is a bit longer than after a vacuum aspiration.\n <\/p>\n \n Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.\n <\/p>\n \n In fact, the pain of medication abortion can be quite intense. In the studies that have looked at it, the average maximum level of pain that people report is about a seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is being expelled.\n <\/p>\n \n The level of cramping and pain can depend on the length of the pregnancy as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth generally have less pain.\n <\/p>\n \n CNN: What can be done to help with the pain of a medication abortion?<\/strong>\n <\/p>\n \n Grossman: <\/strong>There are definitely things that can be used to help with the pain. Research has shown that ibuprofen <\/strong>is better than acetaminophen for treating the pain of medication abortion. We typically advise people to take 600 milligrams every six hours or so as needed.\n <\/p>\n \n Some people take tramadol, a narcotic analgesic, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found medications like tramadol can be helpful if taken prophylactically before the pain starts.\n <\/p>\n \n Another successful regimen that we studied combined ibuprofen with a nausea medicine called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.\n <\/p>\n \n Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medication abortion. It works through pads put on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with the pain signals. That\u2019s something people could get without a prescription.\n <\/p>\n \n Pain can be an overlooked issue with medication abortion because, quite honestly, as clinicians, we\u2019re not there with patients when they are in their homes going through this. But as we\u2019ve been doing more research on people\u2019s experiences with medication abortion, it\u2019s become quite clear that pain control is really important. I think we need to do a better job of treating the pain and making these options available to patients.\n <\/p>\n \n CNN: Are there health conditions that make the use of a medication abortion unwise?<\/strong>\n <\/p>\n \n Grossman:<\/strong> Undergoing a medication abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside of the uterus. It\u2019s rare, happening in about 2 out of <\/strong>every 100 pregnancies \u2014 and it appears to be even rarer among people seeking medication abortion.\n <\/p>\n \n People who have undergone previous pelvic, fallopian tube or abdominal surgery are at higher risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can raise risk, as does smoking, a history of infertility and use of infertility treatments such as in vitro fertilization.\n <\/p>\n \n If a person is on anticoagulant or blood thinning drugs or has a bleeding disorder, a medication abortion is not advised. The long-term use of steroids is another contraindication for using the abortion pill.\n <\/p>\n \n Anyone using an intrauterine device, or IUD, must have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.\n <\/p>\n
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