Pain in Home Medical Abortion: What Women Weren't Told

Highlights:

• Medical abortion using pills to terminate pregnancies up to 10 weeks, is now available for home use
• Telemedicine improves access for women living in rural areas and those who find it difficult to reach clinics
• 92% gave a pain score of at least 4 out of 10 and 41.5% rated their pain between 8 and 10 (severe)

Many women opting for medical abortion at home receive information that the pain will be similar to menstrual cramps. However, a survey conducted by the British Pregnancy Advisory Service (BPAS) indicates that this information often leaves them unprepared for the actual intensity of pain they experience (1^✔).

This highlights the need for more realistic, patient-focused information to empower women in decision-making. It also underscores the importance of adequate pre-procedure counseling on pain expectations and management.

‘Did You Know?
13.5% of women who had medical abortions said they would opt for surgical abortion next time due to pain concerns. #informedchoice #abortioncare #painmanagement #medindia’

Medical abortion using pills to terminate pregnancies up to 10 weeks, is now available for home use. In England and Wales, this has become the primary method for abortions up to 10 weeks with almost all procedures carried out at home. Telemedicine supports this practice by reducing the need for in-person clinic visits.

Telemedicine improves access for women living in rural areas and those who find it difficult to reach clinics. It facilitates remote consultations, prescriptions and follow-up care, minimizing barriers to timely care while ensuring greater privacy and convenience.

Pain Perception and Experience: Medical vs. Surgical Abortion

The survey invited 11,906 clients who had medical abortions up to 10 weeks between to share their experiences. A total of 1,596 (13.5%) responded, with most aged 20 to 39.

About 48.5% reported the pain was more intense than expected highlighting a significant gap between their experience and the counselling they received which described the pain as similar to period cramps.

92% gave a pain score of at least 4 out of 10 and 41.5% rated their pain between 8 and 10 (severe).

While two-thirds said they would still opt for a medical abortion if needed in the future, 13% would choose a surgical abortion instead and 83% cited pain as a decisive factor.

Respondents opting for surgical abortion reported an average maximum pain score of 8.5, compared to just over 6 for those preferring medical abortion.

Unrealistic Pain Descriptions

Many women attributed their unpreparedness to the way pain was described during a consultation or informational materials highlighting the clarity and honesty that can better prepare patients and enhance the overall experience. Common terms like period pain, a bad period or period cramps created unrealistic expectations.

One respondent said "Pain was so much stronger than period pain; it was like having contractions in labour. I've given birth three times, and the pain really wasn't too much different from that contraction pain."

Others felt the information provided had been "washed over," "downplayed," or "sugar-coated." Another respondent emphasized the importance of transparency, stating: "Patients have a right to fully understand the risks and benefits. This should be made absolutely transparent; shared and informed decision-making is essential."

In response, BPAS has revised its approach by introducing more detailed patient materials, including information booklets and digital resources that provide a range of realistic pain descriptions, from mild to severe.

Staff have received improved training to offer clearer counselling on pain expectations and effective pain management strategies, ensuring women are better informed and prepared for their experience. These changes aim to better prepare women for the experience and empower them to make fully informed decisions about their care.

Medical abortion remains a safe and effective option, but women need honest, comprehensive counselling about pain intensity and management to make informed choices and feel adequately prepared for the procedure.

Reference:

1. Expectations and experiences of pain during medical abortion at home: a secondary, mixed-methods analysis of a patient survey in England and Wales - (https:srh.bmj.com/content/early/2024/12/03/bmjsrh-2024-202533)

Source: Medindia

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