According to a research published Tuesday in the journal BMJ Sexual & Reproductive Health, many women are taken aback by the level of pain they endure during a medication abortion.

Medication abortions, in which a woman takes two medications, frequently at home, to terminate a pregnancy, account for more than 60% of abortions performed in the United States. According to the study, which polled women in the United Kingdom, many of them don’t feel ready for the level of agony they would experience during the surgery.

Although some women may feel taken aback by the information they received from medical professionals, pain does not indicate that the treatment is hazardous.

Dr. Alyssa Colwill, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine, who was not involved in the new study, stated that there is currently some reckoning in the field of gynecology regarding the pain that patients are going through during procedures.

Researchers examined survey answers from over 1,600 women in the United Kingdom who had had medication abortions and then responded to questions about their experiences. Half of them had never given birth, and the majority were between the ages of 20 and 39.

About half of the respondents stated that the pain was more than they had anticipated, and over 90% gave their agony at least a 4 out of a possible 10. On a pain rating of 8 to 10, about 40% of respondents reported having severe pain.

In the U.S. and the U.K., women are frequently advised to anticipate discomfort during a medication abortion that is similar to severe menstruation cramps. Some respondents indicated they felt unprepared and that the agony associated with medication abortion was minimized or sugar-coated, while others thought that was a fair assessment.

According to one lady who answered the survey, the pain was so much worse than menstrual discomfort that it seemed like labor contractions. I’ve given birth three times, and each time the pain was essentially the same—a cramping contraction.

According to another, it’s important to reassure them that just because pain is described as severe, it doesn’t always mean that it will be. I worried about the potential negative effects for longer than was necessary!

The researchers came to the conclusion that women wanted general anticipatory advice and comprehensive, realistic pain counseling, including first-hand accounts that showed the range of suffering that women might experience following medication abortion.

The study’s primary author, Hannah McCulloch, an assessment researcher at the British Pregnancy Advisory Service, stated in an email that it’s critical to recognize that each person’s experience of agony during a medical abortion will be unique. To deliver effective patient-centered care, it’s critical to be truthful about what women go through during medical abortion.

Two tablets are taken during a medication abortion. The first, mifepristone, inhibits progesterone, a hormone essential to the continuation of pregnancy. The person takes a second medication, usually misoprostol, one or two days after taking mifepristone. This medication causes the uterus to relax and cramp, and the cervix to dilate so the pregnancy can end, usually within 24 hours after taking misoprostol, according to Colwill.

The uterus’s need to cramp and expel the pregnancy will inevitably create pain, she added, adding that each person’s level of pain is influenced by a variety of circumstances.

According to Colwill, women who have undergone labor or given birth vaginally, as well as those who suffer from intense monthly menstrual cramps, such as those who have endometriosis, may report less discomfort with a pharmaceutical abortion.

She continued by saying she was not surprised to learn that many women did not feel they were sufficiently prepared to manage pain during a medication abortion and that knowing these past experiences, as well as things like how they experience Pap smears and vaginal exams, can help us better support patients to be prepared for how pain may be for them.

Abortion with medication is a very safe operation. According to the drug’s label, less than 0.5% of persons taking Mifeprex, the brand-name form of mifepristone, experience serious adverse effects, and since the Supreme Court reversed Roe v. Wade in 2022, more women are handling their own abortions.

Patients must be given sufficient information about what to anticipate and what is known about pain management. Pain is downplayed in medicine in general and particularly in women s health and obstetrics and gynecology, said Dr. Daniel Grossman, a professor of obstetrics and gynecology and director of advancing new standards in reproductive health at the University of California San Francisco.

Even if a person accessesabortion medication through telehealth, Grossman said people should still be counseled on what to expect and how to treat the intense pain and nausea that can happen during the procedure. His best advice, he said, for managing pain during a medication abortion is to take a nonsteroidal anti-inflammatory drug, or NSAID, such as ibuprofen, at the same time as misoprostol. If possible, he recommends also taking an anti-nausea medication such as metoclopramide, which requires a prescription.

Colwill said that acetaminophen, or Tylenol, is also an option, but NSAIDs do a better job of blocking this specific pain.

Putting a heating pad, a hot water bottle or over-the-counter trans-electrical nerve stimulation pads on the lower belly can also help confuse nerves in the area and help relieve pain, Grossman said.

He said it s also important to understand what pain is normal and when it may be time to seek medical help, especially in situations where people are at home.

Pain in the middle of the lower abdomen is normal, for example, but pain higher up or pain just on one side could be a sign that something is wrong, such as an ectopic pregnancy, a life-threatening condition in which a fertilized egg implants outside the uterus.

If someone experiences severe pain on one side of the abdomen or pelvis, they should go to the emergency room, Grossman said. If they have mild to moderate pain on one side, they might try to talk to a clinician first by phone. But if there s any question, they should go to an emergency department, he added.

Ectopic pregnancies are detected on ultrasounds, however, many people have a medication abortion without having an ultrasound and it can even be missed on an ultrasound, Grossman said.

Medication abortion will not work for an ectopic pregnancy, according to theFood and Drug Administration.

Pain beyond 24 hours after a pregnancy is passed, especially if the person also has a fever or is vomiting, could be a sign of infection, he said.

Women should also not discount the importance of moral support, he added: Feeling supported and having someone there makes a big difference, too.

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