Surgical vs. medical abortion

Everywoman’s Health Centre normally offers aspiration (surgical) and medical abortion with Mifegymiso but there is currently a shortage in Canada of Mifegymiso and so we are not able to offer medical abortions at this time. This chart explains the differences between the two types of abortion.

 

Surgical Abortion

Medical Abortion with
Mifegymiso

What does it cost?
No cost with BC medical coverage (MSP), $500 without MSP
What does it cost?
About $360 for the medications (often covered under extended medical plans, Fair Pharmacare and no charge with First Nations Status), $735 without MSP
How does it work?
A doctor uses gentle suction to remove the pregnancy and blood from inside the uterus.
How does it work?
Mifepristone (taken as a pill) is the first step in the abortion. Misoprostol pills are used at home 24-48 hours afterwards. They cause the uterus to push out the pregnancy tissue.
How effective is it?
More than 99% success rate.
How effective is it?
A 95% success rate at one week follow-up.
When can it be done?
A surgical abortion can be done as early as five weeks from the first day of the last period. The vast majority happen between 5 and 10 weeks of pregnancy. Everywoman’s provides abortions up to 13 weeks 6 days and referrals for those over 14 weeks.
When can it be done?
It can be done as soon as there is a positive pregnancy test and up to 9 weeks from the first day of the last period. The majority happen before 8 weeks of pregnancy.
How many appointments are required?
Most only need one appointment that takes 2-3 hours. This includes counselling, the procedure and recovery time.
How many appointments are required?
Usually it means two appointments including a one-week follow-up, although sometimes this can be done without coming into the clinic. A few will need a third appointment.
How long does it take for the abortion to be complete?
The procedure itself usually takes about seven to eight minutes.
How long does it take for the abortion to be complete?
About 95% will be completed by the one-week followup. Bleeding usually starts 1-12 hours after using the misoprostol and may be heavy for 4-8 hours. Most will pass the pregnancy tissue within four hours of using misoprostol. There is usually some bleeding and/or spotting for a few weeks afterward.
How painful is it?
There can be strong cramping for a few minutes during the procedure and for a short time after. Medications including local anesthetic, painkillers and/or conscious sedation are used to help manage pain. Milder cramps may continue for several days.
How painful is it?
It varies from mild to very strong cramping, with the worst when passing the pregnancy tissue. There are medications to take at home to help manage pain. Milder cramps may continue for several days to several weeks.
Will I be able to get pregnant again in the future?
The chance of an early surgical abortion affecting future fertility is extremely rare: one in 10,000 or more rare than that. In fact, fertility returns very quickly and it is possible to be pregnant again right away. An IUD can be inserted at the end of the procedure, if you want.
Will I be able to get pregnant again in the future?
A medical abortion has no effect on future fertility. In fact, fertility returns immediately; birth control methods like the pill should be started 3 days after using the misoprostol pills. An IUD insertion can be arranged once the followup confirms the pregnancy is gone.
How much will I bleed?
There may or may not be much bleeding immediately after the procedure. Bleeding may start a few days after. It can continue for up to several weeks, but is often less than a period. Some won’t bleed at all afterward.
How much will I bleed?
Sometimes there can be bleeding after taking the mifepristone. Heavy bleeding and clots are common during the abortion process. Afterwards, there may be some spotting and/or bleeding up to the next period.
Can the abortion fail?
There is about a one in 300 chance of needing the procedure repeated because of blood clots forming or tissue remaining in the uterus. A pregnancy continuing is extremely rare.
Can the abortion fail?
There is about a one in 100 chance that the pregnancy will continue and a surgical abortion is necessary. About 4 in 100 will require the misoprostol a second time, or choose to have a surgical procedure to complete the process if they prefer.
What are the possible complications?
Surgical abortion has been formally studied for over 25 years and is very safe. Injury to the uterus is very rare in the first trimester. Excessive bleeding is very rare. Infection or needing a repeat procedure happens in less than one percent of cases. Abortion does not affect future pregnancies unless there is an extremely rare, serious complication.
What are the possible complications?
Medical abortion has been formally studied for over 20 years and is very safe. The risk of excessive bleeding or serious infection is very low. Allergies to the medications are very rare. About 4 percent will need or choose to have a surgical abortion procedure to complete the abortion. Abortion does not affect future pregnancies unless there is an extremely rare, serious complication.
What are common side effects?
Often there are  no side effects. Some have dizziness, nausea or vomiting for a short time after the procedure.
What are common side effects?
Some have few or no side effects, but it’s normal to have some side effects when using the misoprostol. These include mild to strong nausea, vomiting, diarrhea, headache, dizziness, fever or chills.
Are there emotional issues specific to this method?
Some people feel anxious in a medical setting or having a medical procedure.
Are there emotional issues specific to this method?
Some are anxious waiting for the abortion process to complete. Viewing the pregnancy tissue can also be difficult for some, especially when the pregnancy is over 8 weeks and there may be recognizable development. The pregnancy may pass while on the toilet, which might be upsetting for some.
What are the advantages of this method?
• Fee is 100% covered by BC medical insurance (MSP)
• Over quickly and only one appointment
• A very simple, safe procedure that involves suction (no incisions, stitches or scarring)
• Highly successful, effective and safe
• Usually less bleeding and pain for less time
• Performed by a doctor with support of nurses and counsellors
• There is no way for anyone else to know about the pregnancy/abortion later on
• It is possible to have an IUD inserted right away, at the end of the procedure
• Usually requires less time off work
• Free birth control via Safe Methods program
What are the advantages of this method?
• Effective and safe for very early pregnancies
• Avoids a surgical procedure
• Has the appearance of a miscarriage
• Being at home instead of in a clinic during the actual abortion is more private and may be more comfortable
• Medications leave the body within a few days with no long term side effects
• Does not require having a companion to get home after appointments, but it’s helpful to have  support when using the misoprostol at home.
What are the disadvantages of this method?
• A doctor inserts instruments inside the uterus
• Anesthetics and drugs to manage pain during the procedure may cause some short-term side effects (serious problems are extremely rare)
• Needing a ride, a companion on transit, or a taxi to get home from the clinic
What are the disadvantages of this method?
• Costs more, depending on extended health coverage
• The process takes longer than a surgical abortion
• The timing of the misoprostol is not very flexible and must be used between 24 and 48 hours after the mifepristone
• Failure rates are higher than with a surgical abortion
• Bleeding may  be very heavy at times and usually lasts longer than with a surgical abortion
• Cramping can also be strong and usually lasts longer than with a surgical abortion
• Two appointments are usually needed and sometimes more
• Not eligible at this time for free birth control via Safe Methods program