The differences between Medical abortion and Surgical abortion in Australia

Deciding to have an abortion can be challenging, and choosing which type of abortion procedure is best for your circumstances can add to the confusion. Therefore, it is essential to understand the two options: surgical abortion (also known as Surgical Termination of Pregnancy, or STOP) and medical abortion (also known as Medical Termination of Pregnancy, or MTOP).

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Medical or Surgical Abortion?

The MSI Australia team dive into the differences between surgical abortion and medical abortion below to help you better understand the choices available to you.

Surgical abortion

Surgical abortion is one of Australia’s most commonly performed and safest surgical procedures, with up to 80,000 women undergoing the procedure every year. Most commonly performed in the first trimester, up to 14 weeks gestation, surgical abortion has a low complication rate when carried out during this time.

While surgical abortion can be performed in the second trimester (up to 20 weeks in most states and up to 24 weeks in Victoria), this does involve a more complex surgical procedure.

Surgical abortion in the first trimester is most often carried out under twilight sedation, although the option of a local anaesthetic is available. Once the anaesthetic has taken effect, the doctor inserts a small tube into the uterus to gently remove the contents and lining of the uterus.

The procedure takes around 10 minutes; however, from arrival at the clinic to completion of the process, you should allow for 4 – 5 hours. After the anaesthetic has worn off and you have received your aftercare advice, you will need to be driven home by a support person. We can call them and let them know when you will be ready to be picked up, if this is more convenient for you.

The risks of surgical abortion

Surgical abortion is one of the safest operations in Australia; however, all surgery carries risk.

Complications can occur in an estimated 3% of cases; however, significant complications are rare. Below is a list of the risks associated with surgical abortion:

Incomplete abortion is the most common complication (up to 2%), and occurs when a small piece of the pregnancy or lining remains in the uterus. This may result in problematic bleeding or cramping, requiring a repeat procedure.
Ongoing pregnancy is uncommon (1 in 500), but is more likely in procedures performed under six weeks.
Infection is uncommon (less than 1%). You will usually be given or prescribed antibiotics with your procedure to reduce the risk.
Damage to the cervix is uncommon and rarely has longstanding effects.
Perforation of the uterus, where the surgical instruments make a hole in the wall, is potentially the most severe complication but fortunately is rare with an experienced surgeon.
Haemorrhage following a surgical abortion in the first trimester is rare.

Women who experience heavy bleeding, fever or severe pain or discomfort following a surgical abortion must consult a doctor as soon as possible.

Why choose surgical abortion?

Overall, surgical abortion is a very safe and highly successful option for the termination of pregnancy in the first trimester. The advantages of choosing a surgical abortion are:

It can be performed later in the pregnancy than a medical abortion;
The procedure itself takes only a matter of minutes;
It usually involves only one visit to the clinic;
There’s usually less bleeding and cramping than with a medical abortion;
Medical staff are present throughout the procedure;
It can be performed under twilight sedation, which reduces awareness and pain;
It has a very low complication rate and a high success rate;
You can continue to breastfeed, whereas you will need to cease breastfeeding during a medical abortion.

Medical abortion

Medical abortion has been more widely available in Australia since 2012 and is a non-surgical option, available up to 63 days gestation.

For many women and pregnant people, the availability of medical abortion in Australia has meant greater privacy and convenience when having a termination of pregnancy. In addition, the more recent introduction of medical abortion via teleconsultation has made early termination more readily available to women and pregnant people living in rural and regional areas or without easy access to an abortion provider.

Medical abortion is available once a pregnancy is detected via ultrasound (usually around five weeks) up to nine weeks (63 days). Abortion is achieved using a combination of two medications that work together to terminate a pregnancy.

The first medication is administered by your doctor or taken by you at home. This medication is an anti-hormone, which acts by blocking the effects of progesterone – the hormone needed for a pregnancy to continue.
24 to 48 hours after taking the first medication, the second medication is taken by placing the tablets between the cheek and gum for 30 minutes before swallowing any remaining fragments with water.
The second medication opens the cervix and assists the uterus to expel the pregnancy. This should occur between 30 minutes to 24 hours after taking the second medication. Most people can expect to experience vaginal bleeding, cramps and the passing of some pregnancy tissue within 4 hours.

Before being prescribed the medication for medical abortion, you must have an ultrasound to determine that you are no more than nine weeks (63 days) pregnant and to exclude ectopic pregnancy (a pregnancy in the tubes). We complete a bedside scan at your appointment, or for medical abortion via teleconsultation and in some cases where you may have a complex health history, we will provide you with the forms and information you need to have one done prior to your appointment.

Almost all women are suitable for a medical abortion, although a few medical conditions may mean you are not suitable. For example, if you have a bleeding disorder or are on blood-thinning medications, adrenal gland problems, or corticosteroid medications, such as prednisone, medical abortion is unsuitable for you.

Your doctor will take a medical history to ensure that you are eligible for a medical abortion. You will also need to be able to access emergency medical care during the time you are having the medical abortion. We require that you remain within 2 hours of emergency medical care such as a hospital that is open 24 hours a day, 7 days a week, while you are completing your medical termination of pregnancy.

The risks of medical abortion

Medical abortion is a safe and effective method of terminating a pregnancy up to 9 weeks gestation; however, like surgical abortion, a medical abortion carries some risks:

Incomplete abortion is the most common complication (1-4%) and occurs when the pregnancy is not completely expelled from the uterus, causing cramping or heavy bleeding. A surgical procedure may be required if the bleeding or cramping is not settling, which is included in the cost of your service.
Ongoing pregnancy occurs in less than 1% of cases. We may recommend a surgical abortion as treatment for this complication or further medical management, which is inclusive in the cost of your service.
Infection is uncommon (less than 1%).
Excessive bleeding severe enough to require a blood transfusion occurs in around 1 in 1,000 cases. We provide an aftercare service to help you manage any concerns and provide advice about how to act in the rare case that you may require assistance.

What to expect after taking the second medication

Vaginal bleeding and cramping is normal and usually starts within a few hours of taking the second medication. The amount of bleeding and cramping varies from patient to patient.

Bleeding lasts on average 10 to 16 days, and it is usual for bleeding to be heavier than an average period of 2 to 3 days.
Side effects of the medication can also include nausea, vomiting, diarrhoea and chills or fever, but these are usually mild and short-lived.

Contact the MSI Australia aftercare service if:

You are soaking more than two maxi pads per hour for more than two hours;
You have severe cramps or pain uncontrolled by pain medication;
You have fever, chills, severe pain or other side effects which continue more than 24 hours after taking the second medication;
You have any concerns after taking the medication.

If bleeding does not occur, some patients may require a repeat dose of the second medication. Alternatively, our team may suggest another method of termination. You should contact your doctor as soon as possible if this occurs.

Why choose a medical abortion?

If your pregnancy is under nine weeks gestation and you prefer not to undergo surgery, then a medical abortion is a good option. Other reasons women choose medical abortion over surgical abortion include:

It requires no anaesthetic;
The procedure is non-invasive;
There is greater privacy than with a surgical abortion;
As a non-surgical procedure, there are no surgical risks associated with medical abortion;
You are at home and can have the support of friends or family if you choose;
It can feel ‘more natural or similar to having a heavy period or miscarriage.

Choosing the best option for you

The decision to have a surgical or medical abortion requires you to consider your circumstances, medical history and personal preferences. If you are still unsure, make an appointment for a telephone consultation with one of our pre-care nurses.