A British survey has found that many women choosing medical abortions at home are unprepared for the severity of the pain, having been told it would be no more painful than period cramps.
But the survey from the British Pregnancy Advisory Service (BPAS) an independent healthcare and abortion advice charity, revealed more than 40% of women reported the pain score at 8 or higher out of 10.
The results of the surveyed are mirrored elsewhere, with an Australian sexual health researcher saying: “…it’s often perhaps the worst period pain they felt.”
The authors of the report published in BMJ Sexual and Reproductive Health, say that for women to make an informed choice, more realistic patient-centred information about the pain needs to be provided.
A medical abortion involves taking two pills, mifepristone and misoprostol, in the early weeks of pregnancy. In England and Wales, where the survey was based, nearly all such abortions are carried out at home.
“Benchmarking against period pain has long been used as a way to describe the pain associated with medical abortion, despite the wide variability of period pain experienced,” says lead author of the study Hannah McCulloch.
To gain a deeper understanding of the experience and expectation of pain, researchers invited people who recently had medical abortions to fill in an online questionnaire.
From the 1596 responses, 41.5% gave their pain a score of 8 or higher out of a maximum of 10. Most (92%) said they experienced a pain score of at least 4.
About half (48.5%) of the respondents said that the pain they experienced was more than they expected.
While some experienced pain no worse than period pain, many others felt unprepared for the experience.
“It was like having contractions in labour. I’ve given birth three times and the pain really wasn’t too much different from that pain, the cramping contraction pain,” one of the respondents answered.
Many other respondents said they felt the language and information used in consultations about abortions was “sugar-coated” and “washed over” the pain.
“The results of the survey show that counselling on this aspect of medical abortion needs to improve,” says McCulloch.
“For many respondents, using period pain as a reference point for what to expect was not helpful for managing expectations, or in line with their experiences.”
The survey also found that around 1 in 8 patients said they would have a surgical abortion if needed in the future rather than a medical abortion. For 83% of these respondents, pain was a main factor behind this decision.
“Being transparent might put some women off from abortion,” one of the respondents commented.
“However, I feel that patients have a right to fully understand the risks and benefits. This should be made absolutely transparent; shared and informed decision-making is essential.”
Dr Sara Whitburn is Medical Director at Sexual Health Victoria in Australia and is a strong advocate for recognising and properly managing women’s pain especially when it comes to medical abortions.
“I know in our practice, we spend a lot of time talking about pain and really trying to let people know that [a medical abortion] has features of a period pain, but it’s often perhaps the worst period pain they felt,” Whitburn told Cosmos.
“’We’ve really tried to go with the evidence. And last year, we’ve actually increased how much anti-inflammatory we would give. I think there’s always more evidence coming out around trying to manage it.”
McCulloch says: “Women want more detailed, realistic information to make choices about treatment and to be prepared for medical abortion if that is their preference.
“This evaluation led us at BPAS to create new patient materials and provide additional staff training, which we are currently in the process of evaluating.”
“Providing accurate, realistic information on pain is not only important for preparing patients for medical abortion, but for supporting informed consent for abortion method choice, in the context of structural constraints,” write the researchers.
“We work really hard to talk about pain,” Whitburn says.
“You can be prepared with good advice. It’s good advice and good education pre-medical abortion that’s really important.”
“You really want to go away with a fact sheets and a plan, because I think that helps pain management, if you know what you’re going to take.
“But I also say it’s about empowering people that if they’re not managing the pain, then to seek medical care, because it may need a review.”
Whitburn also says that managing pain can be a lot easier with a support person, a person the patient feels most comfortable and trusted with.
“Talk to your partner. Have your plan together and keep that communication open between you and your support person and your health care provider.”
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