Limitations Of The Literature
While randomized controlled trials are the gold standard research design for assessing the health effects of a medical intervention, they are not appropriate for studies assessing the long-term risks of abortion. Women seeking an abortion cannot be randomized to an experimental group that has the abortion or a control group that does not have the abortion. Researchers must use observational study designs to examine abortion’s long-term potential for harm. However, the risk of bias is greater for observational studies than for randomized studies, and it is imperative that published studies be assessed for potential sources of bias that might affect their findings . In research, bias refers to systematic error in a study’s design or execution that leads to an incorrect result .
What Are The Risks From Abortion
According to the American College of Obstetricians and Gynecologists , an abortion is a low-risk procedure. The risk of death following an abortion is less than 1 in 100,000. The later in her pregnancy a woman has an abortion, the greater her risk for complications however, the risk of death following giving birth is 14 times higher than the risk of death following an early abortion.
Some of the potential complications associated with abortion include:
- Bleeding: A woman can experience bleeding after an abortion. Usually, the blood loss isnt so extreme that its a medical problem. However, rarely, a woman may bleed so much that she requires a blood transfusion.
- Incomplete abortion: When this happens, tissue or other products of conception may remain in the uterus, and an individual may need a D& C to remove the remaining tissue. The risk for this is more likely when a person takes medications for an abortion.
- Infection: Doctors will usually give antibiotics before an abortion to prevent this risk.
- Injury to surrounding organs: Sometimes, a doctor may accidentally injure nearby organs in an abortion. Examples include the uterus or bladder. The risk that this will occur increases the further along a woman is in a pregnancy.
Technically, anything that causes inflammation in the uterus has the potential to affect future fertility. However, its very unlikely this will occur.
Teratogenicity And Ongoing Pregnancy
Before undergoing medication abortion, patients should be counseled regarding the teratogenicity of misoprostol in the event of an unsuccessful medication abortion. All patients with a continuing pregnancy after using mifepristone and misoprostol should be provided with all pregnancy options and a thorough discussion of the risks and benefits of each. Most individuals with a continuing pregnancy opt to complete the abortion, but patients should be supported in their choice of how to proceed. No evidence exists to date of a teratogenic effect of mifepristone 34. However, misoprostol can result in congenital anomalies, such as limb defects with or without Möbius syndrome , when used during the first trimester 3536373839. Because misoprostol is the common agent used with every medication abortion regimen, clinicians should counsel all patients regarding potential teratogenic effects.
In the very rare case that patients change their mind about having an abortion after taking mifepristone and want to continue the pregnancy, they should be monitored expectantly 40. There is no evidence that treatment with progesterone after taking mifepristone increases the likelihood of the pregnancy continuing 4142. However, limited available evidence suggests that use of mifepristone alone without subsequent administration of misoprostol may be associated with an increased risk of hemorrhage 43.
What evaluation and ancillary testing are needed before a medication abortion?
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We Should Care About How Medical Decisions Affect Future Fertility
There is more than enough evidence to reasonably conclude that abortion can affect future pregnancies and womens fertility.
The risks of some of these adverse outcomes, like PID, infertility, and preterm birth, may be small enough that a woman does not care about them and would still choose to have an abortion. However, many women who get abortions may want to have a child or multiple children later in life, and these women may decide the possible cost of a first, second, or third abortion is too high and outweighs the perceived benefit of the abortion. As long as abortion is legal, shouldnt women be able perform a cost-benefit analysis and come to an informed decision about not only their current pregnancy, but also their future reproductive health?
I would dare say the majority of both pro-life and pro-choice people genuinely care about the well-being of women and want women to be able to make medical decisions based on accurate information. It seems reasonable to say people on both sides of the abortion debate should, for the sake of womens health and our autonomy over our future reproductive health, agree that a woman seeking abortion should be provided with information on possible affects on her fertility and future pregnancies so we can decide for ourselves whether we want to accept those risks.
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What Is The Outlook For Fertility Following Abortion
According to ACOG, having an abortion doesnt generally affect your ability to get pregnant in the future. It also does not increase the risks for pregnancy complications if you do choose to get pregnant again.
Many doctors recommend using some type of birth control immediately after abortion because its possible a woman can get pregnant again when she starts ovulating.
Doctors will also usually recommend a woman refrain from sexual intercourse for a certain time period after an abortion to allow the body time to heal.
If you do have difficulty getting pregnant after an abortion, its important to consider some of the other factors that could potentially affect your fertility, since a past abortion isnt likely to cause problems conceiving. These factors can also affect fertility:
If you are experiencing problems getting pregnant, talk to your gynecologist. They can advise you on lifestyle steps that may help, as well as recommend a fertility specialist who can help you identify potential underlying causes and possible treatment options.
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Pid Asherman Syndrome And Infertility
Uterine scarring from PID or from curettage can also lead to a specific condition, Asherman Syndrome, which affects fertility. Scarring and/or excess tissue in the uterus involved in Asherman Syndrome can prevent implantation of an embryo and can cause a higher risk for miscarriage . Interestingly, while the Mayo Clinic says women who have multiple surgical abortions can get Asherman Syndrome, the actual papers on Asherman Syndrome say the risk is there, even after the first surgical abortion:
It may occur in up to 13% of women undergoing a termination of pregnancy during the first trimester, and 30% in women undergoing a dilation and curettage after a late spontaneous abortion.The risk increases for patients undergoing repeated procedures for bleeding or repeated elective termination of pregnancies.
Other studies have found that the chance of Asherman Syndrome could range from 10% to 40% after a curettage, no matter the reason for the curettage .
Another cause for infertility can include damage to fallopian tubes , which can come not only from PID, but also from previous abdominal or pelvic surgery, including surgery for ectopic pregnancy. Scar tissue in the tubes can prevent fertilization and can prevent proper implantation, leading to no pregnancy or an increased risk for ectopic pregnancy.
What Happens When You Take The Abortion Pill
The abortion pill is actually a combination of what is usually two kinds of pills that are taken in sequence. In the U.S. these are most often used before 11 weeks of pregnancy.
The first pill, mifepristone, blocks a hormone necessary for a pregnancy to continue to develop. Most people swallow this first pill in our office. A small number of people see some vaginal bleeding after taking mifepristone, but its not common.
The second pill, misoprostol, causes cramping and bleeding from the vagina so that the pregnancy will leave your body . It is usually taken at home within 72 hours after taking the first pill.
Most people start to see cramping and bleeding within about an hour after taking the misoprostol, though some take longer. Its normal to feel chills, nausea or even have diarrhea along with bleeding and cramping while your body is pushing the pregnancy from your uterus.
Its kind of like having a really heavy, crampy period along with mild flu-like symptoms. It is good to have some thick overnite type maxi pads ready along with a heating pad to help with cramping. carafem provides anti-nausea and pain medication to help handle these symptoms.
For most people, the heaviest bleeding and cramping ends once the pregnancy has passed, usually within 3-4 hours. It is important to plan for possible vaginal bleeding to continue after any type of abortion. Some see light bleeding that lasts up until their next period starts, which is usually within about 4-6 weeks.
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Can The Effects Of The Pill Be Reversed After It Has Been Taken
Unfortunately, once the pill has been taken it is impossible to reverse its effects. Learn about all your available options before choosing abortion. Understand the risks and finality of abortion and consult your partner before choosing to terminate your child, after the abortion, it is highly recommended that you follow your doctors guidelines for post-abortion care. Do not miss your appointments for follow-ups and ensure you discuss your fears and address them before taking the pill. Remember, the decision to have an abortion is not a light one, it can cause trauma psychologically as well, please consult a therapist after the abortion to fight off depression.
Having an abortion should never be forced on a woman, remember, this is your body and your choice, always enforce your rights to either have or abort the child. Forcing an abortion or forcing a woman to keep the child against her will is illegal and a criminal offence, it is also extremely dangerous for their body.
What Happens During A Medication Abortion
The abortion pill process has several steps and includes two different medicines.
First, you take a pill called mifepristone. This medicine stops the pregnancy from growing. Some people feel nauseous or start bleeding after taking mifepristone, but its not common. Your doctor or nurse may also give you antibiotics to take to prevent infection.
The second medicine is called misoprostol. Youll either take the misoprostol right away, or up to 48 hours after you take the first pill your doctor or nurse will let you know how and when to take it. This medicine causes cramping and bleeding to empty your uterus.
For most people, the cramping and bleeding usually starts 1-4 hours after taking the misoprostol. Its normal to see large blood clots or clumps of tissue when this is happening. Its kind of like having a really heavy, crampy period, and the process is very similar to an early miscarriage.
The cramping and bleeding can last for several hours. Most people finish passing the pregnancy tissue in 4-5 hours, but it may take longer. The cramping and bleeding slows down after the pregnancy tissue comes out. You may have cramping on and off for 1 or 2 more days.
You can take pain medicine like ibuprofen about 30 minutes before you take the second medicine, misoprostol, to help with cramps. You can also take anti-nausea medicine if your doctor or nurse gives it to you. Dont take aspirin, because it can make you bleed more.
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Heres What Happens In A Surgical Abortion
There are a few different ways doctors can perform a surgical abortion. One method is known as suction curettage, and its often used in the first trimester, which is at or before 13 weeks. Abortion is by far most common in this time frameaccording to data from the Centers for Disease Control and Prevention , 91 percent of abortions in 2016 took place in the first trimester.
During a suction curettage, a health care practitioner will insert a speculum into your vagina and pass a suction tube into your uterus through your cervix, which can either be dilated before or during the procedure, according to ACOG. A suction or vacuum pump on the other end of the tube then works to remove the tissue from the pregnancy. If your next question is what kind of pain management is available for this, you might receive sedatives or general anesthesia beforehand, and you should also receive local anesthesia to reduce sensation in your cervix, ACOG explains. After a suction curettage, you might have cramping for a day or two and see some vaginal bleeding for up to two weeks.
Spontaneous Abortion And Stillbirth
Does Abortion Increase the Risk of Spontaneous Abortion and Stillbirth?
Spontaneous abortion, also referred to as miscarriage, is the spontaneous death of a fetus prior to 20 weeks’ gestation. Stillbirth refers to spontaneous fetal death after 20 weeks’ gestation . Several literature reviews have concluded that abortion is not associated with increased risk of either spontaneous abortion or stillbirth . However, as in the published reviews of abortion and subsequent ectopic pregnancy, these literature reviews include studies of abortions performed with outdated methods and are methodologically flawed by reliance on studies based on maternal recall . The committee could identify no relevant primary literature without these limitations, and thus was unable to draw a conclusion regarding the association between abortion and risk of spontaneous abortion and stillbirth.
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Can You Get Pregnant After An Abortion
“It’s very common for women who’ve had an abortion in the past to worry that their fertility has been affected or damaged,” says Dr. Amersi. But she insists that abortion does not necessarily impact fertility, noting that a medical abortion, i.e. the abortion pill, is preferable over a surgical abortion when it comes to future fertility. “Sometimes multiple surgical procedures in the uterus can cause scar tissue that can affect future pregnancies and fertility,” she explains. This scar tissue is called Asherman’s Syndrome, and according to the Cleveland Clinic, it’s a rare disease.
However, Dr. Amersi emphasizes that a single surgical abortion is not a key perpetrator: “If you had one procedure, it’s not going to impact you, but if you’ve had multiple procedures, absolutely.”
Abortion Pill Side Effects
The Abortion Pill is an extremely powerful drug and side effects are very common. Women who take the abortion pill often experience severe side effects, such as:
Other less serious side effects include:
- High blood pressure
- Fluid retention
- An overgrowth of the uterine lining.
Chemical or medical abortions can potentially be more dangerous than surgical abortions, but can have similar side effects. Although rare, severe reactions to abortion medications can be fatal. Other complications, such as infections or ectopic pregnancies can be severe and even life-threatening.
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Abortion Pill Side Effects On Infertility
Having an abortion, especially a medical abortion, wont usually affect your chances of becoming pregnant or carrying out future pregnancies to term.
According to the FDA, the Abortion Pill medications are not considered harmful to future fertility, but their effects have not been studied as extensively as surgical procedures.
Although they may not show up right away, there are side effects of the abortion pill that can cause problems down the road. According to the Mayo Clinic, there are some studies that link pregnancy termination to an increased risk of premature birth or low birth weight for future pregnancies.
What Color Discharge Is Normal After Abortion
Some may be as big as a lemon. If clots are occurring with heavy bleeding and last more than two hours, you should call your healthcare provider to discuss whether you need evaluation. There may be blood-tinged discharge, too. The discharge may be stringy like mucus, but it shouldnt be foul-smelling, yellow, or green.
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Remote Assessment And Self
Follow-up can be performed by telephone at 1 week, with subsequent at-home urine pregnancy testing at 4 weeks after treatment, which avoids the need for the patient to go to a facility 103104105106. Most studies have used a short series of questions that ask patients whether they have experienced bleeding and cramping and whether they still feel pregnant or if they think the pregnancy has passed 104107. When the clinician and the patient think that expulsion has occurred based on symptomatology, they are correct 9699% of the time 104108. Although urine pregnancy testing alone with standard high-sensitivity or low-sensitivity tests has not been shown to be a viable alternative to other forms of follow-up, newer semiquantitative or multilevel at-home urine hCG tests have shown promise in accurately identifying ongoing pregnancies after medication abortion 109110111112.
Does Medical Abortion Affect Future Pregnancy
Normally an abortion does not cause infertility that the fetus is not growing. You just get expelled from the uterus so the tubes are not involved in a normal miscarriage in any way, but sometimes a small piece can be retained when the uterus is ending the fight. Inside these, we can maintain the products of conception, when a small piece of the placenta or a small piece of the baby is placed inside, it can set up an infection in the uterus.
This infection can go on and spread in the tubes if the tubes get infected. They may have a tubal blockage. It probably occurs in 10 to 15 percent. In abortions where adequate precautions were not taken to prevent infection, the chances of infertility in a properly operated abortion are generally very low. So fertility is usually not affected to assure an abortion but yes there is a short condition.
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