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Abortion pill online: how to order?

The abortion pill is a way of ending an unwanted pregnancy. It contains the active ingredient mifepristone. It inhibits the body’s own hormone progesterone, which is essential for the development and maintenance of pregnancy. However, the abortion pill can only terminate an early pregnancy – not one that is more advanced. Read the most important questions and answers about the abortion pill here!

What is the abortion pill?

The abortion pill is a tablet containing the active ingredient mifepristone. It can be used to carry out a medical termination of pregnancy. But this is only possible in early pregnancy. The abortion pill becomes less effective as the pregnancy progresses.

No “morning after pill”!

The abortion pill should not be confused with the morning-after pill. Depending on the preparation, this must be taken no later than 72 or 120 hours after unprotected sexual intercourse and primarily inhibits or delays ovulation – i.e. prevents pregnancy. The morning-after pill is not an abortion pill.

How does the abortion pill work?

The active ingredient in the abortion pill – mifepristone – is an artificial hormone . It blocks the effect of the body’s hormone progesterone , which is essential during pregnancy: it prepares the lining of the uterus for implantation of the fertilized egg cell and ensures that the pregnancy is maintained. If the progesterone effect is now inhibited by the abortion pill, the cervix opens, the lining of the uterus and the amniotic sac with the embryo detach and can – like with a menstrual period – be expelled.

In addition, mifepristone makes the uterine lining more receptive to another drug that the woman is given to increase the effect of the abortion pill: she is also given an artificial prostaglandin (such as misoprostol ). This is a labor inducing agent that stimulates contractions in the uterus , thereby promoting the shedding of pregnancy tissue.

Who gets the abortion pill?

Medical abortion with mifepristone is only possible up to the 63rd day after the start of the last menstrual period, i.e. up to the 9th week of pregnancy. However, the abortion pill is not simply available in pharmacies and on prescription. Rather, it may only be issued by approved clinics and medical practices that are allowed to carry out abortions. Before the abortion, a consultation and then a three-day waiting period are required by law. Pregnant women who are interested in a medical abortion need a counseling appointment no later than the beginning of the ninth week after the last menstrual period.

An abortion with tablets (mifepristone, prostaglandin) is only possible if these legal conditions are met – provided there are no medical reasons against it.

Medical reasons against a medical abortion

Abortion with mifepristone and prostaglandin tablets is not possible in the following cases:

  • suspected pregnancy outside the womb (such as ectopic pregnancy)
  • chronic adrenal failure
  • congenital porphyrias (a group of rare metabolic diseases)
  • severe, untreatable or untreated asthma
  • known allergy to one of the ingredients of the medication (mifepristone, prostaglandin, etc.)

To be on the safe side, the abortion pill is not recommended in the case of liver failure , kidney failure and malnutrition because there are no corresponding studies.

Individual decision in case of disturbed blood coagulation

In women who have a bleeding disorder or are currently being treated with blood-thinning medication (such as marcumar , heparin ), a medical abortion could cause dangerously heavy bleeding. The doctor must therefore decide on a case-by-case basis whether the unwanted pregnancy should be ended with suction instead of the abortion pill.

How is the process?

The medical termination of pregnancy with the abortion pill usually takes place in several steps, which include three visits to the doctor in addition to the consultation.

Advice

If you want to have an abortion, you must first seek advice from a state-recognized body, such as “Pro Familia”. Contact information for recognized counseling centers in your area can be found here.

The mandatory counseling session is intended to ensure that you are fully informed before you make your decision – both about the options for an abortion and about support options if you decide to have the child. You can also talk to the advisor about any doubts, fears and wishes – the advisor is subject to confidentiality.

In any case, the discussion must be open- ended : the counselor must not influence you in one direction or the other, but only help you to make your own decision for or against the pregnancy.

At the end of the consultation, you will be issued with a consultation slip – i.e. written confirmation that you have been advised in accordance with Sections 5 and 6 of the Pregnancy Conflict Act. Your name and the date of the consultation are noted on it – but not the content of the consultation and your decision. The presentation of the counseling certificate is the prerequisite for a doctor or a clinic to be able to give you the abortion pill.

Preliminary examination

At the earliest three days after your consultation , you can come to the doctor’s office or clinic that is allowed to carry out abortions for a first appointment. You must have the following documents with you:

  • counseling certificate (or the certificate of an abortion permitted for medical or criminological reasons, e.g. if the life of the expectant mother is in danger or the pregnancy is the result of rape)
  • insurance card
  • possibly blood group verification
  • possibly a certificate of assumption of costs if you are entitled to financial support for the abortion

The doctor will use an ultrasound scan to check how far along your pregnancy is. He will also clarify whether you have any medical reasons against using the abortion pill (plus the additional prostaglandin preparation). Among other things, he will ask you whether you suffer from previous illnesses (such as asthma, kidney disease), whether you are taking any medication and if so, which ones.

If nothing speaks against a medical abortion, the doctor will explain the exact procedure and the possible side effects of the abortion pill and the prostaglandin preparation.

Taking the abortion pill

After the preliminary examination and the interview, the doctor will give you the abortion pill – either one tablet of 600 mg mifepristone or three tablets of 200 mg each. You must take these under his supervision. You can then go home – with precise instructions from the doctor as to what you should do if you have any health problems (eg heavy abdominal bleeding).

Most women develop bleeding similar to normal menstrual bleeding about 24 hours after taking the abortion pill. A few women (three percent) even experience heavier bleeding, which already sheds the embryo and uterine lining – something that usually occurs after the prostaglandin supplement has been administered. The planned second visit to the doctor, where this preparation is actually administered, should still be taken.

Administration of Prostaglandin

The second appointment at the doctor’s office or clinic is scheduled 36 to 48 hours after taking the abortion pill. At this appointment you will receive a prostaglandin preparation:

  1. Up to the 49th day of pregnancy (i.e. 7th week of pregnancy), the prostaglandin is administered as a tablet by mouth . The tablet can be kept in the cheek or under the tongue until it dissolves. The active substance is then absorbed into the blood via the mucous membrane.
  2. If you are already in the 8th or 9th week of pregnancy, the prostaglandin is introduced as a tablet via the vagina (vaginally).
  3. After the administration of the prostaglandin preparation, you will remain under the doctor’s supervision for about three hours . Most women will have an intended miscarriage within this timeframe – the lining of the uterus and the embryo implanted within it are expelled by bleeding.

If there is still no bleeding at the end of the three-hour observation period, the doctor usually administers a second dose of prostaglandin . It takes more than 24 hours for one in four women to have an abortion.

Before you are allowed to go home, you will be given information on how to behave in the next few days (eg no sexual intercourse). You will also be given a phone number to call if you have any questions.

Follow-up examination

Approximately 14 to 21 days after the abortion using the abortion pill and prostaglandin, there is a follow-up check in the doctor’s office or clinic. It is very important: the doctor uses an ultrasound or blood test to check whether the pregnancy has really ended completely. It is possible that the abortion did not work out – so the pregnancy continues. Or there is still residual pregnancy tissue in the uterus. In such cases, re-administration of medication or surgical intervention (suction) could be necessary.

Abortion Pill: Benefits & Risks

An abortion with the mifepristone pill and prostaglandin supplement is successful about 95 to 98 percent of the time . In contrast to the instrumental abortion (suction), it usually does not require anesthesia and no surgical intervention (which also carries the risk of damaging the uterus). Medical abortion is also possible very early in pregnancy . It also has no effect on the woman’s fertility, as long as it proceeds without complications. In this respect, nothing stands in the way of a later desire to have children.

The disadvantage is that the medicinal termination extends over several days and thus lasts longer than an instrumental termination. Women have to be prepared for an average bleeding time of 12 days. Light bleeding (spotting) can also last up to four weeks, rarely longer.

Side Effects & Complications

The most common side effects of medical abortions with abortion pills and prostaglandins include cramping abdominal pain, nausea, vomiting, diarrhea and circulatory problems . If necessary, the doctor will prescribe medication for you.

Rarely does the withdrawal bleeding after the medical abortion last so long that medical treatment is necessary (excision). Pregnancy tissue (placenta) left behind in the uterus also carries the risk of infection. This is why follow-up after an abortion is so important.

Overall, complications after an abortion (with tablets or suction) are rare.

Abortion pill: cost

In general, the costs for an outpatient abortion (whether with tablets or by suction) are between 350 and 600 euros. A medical abortion costs less than an instrumental abortion. Whether and to what extent the costs are covered by another body (e.g. health insurance company) depends first of all on whether the termination occurs according to the counseling regulation (as described above) or on the basis of a medical or criminological indication.

Medical abortion according to counseling regulations

In this case, a woman usually has to pay for the medical abortion out of her own pocket . Only a small part can be billed for women with statutory health insurance, such as the costs for medical advice before the medical abortion.

However, if a woman is in social need (e.g. low or no income), the federal state in which she lives pays for the abortion. However, you must submit the application for reimbursement of costs to your health insurance company in advance. This will confirm the assumption of costs in writing if the conditions for this are met, and then take care of the financial settlement. The woman must bring the confirmation with her to the doctor’s practice or clinic at the first appointment.

What do women feel?

An abortion is a psychologically stressful situation for most women, regardless of which abortion method they choose. Many women consider abortion using abortion pills and prostaglandin tablets to be at least physically gentler than instrumental abortion. In addition, some feel more self-determination and responsibility when using medication than during surgery under anesthesia, while this is not the case for other women.

It is also perceived differently that the abortion using the abortion pill and prostaglandin preparation takes longer than the instrumental abortion. The fact is: A woman experiences the abortion with tablets more consciously in all phases than suction under anesthesia. In addition, the medical abortion with its termination bleeding is similar to a miscarriage. For some women, this represents an additional psychological burden. For others, however, the direct, intensive experience of the abortion helps them to process it emotionally.

Mental consequences?

According to studies, an abortion alone does not increase the risk that a woman will later develop a mental disorder – regardless of whether the pregnancy was terminated by abortion pills or suction. It is crucial that women in this exceptional situation receive good medical and psychological care. Then they do not develop psychological problems more often than women who carry an unwanted pregnancy, as the current study shows.

However, unfavorable circumstances can increase the risk of psychological problems after an instrumental or drug-based abortion. These include stressful living conditions such as experiences of violence or poverty, but also pressure from the partner or family to terminate the pregnancy. If a woman does not receive sufficient social or emotional support or is forced to keep the abortion a secret, this also encourages psychological problems.

Allow time to decide

The legislature only grants an unpunished abortion for a limited period of time. However, as long as this is not almost exhausted, women should take the necessary time to decide whether they want to terminate an unwanted pregnancy and if so, how – by means of abortion pills and prostaglandin preparations or by suction. Empathetic and open-ended discussions with a doctor or pregnancy conflict counselor can help the woman.