See also:
Medical Abortion Prescriber Checklist Resource Guide PDF [284 KB]
Canadian Protocol for the Provision of Medical Abortion via Telemedicine PDF [458 KB]
How to Arrange an Abortion PDF [1.23 MB]
Patient Handouts:
What to expect when ending a pregnancy at home PDF [1.57 MB]
Medication Abortion Checklist PDF [258 KB]
Medication Abortion Instructions PDF [302 KB]
"Taking your pills" instructional flowchart PDF [1.11 MB]
Answers to most common calls from medication abortion patients PDF [165 KB]
Additional Resources:
SOGC Canadian Abortion Provider Support website (See prescribing link for detailed step-by-step support)
Clinical Pearl:
An ultrasound is not required if a person indicates an EGA <77 days, is sure of their LMP, and has no risk factors or signs of ectopic pregnancy.
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Medication abortion |
Procedural abortion |
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Indications |
Gestations up to 10 weeks and 6 days |
Gestations up to 14 weeks with most outpatient clinics but depending on the location may be available up until the third trimester. |
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Off-Label past 11 weeks |
(Under some circumstances travel to the USA or Mexico might be needed to access care.) | |
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Effectiveness |
99% success rate up to 7 weeks |
99% success rate |
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≥ 97% success rate up to 10 weeks |
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Process and time length |
Non-invasive method. |
Takes place in a medical clinic or hospital. |
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Takes place at home or wherever the person feels comfortable and safe to experience heavy bleeding and cramping. |
Requires at least 1 in-person visit. Not possible through telemedicine. |
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Requires 2 to 3 visits for assessment and follow-up (and optional counselling). Telehealth may be available. The process takes 2 to 3 days from the time medication is taken to the time of expulsion. Most people can return to normal activities after 1-3 days. |
The procedure lasts 5 to 10 min, followed by 30 to 60 min of monitoring and observation. Upon clinic discharge, most of the bleeding has subsided. Most people can return to normal activities after 1-2 days. |
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Person support |
Can have the support from friends or family if desired. |
Requires a support person to drive the person home if sedation is used. Support person during the appointment may be possible, depending on the clinic or hospital. |
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Side effects |
Much heavier bleeding than a period. |
Usually light bleeding. |
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Cramps might be more severe and last longer than a menstrual period. Pain medication can help. |
Mild to strong cramps during the procedure and shortly after. Pain and anxiety can be controlled by intravenous medication. |
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The person may experience diarrhea, nausea, vomiting, abdominal pain, gas, fever, chills, and headaches. |
If taking sedation or general anaesthetic, side effects may include drowsiness and mild upset stomach. |
Medical Abortion via Telemedicine
Medication abortion through telemedicine has been evaluated in observational studies and found to be equally effective as an in-person visit. A large study of 52,142 medication abortions demonstrated no evidence of worse outcomes in failure rate, haemorrhage, need for surgery or failure to detect ectopic pregnancy. Post-abortion testing of fetal red blood cells has revealed that pregnancies that end prior to 12 weeks gestation do not meet the threshold for maternal sensitization, negating the need for ABO testing and administration of Rho(D) immune globulin. In light of this research, the World Health Organization recommends against routine pre-abortion imaging and lists telemedicine as a mode of service delivery that can increase access to abortion care.
A Note on Setting Pain Expectations
While the pain experienced during a medication abortion varies from person to person (and abortion to abortion), resources frequently compare the pain to strong menstrual cramping. Recent studies, however, indicate that more than half of the people who carry out medication abortion have severe pain, with many feeling caught off guard and unprepared for the type and intensity of pain. When an abortion turns out to be much more painful than expected, it may cause anxiety and concerns that something may be wrong. These feelings, in turn, can lead to more pain and distress.
When discussing pain expectations for a medication abortion, balance your desire to avoid causing unnecessary alarm with the need for transparency about the range and potential intensity of pain. It is crucial to establish realistic pain expectations and a comprehensive pain management plan to ensure people are well-informed and better equipped to manage pain effectively throughout their abortion experience. You can start by asking each person seeking an abortion to describe their personal pain tolerance (“tough-as-nails,” “feel pain easily,” or somewhere in between) and what comfort measures/pain medications they’ve used in the past to guide your strategy.
- Describe prescribed medications (e.g., Tylenol 3, Percocet, Naproxen, etc.) and their potential side effects.
- Inquire about prior use of prescribed medications, explain how they work, proper usage, and what to expect.
Source: UBC CPD: We All Have a Role to Play: Increasing Access to Abortion Care in Canada
