Abortion choices
The choice of abortion you are offered will depend on how many weeks of pregnancy have passed. There are 4 options. 2 are medical, which means you take medicine to prompt abortion, and 2 are surgical, which means a doctor removes the pregnancy tissue. Before having an abortion, you’ll have an appointment to talk about your decision and what happens next.
Whenever possible, you should be given a choice of how you would like the abortion to be carried out. The choice for the type of abortion is dependent upon how many weeks pregnant you are.
- A termination of pregnancy at home is a medical termination that takes place when the patient is under 10 weeks pregnant. You are given medicine in hospital, and are also given other tablets to take 48 hours later at home. The pregnancy passes at home.
- A medical termination in hospital will happen in the hospital if you are under 20 weeks. Like the option above, you come in, take medicine, then go home. You return 48 hours later but you are admitted to the hospital to pass the pregnancy.
- A manual vacuum aspiration (MVA) is a type of surgical termination that is suitable for women under 12 weeks pregnant. It requires local anaesthetic.
- A surgical termination is an operation to remove the pregnancy from the womb. It is suitable for women who are under 20 weeks pregnant. It requires a general anaesthetic.
How can I self-refer for an abortion?
To have an abortion at the RVI, you must self-refer to our service. However you self-refer, you will be asked some brief questions about your general health, as well as the date of your last period (you may not know this).
Self-refer using a self-referral form self-referral form
Fill in the self-referral for an abortion form online. We aim to contact you within 3 working days of receiving your form.
If you have not heard from us in this time, please call the number below between 9am and 3pm.
Self-refer by calling the RVI appointment line directly
Call the number below between 9am and 3pm. You will be asked the same questions over the phone as those on the online self-referral form.
We will check with you before we call you on your phone, email you or contact your GP. Please leave a message if you are happy to be called back from the hospital. The number we call you back on is a withheld number.
Lines are open 9am – 3pm. Please leave a message if you are happy to be called back from the hospital. The number we call you back on is a withheld number.
Important
If you do not want to tell anyone, your details will be kept confidential.
If you’re under 16, your parents do not usually need to be told. The doctor or nurse may encourage you to tell a parent, carer or other adult you trust, but they will not make you.
We are happy to offer an appointment if you are unsure and would like to discuss your options.
British Pregnancy Advisory Service (BPAS)
As an alternative to NHS care, you can contact British Pregnancy Advisory Service (BPAS) online or by telephone.
After an abortion
After an abortion, you’ll probably need to take things easy for a few days. It’s likely you’ll have some discomfort and vaginal bleeding for up to 2 weeks but for some it can be longer.
You do not usually need to have any other tests or appointments after an abortion.
If you have a medical abortion, you may have short-lived side effects from the medicines, such as diarrhoea and feeling sick.
If you have a surgical abortion, the general anaesthetic and sedation medicines can also have side effects.
After an abortion, you can
- Take painkillers like ibuprofen or paracetamol to help with any pain or discomfort
- Use period towels or pads (not tampons) until the bleeding has stopped
- Start using contraception anytime (although we advise to start this immediately where possible).
- Have a bath or a shower
- Undertake your usual exercise.
If you have a medical abortion you will be asked to take a pregnancy test 3 weeks after the procedure. If this is positive, please contact the day unit.
If this is negative you can expect your usual menstrual period to restart 4-6 weeks after the abortion. We will advise you if this is not the case with certain types of contraception.
When to get medical help
Get advice if you
- Have worsening pain or bleeding after your abortion
- Still feel pregnant after about a week
- Have a temperature, flu-like feelings or unusual vaginal discharge – these could be signs of infection
- Have any other worries.
Please get in touch with the team, your own GP or NHS 111.
You may experience a range of emotions after an abortion. This is common and if you need to discuss how you’re feeling, contact your GP, or you can visit support websites such as www.archtrust.org.uk.
Can everyone have an abortion?
In England, Wales and Scotland, almost all abortions are carried out before 24 weeks of pregnancy. Here at the RVI we perform abortions up to 20 weeks of pregnancy and in special circumstances up to 24 weeks.
Types of abortion
Before having an abortion, you’ll have an appointment to talk about your decision and what happens next.
Whenever possible, you should be given a choice of how you would like the abortion to be carried out.
The choice for the type of abortion is dependent upon how many weeks pregnant you are. There are two main options.
Medical abortion
Medical abortion involves the following steps
- First you take a tablet that contains a medicine called mifepristone, which helps prepare your body for the next medicine. Once you’ve taken the medication in the hospital, you’ll be able to go home and continue your normal activities
- Usually 1 to 2 days later, you take a second medicine called misoprostol. The tablets are placed under your tongue, between your cheek and gum, or inside your vagina. You can usually take the medicine at home if you’re less than 10 weeks pregnant – if you’re over 10 weeks pregnant you need to take these tablets in hospital
- Within 4 to 6 hours of taking the second medicine, the lining of the womb breaks down, causing pain, bleeding and loss of the pregnancy.
Sometimes you need to take more doses of Misoprostol to make the pregnancy pass. Occasionally, the pregnancy does not pass and an operation is needed to remove it.
Surgical abortion
Surgical abortion involves an operation to remove the pregnancy from the womb. There are 2 main types of surgical abortion.
Manual vacuum aspiration
This is a procedure performed as an outpatient under local anaesthetic or conscious sedation if available. There is Entonox (gas and air) for you to use throughout the procedure and it involves passing a hand held suction device through your cervix into your womb to remove the pregnancy tissue. You are able to go home straight after the procedure.
Suction Aspiration/Dilatation and Evacuation (D&E)
This procedure is performed in theatre while you are under general anaesthetic (asleep). You attend the ward early in the morning and are usually able to go later that day after your procedure.
You will need medication to help prime your cervix to make it soft to help aid the procedure. If you are under 14 weeks this is by placing 2 tablets under your tongue or in the vagina on the morning of your surgery.
If you are over 14 weeks this will involve placing thin rods called Dilapan through your cervix which swell and help open your cervix.
They are placed the morning over your surgery if you are 18 weeks or under or the afternoon before your surgery if you are 19 weeks and over and are removed at the time of your procedure. If you have them inserted the afternoon before you can go home with them in and return the following morning.
What happens at my first appointment?
Your first appointment might be in the hospital or on the telephone. We will take some medical details and then you will have an ultrasound scan to work out how many weeks pregnant you are.
Abortions are safer the earlier they’re carried out. Getting advice early on will give you more time to make a decision if you’re unsure.
The scan is usually an abdominal scan where the scan probe is placed on the abdomen. It is helpful to have a full bladder when this is done. Sometimes a transvaginal scan is needed where an ultrasound probe is placed inside the vagina. The scan measures the size of the pregnancy so that we can be sure how many weeks pregnant you are.
After the scan, your options will be discussed and additional information given. We will also discuss contraception with you so that we can help you to prevent a further pregnancy if you do not wish to have a baby.
What should I do before I come to the Ward 40 day unit?
You will get pain during or after an abortion and for some women this can be strong so it’s a good idea to make sure that you have a small supply of simple painkillers like paracetamol and or ibuprofen at home. You will bleed so it’s also important to make sure that you have some sanitary pads and wear underwear that’s suitable for this.
You will not be able to bring any children in the day unit during your appointments but you can bring an adult friend or family member.
Where should I go in the RVI?
The day unit (Ward 40) is based opposite Ward 41 entrance on level 4 of the Leazes wing at the RVI hospital (entrance off Richardson Road).
There is a doorbell at the entrance to the Day Unit and a member of the team will welcome you.
Risks of abortion
Abortions are generally very safe and most women will not experience any problems. But like any medical treatment, there’s a small risk that something could go wrong. The risk of complications increases the later in pregnancy an abortion is carried out.
Most women will not experience any problems, but there is a small risk of complications.
Complications that can occur
- Infection of the womb (uterus)
- Some of the pregnancy remaining in the womb, which may require further treatment
- Excessive bleeding
- Damage to the womb, entrance to the womb (cervix), or internal organs with surgical abortion.
If complications do occur, you may need further treatment, including surgery.
Having an abortion will not affect your chances of becoming pregnant again and having normal pregnancies in the future. You may be able to get pregnant immediately after an abortion. You should use contraception if you do not want to get pregnant.
Contraception
Over 90% of women will ovulate in the first month following an abortion. It is therefore really important to start contraception as soon as possible following an abortion to prevent an unwanted pregnancy. There are different options and below is a summary of each option to help you decide which one will be right for you.
Combined Hormonal Contraception (CHC)
Combined hormonal contraception contains both oestrogen and a progestogen delivered either as a pill, patch or vaginal ring.
With perfect use the failure rate is under 1% but with typical use the failure rate is 9% (9 out of 100). It can also be affected by taking other medications or absorption (vomiting).
You can take the CHC for 3 weeks of the month to have a monthly bleed or a more tailored regime so you have less bleeding, and we can discuss this with you.
Benefits of the CHC include helping with heavy, painful periods and PMS/PMDD and acne management. It also lowers your risk of developing endometrial, ovarian and colon cancer.
Risks include blood clots and an increased risk of breast and cervical cancer.
Side effects include:
- Irregular bleeding
- Headaches
- Mood changes
- Breast tenderness
Not all women are able to use the CHC due to certain health conditions so your medical history will need to be taken to make sure this is safe for you.
Progesterone only pill (POP)
There are 4 different POP’s available in the UK. With perfect use the failure risk is <1% but with typical use the failure risk is 9% (9 out of 100). Certain medications or malabsorption (vomiting) can increase the failure risk.
The pill’s are taken every day without a break. Some women still have regular bleeding, some have no bleeding and some have irregular bleeding.
Benefits of the POP include helping with heavy, painful periods and managing PMS/PMDD (with certain POP’s).
Risk with the POP is a slight increased risk of breast cancer.
The main side effect of the POP is irregular troublesome bleeding.
Progesterone only implant
This is a small rod which is inserted just under the skin in your upper arm and releases progesterone. It is effective for 3 years with a failure rate of 0.05% (less than 1 in 100)
Some women will have no bleeding, some will still have regular bleeding and some with have irregular bleeding.
It may help if you hav heavy, painful periods.
It has a slight increased risk of breast cancer.
Problematic irratic bleeding is the main side effect of the implant and is ocurrs more commonly than with the other contraceptives.
Some women report new onset or worsening acne but some report an improvement in their acne.
Progestrone only injection
This is an injection given either in a muscle (IM) or under the skin (SC) every 12 weeks and 13 weeks respectively. When used perfectly the failure rate is 0.2% (less than 1 out of 100) in the first year but with typical use it is 6%. (6 out of 100)
The majority of women using the injection will have no bleeding. Therefore it can help if you have heavy, painful periods.
It has a slight increased risk of breast cancer and cervical cancer.
It is the only hormonal contraceptive with evidence that it can cause weight gain. This is because it increases your appetite.
It can cause bone thinning so would not be used if you were at risk of this ie under 18 years old, low BMI.
There can be a delay of up to 1 year in return of fertility once stopping the injection.
Intrauterine Contraception (Coil)
Intrauterine coils are devices which sit inside the womb and there are 2 types of coil available: the copper coil or the levonorgestrel coil (hormonal coil). The hormonal coil is available in different strengths. They can both inserted at the time of a surgical abortion.
They are both very effective with a failure rate of 0.3 – 0.8% (less than 1 in 100).
The copper coil can be used for contraception for 5 or 10 years depending on the device inserted and the hormonal coil can be used for 8 years.
The copper coil is not hormonal so it will not effect your hormonal cycle. However it can cause periods to be heavier, last longer and be more painful. It can cause bleeding in between your period.
The hormonal coil can also be used a treatment for heavy painful periods. Some women have no bleeding, some women have lighter periods and some women can have irregular bleeding, This may be infrequent or may happen more often and be problematic.
There is a very small increased risk of breast cancer with the hormonal coil.
Barrier Methods
These include:
- Male condoms
- Female condoms
- Diaphragms
- Cervical cap
Condoms can be used for contraception and for protection against sexually transmitted infection and HIV. As diaphragms and caps only cover the cervix there is still a risk of contracting a sexually transmitted infection or HIV.
With perfect use the failure rate of female condoms is 5% (5 out of 100) and 2% (2 out of 100) for male condoms. However for typical use (ie not used consistently or used incorrectly) the failure rates for female condoms are 21% (21 out of 100) and for male condoms 18% (18 out of 100).
With perfect use the failure rate for the diaphragm is 6% (6 out of 100) but with typical use the percentage increases to 12% (12 out 100).
Spermacides do not need to be used with condoms but are recommended to be used with the diaphragm.
