Study reports medical abortion pain higher than expectations

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When seeking medical abortion, women will often be told that the severity of pain is no more than pain caused by period cramps, according to a recent study published in BMJ Sexual & Reproductive Health.¹

Medical abortion is performed at up to 10 weeks’ gestation through the consumption of pills. This method of abortion can be provided through telemedicine, removing the need for a clinic appointment and allowing patients to complete abortion at home.

Data has indicated medical abortion is common in England and Wales and is often performed at home. However, medical abortion is often painful, highlighting the need for proper counseling about pain management.This information is needed to encourage informed decision-making among patients.

Investigators conducted a secondary analysis to assess counselling among patients receiving medical abortion.² Patients receiving medical abortion up to 10 weeks’ gestation were invited to complete an anonymous online questionnaire between November 2021 and March 2022.

The survey asked patients about their experiences with pain management of medical abortion at home. This included questions about future abortion methods and 3 optional free-text questions. Quantitative responses were summarized using descriptive statistics, and mean pain scores were compared based on future method preference.

Participants with at least 1 free-text response were included in the analysis. The analysis was performed by experts in abortion, endometriosis, chronic pelvic pain, and pain within other gynecologic procedures.

There were 1596 participants included in the final analysis, one-third of whom performed abortion at 8- to 9-weeks’ gestation. Nulliparity was reported in 48.7% of participants.

Experiencing more pain than expected was reported by 48.4% of participants, with 92.2% experiencing moderate to severe pain. Of participants, 12.7% reported they would choose surgical abortion if they needed a future abortion. Pain influenced this decision in 82.7% of cases.

For other future abortions, 65.6% indicated they would choose a medical abortion, and 42.7% of these patients cited pain as a deciding factor. An average maximum pain score of 8.5 was reported among patients choosing surgical abortion for the future, vs 6.2 among those choosing medical abortion.

When reporting the severity of pain, patient responses included “I didn’t suffer any pain,” “very mild,” “moderate,” “very strong, but not severe,” “excruciating,” and “the worst pain I have ever gone through.” This indicated significant variety in the level of pain experienced.

There was also significant variation in how patients described the quality of pain. This included aching, pulling, crunching, stabbing, twisting, and squeezing. Some patients also described their pain as cramping or contracting.

When comparing their pain to reproductive experiences, some described the pain as similar to that of a regular period or a severe period. However, many participants also reported the pain from medical abortion as worse than period pain.

Comparisons were also made to the pain experienced during birth. Some participants reported their abortion pain as worse than period pain but better than labor pain.

For some participants, the expected pain was similar to that of their experienced pain. This indicated proper preparation, and while online forms were sometimes used, there were cases of sufficient counseling from reproductive services.

In other participants, experienced pain was significantly greater than expected. Patients reported information about pain in discussion or leaflets being “washed over,” “downplayed,” or “sugar-coated,” and many had based their expectations toward pain on descriptions from their provider.

Many participants were unprepared for the pain they experienced, and a few felt they needed emergency help during abortion because of the lack of proper pain preparation. Some stated they would have chosen to receive surgical abortion had they been aware of the potential pain severity.

These results indicated counselling for medication abortion pain leaves many patients unprepared for the level of pain they will experience. Investigators recommended further research focus on developing methods of managing pain expectations.

References

1. Women often told that severity of medical abortion pain no worse than period cramps. BMJ Group. December 17, 2024. Accessed December 20, 2024. https://www.eurekalert.org/news-releases/1068226
2. McCulloch H, Perro D, Taghinejadi N, et al. Expectations and experiences of pain during medical abortion at home: a secondary, mixed-methods analysis of a patient survey in England and Wales. BMJ Sexual & Reproductive Health. 2024. doi:10.1136/bmjsrh-2024-202533