Medical Abortion is Safe Even at the Very Early Stages of Pregnancy

Medical abortion is performed using medication without surgical intervention. In 2023, as many as 99 percent of all terminations were done with medication. Traditionally, medical termination has been performed only after pregnancy is confirmed by ultrasound. Medical termination uses two different medications: the first, mifepristone, blocks the effects of the corpus luteum hormone on the uterus, and the second, misoprostol, causes uterine contractions and empties the contents of the uterus. Medical abortion can often be done at home using instructions that the patient can follow.

Researchers wanted to find out if an abortion could be performed earlier than recommended 

"Although healthcare primarily recommends medical abortion over surgical termination, we have little evidence of its effectiveness in the very early stages of pregnancy, before the pregnancy is visible on ultrasound. Therefore, we do not have precise treatment recommendations for performing medical termination before intrauterine pregnancy is confirmed," says Professor Oskari Heikinheimo, Chief Physician of Obstetrics and Gynecology at HUS.

The international study, led by Sweden's Karolinska University Hospital and University and published in The New England Journal of Medicine, investigated whether medical abortion performed at the very beginning of pregnancy is as effective and safe as conventionally-timed medical terminations. 

"Obtaining a medical abortion only after pregnancy is confirmed by ultrasound can extend waiting times and increase the psychological and physical burden on the person seeking an abortion, as well as practical challenges such as social pressure and the risk of more severe physical symptoms as pregnancy progresses," Heikinheimo notes.

The study confirmed that medical termination can be safely performed at the very early stages of pregnancy

The study was conducted in nine countries as a multicenter study with a randomized, controlled trial design. From Finland, HUS Helsinki University Hospital Women's Clinic and the University of Helsinki participated in the study. 

In the study, 1504 women were divided into two groups: one group started medical abortion immediately without confirmation of intrauterine pregnancy, and the other waited to start treatment until pregnancy was confirmed by ultrasound. The main objective of the study was to determine whether a successful abortion occurred equally often in both groups. 

"Complete abortion occurred in 95.2 percent of the early initiation group and 95.3 percent of the conventional group, meaning that based on the study results, medical termination can be safely performed even before pregnancy is confirmed by ultrasound," Heikinheimo says.

Research article: Randomized Trial of Very Early Medication Abortion

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