Pain during medical abortion "high"

Last Updated: 2015-10-09

By Reuters Staff

NEW YORK (Reuters Health) - Women undergoing medical abortion with mifepristone/misoprostol often report significant levels of pain and more so when mifepristone is dosed at 200 mg as opposed to 600 mg, according to a French study.

"Our results show a high level of pain in the days following a medical abortion. They emphasize the need to improve the analgesic strategies and suggest the option of a protocol of 600 mg instead of 200 mg mifepristone," the authors write in the European Journal of Obstetrics & Gynecology and Reproductive Biology, online September 27.

"A regimen of mifepristone plus misoprostol is the most widely used protocol to induce abortion, and its effectiveness has been demonstrated," Dr. Marie-Josephe Saurel-Cubizolles from Tenon Hospital in Paris and colleagues note. In France, the regimen is mifepristone 200 or 600 mg followed by misoprostol 400 or 800 mcg 48 hours later.

The French clinicians assessed pain by dose of mifepristone in an observational study involving 453 women, mean age 29, who underwent medical abortion. The women completed a questionnaire during five days following the abortion and pain was recorded daily on visual analog scale.

The highest pain levels were reported on day three after the abortion (mean, 4.7 on a 0 to 10 scale), with more than a quarter of women reporting pain levels of 8 or greater.

The level of pain did not differ by misoprostol dose but was greater for women who received 200 than 600 mg mifepristone.

A third of women reported pain of at least 8 on day three with 200 mg mifepristone as compared with 16% with 600 mg. "This difference remained after controlling for age, gestational age, gravidity, usual painful menstruation and misoprostol dose," the researchers say.

In addition, the number of women who reported at least one of five symptoms - nausea, vomiting, diarrhea, dizziness, headache - was much higher in those who got the lower dose of mifepristone.

And the number of women who said they'd choose the same method of abortion again, if necessary, was lower for those who got 200 mg mifepristone.

"Despite the WHO's recommendation that appropriate management of pain is an important public health concern, pain associated with medical abortion seems to be a neglected issue," the investigators say.

The current study shows a "high level" of pain in the days following a medical abortion and suggests that mifepristone 600 mg would be preferred to 200 mg, they conclude.

The study had no commercial funding and the authors have indicated no conflicts of interest.

SOURCE: http://bit.ly/1L9gqLp

Eur J Obstet Gynecol Repro Biol 2015.