For pregnancies between 4 and 7 weeks LMP options include a vacuum aspiration or a medical abortion using the pill. These can be done as soon as a woman has a positive pregnancy test.

Many providers discourage vacuum aspiration earlier than 7 weeks because of concern of missing the pregnancy. With state-of-the-art vaginal ultrasound, Dr. Seletz has performed thousands of early surgical abortions, with no increased risk, since 1992. This early vacuum aspiration technique was published in the medical literature in 1995 at the same time that the medical abortion with Methotrexate was introduced in the United States. To read further go to the website of Planned Parenthood at www.plannedparenthood.org and under "Research Information" choose the fact sheet "Safe Surgical Abortion Before Six Weeks."

Medical abortion is a new option. Methotrexate - a folic acid antagonist - has been used in the United States and Canada, and at the Pro-Choice Medical Center, since 1995. The abortion pill Mifepristone - a progesterone hormone antagonist - has been used in Europe since 1988. The pill was approved by the FDA in October 2000 and is called Mifeprex in the US. It is made by the Danco Laboratory and their website is www.earlyoptionpill.com. Both drugs are used in combination with Misoprostol, a prostaglandin drug that causes the uterus to contract and expel the pregnancy. Mifeprex works faster than Methotrexate but is also more expensive.

Women choose medical abortion in order to avoid surgery but the medical abortion has a failure rate of up to 8%, which then requires a surgical abortion. Some surgical interventions are done because the woman changes her mind, not because of necessity. Compared to surgical abortion, the medical abortion requires more time from initial drug treatment to completion and the doctor is not able to control the timing of the abortion or the success rate. Unlike surgical abortion where the uterus is mechanically aspirated in a few minutes, the medical abortion is a process of expulsion over a period of up to 2 weeks. A continuing pregnancy two weeks after the Misoprostol is used is considered a failure. A failure that results in a continuing pregnancy or an incomplete abortion with persistent bleeding can be managed differently than a failure that results in uterine hemorrhage. Profuse bleeding requires immediate surgical intervention. The likelihood of failures depends largely on the gestation age of the pregnancy and on the type of treatment protocol. The FDA has approved use of Mifeprex up to 49 days (7 weeks). After 49 days the risk of hospitalization for emergency bleeding increased from 2 to 4% in the US clinical trials. Our protocol has a success rate of 98% up to 49 days.

If you want a non-surgical abortion, it is better to begin as early in the pregnancy as possible. The number of failures as well as the amount of pain and bleeding increases with increasing gestational age. To read more about the medical abortion and a comparison of the pros and cons of both methods, see the website of the National Abortion Federation at www.prochoice.org/Facts and read the fact sheets "What is Medical Abortion" and "First Trimester Abortion: A comparison of procedures."