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A new survey from the British Pregnancy Advisory Service (BPAS) has shed light on the experiences of women undergoing medical abortions at home, revealing that many are unprepared for the intensity of pain, which is often described as far worse than what they were led to believe. The survey, published in BMJ Sexual & Reproductive Health, suggests that the common description of medical abortion pain as no more severe than period cramps may contribute to unrealistic expectations and increased discomfort.
Medical abortions, which are typically performed using pills up to 10 weeks into pregnancy, are a common method in England and Wales. Most of these procedures are carried out at home, with some conducted via telemedicine without the need for an in-person clinic visit. However, the procedure is known to be painful, and previous studies have emphasized the need for better anticipatory counseling to help women manage the pain and reduce anxiety.
Between November 2021 and March 2022, BPAS surveyed 11,906 clients who had undergone a medical abortion to assess their pain experiences and expectations. The survey received 1,596 responses, with the majority (85%) of participants aged 20 to 39. While some women described the pain as similar to period cramps, others felt the pain was much more intense and comparable to labor contractions.
Approximately 48.5% of respondents reported that the pain they experienced was more severe than expected, with nearly 42% giving it a pain score of 8-10 out of 10. The intensity of the pain led many to reconsider their future options; while 66% of respondents said they would choose a medical abortion again, 13% indicated they would opt for a surgical abortion instead. Pain was the key factor influencing this decision for 83% of those who preferred surgical abortion.
One participant described the pain as “so much stronger than period pain, it was like having contractions in labor.” Another noted, “The pain really wasn’t too much different from that pain, the cramping contraction pain.” Such testimonies suggest that the widespread characterization of medical abortion pain as period-like may be downplaying the severity for many women, leaving them unprepared.
Some women expressed frustration with the language used in consultations and information leaflets, feeling that it downplayed the reality of the pain. One respondent said, “Pain was washed over, downplayed, or sugar-coated,” which she believed had contributed to her shock when the pain proved to be far more intense than anticipated.
The survey highlights a significant gap in patient education, with respondents calling for more detailed, realistic information about the pain associated with medical abortion. Many believe that more transparency is needed to ensure informed decision-making, with one respondent suggesting that while being honest about the pain might discourage some women, it is crucial for patients to fully understand the risks and benefits.
Hannah McCulloch, lead author of the study, commented that using period pain as a benchmark for medical abortion pain is unhelpful. “For many respondents, using period pain as a reference point for what to expect was not helpful for managing expectations, or in line with their experiences,” she said. McCulloch emphasized the need for detailed counseling to provide women with a more accurate understanding of what to expect during a medical abortion.
In response to the findings, BPAS has already updated its patient information materials and is providing additional training to staff to ensure women receive more comprehensive and realistic pain counseling. The organization is continuing to evaluate these changes to improve the experience for future patients.
As McCulloch concluded, “Women want more detailed, realistic information to make choices about treatment and to be prepared for medical abortion if that is their preference.”
For more information, see the full study: Expectations and experiences of pain during medical abortion at home in BMJ Sexual & Reproductive Health (2024). DOI: 10.1136/bmjsrh-2024-202533.
