Experiences of managing pain with early medical abortions: confusing comparisons and unclear expectations

Most abortions in the UK are now carried out using medication, rather than surgical methods, particularly in early pregnancy. Since the Covid-19 pandemic, a growing proportion of early medication abortions – that is, those at 14 weeks of gestation or less - have involved the pregnant person self-managing their abortion at home.   

Pain has long been a known issue in relation to medication abortion, but one which has seen little attention until relatively recently. There could be a number of reasons for this lack of attention, not least among them concerns that highlighting abortion as something that can be painful might be co-opted by those who wish to restrict pregnant people’s access to it. Stereotypical assumptions about pain in relation to female bodies may also play a part.  

Our recent research paper explores the experiences of individuals who self-managed early medication abortion (EMA), and takes a particular focus on pain. Our aim was to shed light on the subjective experiences and challenges related to pain in that context. The study took place during the early days of Covid-19, and 20 participants (all cisgender women aged 22-43) shared their stories about seeking abortion during the pandemic. 

We found that, while some participants felt that pain was minimal or manageable, and in line with what they had expected, others experienced more intense pain which was worse than anticipated.  

We identified four key points from these interviews: 

1. Expected pain can be manageable

Some participants talked about the pain expectations set by healthcare providers. For example, one person mentioned that the pain wasn't as bad as they thought it would be, though there was still some discomfort. However, our data also suggested that the manageability of pain could be influenced by negative expectations i.e. it wasn’t as bad as expected when it was expected to be really severe or awful.  

2. There was a difference between expected and unexpected pain

While pain that matched up with expectations tended to be described as manageable, we found that unexpected pain could be a significant issue. Some participants described the pain as excruciating and, perhaps not surprisingly, this shaped their overall abortion experience.  

3. Pain generates fear

It is well known more generally that there is a relationship between anxiety, fear and pain. In the context of EMA, intense pain led some to feel afraid, extremely anxious, and to have concerns that the abortion process was going wrong. We heard about these worries particularly when the pain was more severe or intense than expected.  

4. Talking about 'period-like pain' can be a problem 

Pain experiences were commonly compared in some way with period pain. However, there was a wide variety in whether the pain was similar or much worse than participants’ experiences of menstrual pain. Several women described pain that was, for them, significantly worse than a period.  The variation here suggests that comparing EMA pain with period pain could create confusion, and may also play down the severity of pain experienced by some.  

Much of the kind of information that we gathered in this study is not always readily available to abortion services, since those who have undergone abortion often do not contact services again once their abortion is complete. In this way, our findings play a key part in shaping potential improvements to the provision of this essential component of healthcare.  

Based on our findings from these interviews, we have suggested that better information on pain, and a shift in how pain is discussed in abortion care, could improve the overall experience of self-managed medication abortion. Ideally, this would be accompanied by the development of more effective methods of pain management. Abortion care in the UK could be improved by incorporating clearer information on potential pain scenarios which covers a range of experiences. This could in turn allay fears and support a more positive overall experience overall.  

An open access version of Carrie’s paper can be found here.