There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

Though pregnancy is one of the most cherished phases in a woman s life, there are times when it is not desired. This can be due to various reasons ranging from premarital sex to the couple not being ready yet. Whatever the reason, emergency contraceptive measures are available, and I-Pill has become synonymous with that.

Since its introduction, it is widely used to prevent unwanted pregnancies. The easy availability (no prescription required) and low cost have added to its popularity. However, not many realize it has some side-effects and the need to be aware of certain facts when using the I-pill.

It is an emergency contraceptive pill, should be used between 24 to 72 hours after unprotected sex
It is effective in 95% of the women when taking during this time frame
It prevents pregnancy by stopping fertilisation or preventing implantation of the fertilising egg
It stops pregnancy; however, if you conceive before the pill it was taken, it will not have any effect. It is therefore not an abortion pill
So, if you miss the period the next month, test for pregnancy
It does not offer protection against sexually transmitted disease including HIV/AIDS
It is not to be used on a regular basis
If you are on long-term medication, please consult with the doctor before taking the I-pill
It has no long-term consequence. However, there could be some minor symptoms including breast tenderness, nausea, vomiting, headache, and lower abdominal pain (pelvic area),
The next menstrual cycle could be delayed by a couple of days
There could also be spotting before the actual period starts
Women who are allergic to levonorgestrel should not take I-pill.
It can cause skin allergies and reduce libido.
When used repeatedly, it can cause delayed and irregular menstruation
It is ideal for use between the age of 25 and 45. Teenagers should not use it regularly. This needs to be made aware through sex education, as the prevalence of teenage sex and pregnancy is on the rise in India
Repeated usage can cause ovarian damage and severe menstrual issues, so occasional use is the only recommended usage
It is safe to take the pill during lactation. There is no effect on the quality of milk or any other adverse effect on the baby
I-Pill was introduced as an emergency contraceptive method, and not for regular contraceptive purpose. Its correct usage and avoiding complications is largely dependent on sex education which needs to start early and talk about other safe sex measures and avoid using it on a regular basis.


Side-effects of i-Pill Tablets - Every Woman Must Know!! 

If your teenager finds out that she is pregnant, and will be having a baby soon, it is a very difficult situation to cope with. Teenage pregnancy is associated with intense stress and trauma in both the girl and her parents, and family. It is important for you to realise that teenage pregnancy can be okay, based on good and wise decisions. You should seek all options at hand, and discuss them with people you trust. There are several coping methods for dealing with the stress, trauma, and difficulty of teenage pregnancy. They are as follows:

Keep in mind that it is okay to be overwhelmed

A flood of emotions is likely to flow through your body on finding out that your teenage daughter is pregnant.
Your mind has to be set for facing several challenges which lie ahead. You have to go ahead.
It is okay to feel upset, but avoid showing it in front of your daughter.
Be supportive

You might be upset and angry, but you need to realise that your daughter is scared and alone.
She needs you by her side during this phase more than ever. Your child s health has to remain relaxed both physically and mentally during pregnancy.
Do not make your daughter feel shameful as it will worsen the trauma. You need to make her understand that you are with her to figure out some kind of solution.
Ask your daughter what she wants

It is important for you to ask your pregnant teenage daughter about what she wants, and you should respect her wishes.
Your daughter has to be comfortable with the choices you make regarding the pregnancy.
Give her advice and help her in exploring options

Instead of forcing your opinions and views on your daughter, you need to lead her to beneficial resources and support centres.
It is important for your daughter to make the best decision, without a lot of influence over what has been decided.
Explore the available options with her and point out the various pros and cons.
Teach your daughter the skills required to become independent

While you have to help your teenage daughter emotionally, financially and in many other ways, you should also teach her the ways of becoming an independent self sufficient adult.
If she decides on having the baby, it is very important for her to learn to take care of the baby and deal with all the issues that are likely to be faced.
It is also recommended for you to take your pregnant teenage daughter for therapy and proper counselling. These are also important for her to cope with the trauma and make the best decisions.

Teenage Pregnancy - How To Deal With Stress And Trauma?

With an upsurge in the number of women suffering from dysfunctional reproductive system and a myriad of gynecological problems, resulting in irregular periods, infertility and several other complications, it is of paramount importance to keep a record of the dates and duration of your monthly cycles. This is not only useful for future reference when you visit a gynecologist, but it also helps you to understand if there are any delays in your mensuration cycle or you are having excess bleeding in a particular month.

Why tracking your menstrual cycle is important?
Keeping a track of the menstrual cycles is a mandatory exercise for women who are thinking about pregnancy or those trying to avoid it. Based on you period calendar, you can avoid getting pregnant without opting for contraceptive methods, if you have extremely regular period patterns. It is advisable to abstain from intercourse for a few days before and after the period, which is the prime time for ovulation. Keeping a track of your periods will give you a clear indication as to whether you are pregnant, because delay in the menstrual onset can be an indication of pregnancy. The reverse is also true; if you are trying to get pregnant, conception is usually fruitful on these days of maximum ovulation, which you can easily calculate based on your well maintained menstrual record.

How should you go about keeping a track of your menstruation cycle?
While it not possible to note down every possible aspect of the menstruation in a notebook, the easiest way of maintaining a planner is to mark the first day of each period on the calendar. The difference between two consecutive periods will give you your cycle lengths. In addition you can choose to make a note of how heavy the bleeding is or if there are changes in mood and appetite on those days. You will then be well prepared for your next visit to the gynecologist.

How Tracking Your Menstrual Cycles Can Be Beneficial For Your Reproductive Health?

Contraceptives are generally drugs and devices, which are used to prevent pregnancy. A large number of contraceptives are available which allow the couple to enjoy sex without running the risk of unwanted pregnancies. The general categories of contraceptives are explained below:

Barrier Methods:
i. Male Condom: It is one of the most common forms of contraception. They are worn on the penis before sex is initiated. For safety purpose, a new condom should be used every time the person has sex.

ii. Female Condom: Much like male condoms, these are available at over-the-counter pharmacies without prescription. The condoms can be inserted to the vagina anytime within a period of 8 hours prior to sex.

iii. Diaphragm: This should be coated with a spermicide before sex and placed inside a woman's vagina so that the sperms are prevented from entering the uterus.

iv. Cervical Cap: These are used as replacements for diaphragms because some women may develop bladder infections such as cystitis while using it and these caps have lesser contact with the vagina.

Hormonal Methods:
The main implementation of hormonal changes to provide contraception is the pill. This is the most common form of female contraception available. It comes in two forms:
i. Combined contraceptive pill: Contains a combination of hormones such as progestin and oestrogen.
ii. Mini-pill: Contains only progestin: It is available only with the prescription of the doctor and should be used as per the prescription.

Intrauterine Devices
The intrauterine device (IUD) is a long-acting and reversible form of contraception for women. It is of two types: Copper IUD (contains copper) and Hormone-releasing IUDs (progestin hormone is released into the womb slowly). It is a small device that is fitted inside the womb and it provides contraception by facilitating the prevention of fertilization of the egg.

Sterilization
This is a lifelong option that is available for both men and women. In males, the procedure is known as vasectomy which basically ties and cuts off the tubes that carry the sperm.

In women, two forms of sterilization are available; surgical and non-surgical. Surgically, the fallopian tubes are cut and tied using small cuts in the belly so that the ovaries and uterus are not linked. Non-surgically, coils are inserted into the fallopian tubes so the resultant development of scars leads to complete blockage of the tubes.

Other forms of contraceptives include contraceptive patches, vaginal rings, contraceptive injections, spermicides and contraceptive implants.

Different Types of Contraceptives and Its Uses

Use of contraceptives is really important to avoid unwanted pregnancy. Countries like China and India, facing the problem of population explosion lay more stress on the use of contraceptives. However, you must always use or take oral and barrier contraceptives following the advice of a medical practitioner unless it is absolutely necessary to go ahead without consultation. The reason behind medical assistance is your own health. Contraceptive methods do have a vast range of side effects that can result in health hazards. There are various kinds of contraceptives; each having its own set of advantages and disadvantages. Being acquainted with the side effects of some contraceptive methods can help you choose wisely in times of need.

Possible side-effects of using condoms: Some men are allergic to latex. Using condoms can lead to heightened sensitivity. It can also lead to rashes in your genitals. Condoms are not foolproof. They do not provide total protection against sexually transmitted infections, HPV or against Syphilis and Herpes. These diseases can be contracted by coming in contact with genital skin that is not covered by a condom.
Possible side-effects of a Contraceptive Film: A contraceptive film might act as an interruption in your sexual activities if it is not placed properly, that is to say it must come in contact with the cervix to be effective. Using the film nonoxynol- very frequently can make you susceptible to life threatening diseases like HIV and other STIs.
Possible side-effects of a Cervical Cap: A cervical cap has to be inserted by a clinician and requires immense care to be fitted in later. Some of its side - effects can be of serious concern. If it is left inside for more than forty eight hours, it can result in toxic shock syndrome. Toxic shock syndrome is an infection that mars your overall health. It is also known to increase the chances of inflammation of the surface of your cervix.
Possible side-effects of Progestin only pills: Progestin only pills or mini pills can subject you to long- lasting depression. It can make you feel bloated and can actually increase your weight to a great extent if used on a regular basis. Minipills lead to irregularities in your menstrual cycle and might also make bleeding during menstruation scanty.
Possible side-effects of combined oral contraceptives: If this is your first month on combined oral contraceptives, you might feel nauseous and they can give you a terrible headache. Women taking these pills have a higher chance of developing cervical dysplasia. If you wish to discuss about any specific problem, you can consult a gynaecologist and ask a free question.

Side Effects of Different Contraceptive Methods

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