How Safe Is the Abortion Pill?

Most women can have a medication abortion safely. But all medical procedures have some risks, so safety is a concern.

Rare, but possible risks include

* an allergic reaction to either of the pills
* incomplete abortion — part of the pregnancy is left inside the uterus
* infection
* undetected ectopic pregnancy
* very heavy bleeding

Most often, these complications are simple to treat with medicine or other treatments.

In extremely rare cases, very serious complications may be fatal. The risk of death from medication abortion is much less than from a full-term pregnancy or childbirth.

Serious complications may have warning signs. Call your health care provider right away if at any time you have

* heavy bleeding from your vagina and are soaking through more than two maxi pads an hour, for two hours or more in a row
* clots for two hours or more that are larger than a lemon
* abdominal pain or discomfort that is not helped by medication, rest, a hot water bottle, or a heating pad
* a fever of 100.4°F or higher that lasts for more than four hours
* vomiting for more than four to six hours and you are not able to keep anything down
* an unpleasant smelling discharge from your vagina
* signs that you are still pregnant

You should start to feel better each day after the abortion. Feeling sick — having abdominal discomfort, diarrhea, nausea, vomiting, or weakness — more than 24 hours after taking misoprostol could be a sign of serious infection. Contact your health care provider right away if you have any of these symptoms. Do not wait until your scheduled follow-up.

You may need another visit with your provider. Rarely, women need vacuum aspiration or hospitalization. Take your medication guide with you if you need to visit an emergency room, a hospital, or a health care provider.

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Menopause—Important Time of Women’s Life

Menopause, in simple words, is the medical term for the end of a woman's menstrual periods. That means end of pregnancy. It is a natural part of aging, and occurs when the ovaries stop making hormones called estrogens. This causes estrogen levels to drop, and leads to the end of monthly menstrual periods. Although its time period varies from individual to individual (generally happens between the ages of 45 and 60), but it can happen earlier. Menopause can also occur when the ovaries are surgically removed or stop functioning for any other reason.

Low estrogen levels not only make pregnancy difficult, but also linked to some uncomfortable symptoms in many women. The most common and easy to recognize symptom is hot flashes (sudden intense waves of heat and sweating). Some women find that these hot flashes disrupt their sleep, and others report mood changes or also called mood swing.

Other symptoms of menopause may include:

• Irregular periods

• Vaginal or urinary tract infections

• Urinary incontinence (leakage of urine or inability to control urine flow)

• Inflammation of the vagina

Because of the changes in the urinary tract and vagina, some women may have discomfort or pain during sexual intercourse (either because of vaginal dryness or lack of desire). Many women also notice changes in their skin, digestive tract, and hair during menopause. And in the long term, some women experience problems linked to the low levels of estrogen found after menopause. These may include osteoporosis and increased risk for heart disease.

Undoubtedly, menopause is an important time in a woman's life. Her body is going through changes that can affect her social life, her feelings about herself, depression and even her functioning at work. In the past, menopause was often surrounded by misconceptions and myths.

Now, it is recognized that menopause is a natural step in the process of aging. The hot flashes, changing moods, and confusion usually disappear eventually as your estrogen stays at a low level. However, you still have to protect yourself from bone loss and heart disease. Contrary to the old-fashioned view that graph of life starts downward after menopause; many women today find that the years after menopause offer new discoveries and fresh challenges.

Basically, the symptoms of menopause arrive when your estrogen levels start changing and normally these symptoms stop when estrogen level settles down. A woman's body can go through several kinds of changes at the same time. Early in menopause, estrogen levels can rise sharply and then drop, which means you, may skip periods or even have heavier flow than usual some months. Your period may become increasingly irregular, and then eventually stop altogether. Menopause can affect your body organs and systems in many different ways.

Treatment for the symptoms of menopause can be approached in two phases. During the early time period of menopause, you and your doctor should discuss your symptoms and whether to treat them as they occur. You should be evaluated for your risk of getting breast cancer, osteoporosis (severe bone loss), and heart disease. If you're not at high risk for breast cancer, you may want to consider taking estrogen for a limited time, and using the lowest effective dose, which can help manage several symptoms at once. If you are at risk, other treatments are available. Similarly, during the later part of menopause you should focus on effectively preventing disease. Your earlier symptoms will probably disappear.

For diagnosis and then treatment of your specific symptoms you and your doctor should discuss frequently and share information that will help you make the best decisions about your health. There are many things to keep in mind, because menopause and the years that follow it usually cover the second half of a woman's life. Talk to your doctor about all of the treatment choices to decide what is right for you.

Many women want to replace the estrogen their body is losing, because estrogen does relieve many symptoms of menopause. Women who still have a uterus usually take a combination of estrogen with a form of progesterone, called progestin. Tamoxifen (used to prevent breast cancer) and raloxifene (used to prevent osteoporosis) are drugs known as "designer estrogens." These drugs have been developed to act beneficially as estrogen on some tissue and to act as estrogen-blockers (anti-estrogens) on other tissue. These drugs also are known by the more technical name Selective Estrogen Receptor Modulators or SERMs.

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Procedures of abortion.

Doctors use various means and ways to conclude a pregnancy. Normally abortion is persuaded using a chemical or surgical practice. The abortion procedure which is chosen by the doctor or an individual is preferred directly correlated to the phase of pregnancy whether it is in early weeks or in the first stage that is term of 3 months, or second stage.

The abortion via chemical practice is merely by means of giving pregnancy termination drugs or medicine to the patient concerned. Most of the mother-to-be is more inclined towards this type abortion method rather than the surgical technique. Such drugs or chemicals which are prescribed to an individual are generally called as abortion pills. The RU-486, mifepristone normally are used to set a halt to the action of the body's progesterone. As a consequence, the embryo splits from the uterus and bleeding takes place. Once the bleeding starts, its recommend by the physicians to take a dose of misoprostol which contains uterine contractions, thus ejecting the unborn foetus. In spite of effective and very safe technique this type of abortion procedure can be espoused only within the first two months of pregnancy. In some exceptional cases, the patient may be required to end the treatment with a surgical method.

During the first three months of the pregnancy with the help of surgical techniques termination of pregnancy can be done by three different methods of abortion .First method is after the cervix is expanded, the embryo is worn out off the ramparts of the uterus with the help of a sharp surgical instrument. This abortion practice is known as Dilation or Curettage. Second method of surgical abortion technique is Manual Vacuum Aspiration where after expanding the cervix, the doctor takes away the embryonic tissue using a syringe with the assistance of suction. Lastly the method is as alike to the second method and is known as Electric Vacuum Aspiration. In this the syringe is substituted with an electric pump.

During the second trimester that is duration from third month to sixth month of pregnancy there are again three choices offered for termination of pregnancy. First procedure of abortion is Dilation and Evacuation. In this procedure after expanded the cervix, the uterine walls are worn out with instruments. Whereas finally, the embryonic tissue is separated with the assistance of suction. The Second method is Hysterectomy or surgical slit of the uterus which is very much alike to caesarean operation, where the terminated foetus is separate. The last abortion procedure is known as Partial Birth Abortion which is still in today’s society comes under some arguments. The cervix is expanded, and then a forceps is required to reverse the foetus into a breech situation. After which suction device is inserted into the foetus' skull after a cut is made at its base. This device abandons the brain tissues which are present inside.

Although there is one more technique of abortion, which was very accepted till the time anaesthetics and surgery were imaginary, it is neither promoted by law nor accepted by the medical fraternity division. This is the herbal procedure of abortion and is normally measured as unsafe. So perhaps it would be wiser to excuse yourself from it altogether.

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MENOPAUSE

Menopause is the point in a woman’s life when there is permanent cessation of menstrual periods. This is a natural event that occurs following the loss of ovarian activity. The average age of menopause in this country is approximately 51 years old, although women who smoke usually begin several years earlier.

The perimenopause is the time period immediately before and after the menopause. This is a time that marks the transition from the reproductive years to the postmenopausal years. The effects of the perimenopause are related to waning ovarian function and include: disturbances in menstrual pattern, vasomotor instability (or "hot flushes"), mood swings, and other physical symptoms.

Unfortunately, over the years, the menopause has been associated with negative symbolism, when in fact this should be viewed as a point in a woman’s life where she has decades of productivity and healthful living ahead of her. For many women hormone replacement therapy is the cornerstone of this transition.

Hormone replacement therapy (or "HRT") means the replacement of the female hormone estrogen in physiologic doses. Modern therapy involves daily oral estrogen tablets or weekly estrogen patches applied to the skin, with the addition of the hormone progesterone for women who still have their womb. Older therapies include estrogen injections, and sub-dermal pellets. HRT can alleviate most of the annoying effects of the menopause, such as hot flushes and mood swings. HRT also may provide some health benefits, although the recent Women's Health Initiative (WHI) study has demonstrated that it should be used with caution.

In addition to providing relief from hot flushes, other health benefits include a significant reduction in the occurrence of osteoporosis (brittle bones), and a 29% reduction in the risk of death from colon cancer. However, as I mentioned above, risks do exist. The WHI study (see my article "Warning on Hormone Replacement") demonstrated higher risks of breast cancer, stroke and heart disease, although these events were mostly seen after 5 years of treatment.

Another benefit of HRT was mentioned in a study by the National Institute on Aging, published in 2000 in the journal Neurology found that women who used estrogen reduced their risk of Alzheimer’s disease by 54%. Alzheimer’s disease affects twice as many women as men. Although the authors felt that further studies are needed on this issue, this is nonetheless important news.

In summary, the decision to take or not to take replacement hormones remains a very personal and complicated one. A woman should discuss this with her physician before reaching any conclusions. Although not for everyone, hormones may provide relief of some of the annoying symptoms of menopause, but all should be aware that potential risks exist. For those not willing to take the risks there are alternatives. These alternatives may not provide the same level of relief, buy do not carry the risk either.

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The IUD

The intrauterine device (IUD) is used by an estimated 90 million women world wide. This makes it the most widely used method of reversible contraception in the world, being especially popular in the Scandinavian countries such as Sweden, Norway, and Finland. Unfortunately, in the United States, less women use this method than in any other developed country in the world.

The reason for this low rate of use among American women stems from a fear of infection that really is no longer an issue. This fear was the result of problems surrounding a particular brand of IUD called the Dalkon shield, which has been off the market since 1974. The Dalkon shield was very different from currently available IUD’s, and had several design flaws which led to a rate of pelvic infection that was up to eight times higher than that seen with other available devices.

Modern IUD’s are very safe and effective. The two that are currently available in this country are the Copper T380 (ParaGard) and the hormone-releasing Progestasert and Mirena, which continuously release the female hormone progesterone. Although the Progestasert must be changed yearly, Mirena lasts for 5years and the copper containing ParaGard can be left in place for up to ten years. Since the only costs involved are related to the initial insertion fee and the price of the IUD itself, the copper IUD is the least expensive reversible contraceptive available, with an average monthly cost of about $5, assuming 10 years of use.

Currently, the copper containing IUD has been tested in over 9,000 women in studies that began in 1972 and its safety has been proven. Although there is a slight risk of pelvic infection in the first 3-4 months after insertion, after this time period the risk is the same as for non-users. For women who are in monogamous relationships, the risk of infection is very low, or non-existent. In addition, your doctor can prescribe antibiotics at the time of insertion which could decrease this risk even further.

The IUD’s currently available have extremely low pregnancy rates, and are over 99% effective. This is more effective than the typical use of either condoms or the pill. Another important point is that the IUD does not cause abortions, it works by interfering with the sperm passage through the uterus, and actually creates an environment in the uterus that is spermicidal. Although it does also prevent implantation, this is not the mechanism that makes it effective.

The IUD can be inserted in your doctors office in about 5-10 minutes. It is a "T" shaped device that is placed within the uterine cavity through the natural opening of the woman’s cervix. Side effects can include cramping and heavier periods, although these can usually be controlled with mild medications.

The IUD is not for everyone. Good candidates are women who have had at least one child, are in a stable, faithful relationship (which minimizes the chance of exposure to sexually transmitted infections), desire reversible contraception, and have no recent history of or current pelvic inflammatory disease (pelvic infection). If you think this might be the method for you, please discuss it further with your physician.

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Anesthesia

Anesthesia for the obstetrical patient has evolved rapidly the past several years. The important difference in this group of patients is that each patient is really two patients, mother and child. Also, the pregnant mother is herself a different patient physiologically from a non-pregnant female, with necessary special considerations. Together, these issues have been the reason for the direction that obstetrical anesthesia has taken.

Mothers have been having babies without anesthesia for most of the history of humankind. It has only been since the mid 1800's that a scientifically based approach to relieve the pain of labor has been attempted. These early attempts started in England, and involved the mother breathing the vapor of ether or chloroform from a soaked cloth held over the face by a physician. While effective in the relief of labor pain, complications from the use of this approach led to the search for safer techniques. One of the important complications centered on the fact that pregnant moms retain food and fluid in their stomachs, not emptying their stomachs as non-pregnant adults do. When made unconscious under anesthesia, mothers were placed at risk for regurgitation and aspiration of stomach contents, sometimes with severe consequences. In addition, the process making the mother unconscious often resulted in a sleepy or depressed baby.

These considerations still hold true today even with our more modern and safer anesthetic drugs and techniques. While general anesthesia is safely and effectively given to pregnant patients today, the fact that these risks remain has led to the refinement of regional anesthetic techniques for labor, delivery, and cesarean section. Anesthesia falls roughly into three approaches for labor and delivery. The first is essentially the non-pharmacological approach. Many mothers select this feeling that it is best for them and their babies. Also, Lamaze and other techniques have become more popular as methods for dealing with the pain of labor, and in some women, may be enough. Certainly, the pain of labor can vary from one patient to another. For many, the pain of labor is something they choose not to suffer if it can be safely dealt with, and it can.

The next approach would be to give mom some pain relieving medication, usually a narcotic, by the intra-muscular or intravenous route. This approach has been used successfully for many years. It has some drawbacks. It is a systemic approach in that the drugs are distributed to the mother's entire system. Consequently, they can also effect the baby, again potentially resulting in a sleepy or depressed baby. The dosage and frequency of these drugs has been adjusted over the years to minimize effects on the baby. The mothers frequently become sleepy, and may have less or no memory of this important first experience with their new child.

The most sophisticated and direct approach is regional anesthesia. And this is where an anesthesiologist becomes involved. He or she will evaluate the patient (with the patient's obstetrician) to determine that epidural anesthesia is appropriate and to choose the best timing for starting an epidural. Epidural anesthesia is a technique for blocking the pain sensations in the appropriate nerves directly, specifically to avoid systemic effects on mother or baby. It involves using a needle to place a very small plastic tube (called a catheter) into the mother's epidural space in her back. The needle is removed and only the soft plastic tube remains. Medications can then be given in a controlled fashion as needed to relieve pain without making mother or baby sleepy or unconscious. Also, the catheter can remain in place for hours or even days to continue to give relief. Frequently, a small pump with a reservoir of medication is attached to give continuous pain relief without interruption. An added benefit is that should the patient require C-section, the epidural can be used for anesthesia for that as well by simply giving a larger, stronger dose of local anesthetic. The risks of this procedure are well defined, very low, and avoidable. This makes epidural anesthesia for labor and delivery the standard all across the nation if not the civilized world.

If C-section is necessary in a patient who has not chosen an epidural for labor, a regional anesthetic technique is still the prefered approach. Most commonly, this is late in labor and there may be some urgency. A similar technique called a subarachnoid or spinal block is most commonly used. It is easier and much quicker to perform, using a smaller needle and less medication, and having a more rapid onset of action. Again, the risk is very low, causing this to also become a standard practice in obstetrical care.

This summary is an overview of the available options. Many variations of these techniques exist and your anesthesiologist may feel that one of these approaches or even another not specifically mentioned here would be best for you. Contact your anesthesiologist in the Anesthesia Department of your hospital to have your questions answered.

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