BMJ Sexual and Reproductive Health published a report by Hannah McCulloch et al “Expectations and experiences of pain during medical abortion at home: a secondary, mixed-methods analysis of a patient survey in England and Wales” on 18 December 2024. The study found that over 40% of participants rated their pain as 8-10 on a maximum pain score (10 = worst pain). Also, 30% of participants stated that their actual versus expected experience of pain was “a lot more than expected.”
Objective
To explore experiences of pain during medical abortion and provide patient-centred recommendations for improving abortion experience and pain counselling.
Methods
We invited patients of British Pregnancy Advisory Service who underwent medical abortion up to 10 weeks’ gestation to participate in an online, English language questionnaire from November 2021 to March 2022. Participants answered questions about pain, method preference, abortion experience, advice, and how they would describe pain experienced to a friend. In this secondary analysis, we analysed free-text responses using reflexive thematic analysis techniques. We used descriptive statistics and parametric tests to analyse quantitative responses.
Results
Of 11 906 patients invited to participate, 1596 (13.4%) completed the questionnaire, including at least one free-text comment. Participants used a range of descriptors for medical abortion pain across three broad themes: pain severity, pain quality and comparisons to other reproductive pain. Some found the commonly used analogy to period pain misleading. Many felt unprepared for the level of pain they experienced, which they attributed to provider comparisons to period pain, as well as a lack of detailed, realistic anticipatory pain counselling. Qualitative and quantitative results suggest pain experiences impact method preference. Participants recommended better counselling for pain and abortion preparation, including first-hand accounts of medical abortion at home and a wide and accessible range of descriptions of pain.
Conclusion
Abortion providers should use patient-centred recommendations to better prepare patients for pain during medical abortion. Setting realistic expectations can improve abortion experience and support informed method choice. Further research is needed to develop and test patient-centred counselling materials.
Citation
McCulloch H, Perro D, Taghinejadi N, et al. Expectations and experiences of pain during medical abortion at home: a secondary, mixed-methods analysis of a patient survey in England and Wales. BMJ Sexual & Reproductive Health Published Online First: 18 December 2024. doi: 10.1136/bmjsrh-2024-202533.
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