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Medical Termination of Pregnancy (MTOP)

What is a medical abortion (MTOP)?

A medical abortion uses 2 medicines, mifepristone and misoprostol, to end an early pregnancy (usually up to 9 weeks or 63 days).

It works in a similar way to a miscarriage and happens mostly at home.

How does MTOP work?

  1. Mifepristone is taken first. This stops the pregnancy from continuing.
  2. Misoprostol is taken 24-48 hours later. This causes the uterus to contract and pass the pregnancy.

After taking misoprostol, you will usually have bleeding and cramping within a few hours.

What can I expect?

Most people experience:

  • Cramping (often stronger than period pain)
  • Vaginal bleeding (light to heavy) for up to 2–3 weeks
  • Passing clots and tissue
  • Nausea, diarrhoea, fatigue
  • Mild fever or chills for a short time

These are normal parts of the process.

How effective is MTOP?

Medical abortion is successful in 98% of procedures. A small number may need extra medication or a surgical procedure.

It is very important to complete your follow-up appointment or test.

Possible risks of medical abortion

Most complications are uncommon and treatable.

Risk

Incomplete abortion

Infection

Heavy bleeding

Ongoing pregnancy

What it means

Some tissue remains

Usually mild, treated with antibiotics

May need treatment

Pregnancy continues

Approximate chance

2-4 in 100

<1 in 100

<1 in 500

1 in 100

When might surgery be needed after MTOP?

Some people need a surgical procedure if:

  • The abortion is incomplete and there is a contraindication to medical management
  • Bleeding is heavy
  • The pregnancy continues
  • Infection develops

This is uncommon, but your doctor will discuss this if needed.

Risks of surgical abortion?

If surgery is needed, it is also very safe.

Modern technoglogy and medication great greatly reduce these risks. Possible risks include:

Risk

Incomplete abortion

Infection

Heavy bleeding

Cervical injury

Uterine perforation

Ongoing pregnancy

Asherman’s syndrome

What it means

Tissue remains

Usually mild

May need treatment

Damage to cervix

Hole in uterus (very rare)

Procedure not successful

Scar tissue in uterus

Approximate chance

1–2 in 100

<1 in 100

<1 in 1000

1 in 100

<1 in 1000

<1 in 500

<1 in 100

What if I don't know which option is best for me?

If you are unsure if surgical or medical abortion is best for you, you can come and speak to our clinicians and discuss your options.

This resource may also help you with your decision-making: RANZCOG Abortion Decision Aid

What if I am unsure if abortion is the right decision for me?

We offer free non-directive pregnancy options counselling sessions with one of our SHFPACT counsellors, or we can recommend external counselling services. 

Find out more about our Pregnancy Options Counselling here.

Children by Choice also has resources that can help. Find their website here. 

Fertility and future pregnancy

Abortion does not affect your ability to have children in the future.

You can become pregnant again quickly.

Start contraception as advised.

It does not increase your risk of future miscarriage risk or fertility problems.

What to expect at an MTOP appointment at SHFPACT
After an abortion

References

  • Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Abortion Care Clinical Practice Guideline, 2023.
  • World Health Organization. Abortion care guideline, 2022. Geneva: WHO.
  • National Academies of Sciences, Engineering, and Medicine. The Safety and Quality of Abortion Care in the United States, 2018.
  • Medical and surgical abortion: Overview and risks, 2024.