Medical Abortion

Early medical abortion — mifepristone followed by misoprostol to end an early pregnancy — is well within community general-practice scope and is more accessible and less invasive than surgical termination. About one in five Australian women will have an abortion in their lifetime, yet access is inequitable, especially in rural/remote areas. Abortion is now decriminalised across all Australian states and territories (details of gestational limits and later-gestation requirements vary by jurisdiction).

Eligibility & gestational limit

• Available in Australia up to 63 days (9 weeks / 9+0) gestation for the MS-2 Step medical regimen. Beyond this, surgical abortion (or later medical regimens in a specialist setting) is needed.
• Accurately date the pregnancy and exclude ectopic — ultrasound is the usual way to confirm gestational age and intrauterine location before prescribing.
• Confirm the decision is settled and informed; offer (but don’t impose) options counselling covering continuing the pregnancy, adoption, and abortion.

The MS-2 Step regimen

1. Mifepristone 200 mg orally (an antiprogestogen — softens/dilates the cervix, sensitises the myometrium).
2. Misoprostol 800 micrograms (a prostaglandin — buccal/vaginal) 24–48 hours later, causing cramping and expulsion.

Effective in ~95–98% of cases. Provide analgesia (NSAIDs + paracetamol ± codeine) and antiemetics, and set expectations: heavy cramping and bleeding (heavier than a period, with clots) are normal for a few hours around the misoprostol.

Contraindications & cautions

• Contraindicated: confirmed or suspected ectopic pregnancy; chronic adrenal failure; long-term corticosteroid therapy; coagulopathy or current anticoagulation; allergy to mifepristone/misoprostol/prostaglandins; an IUD in situ (remove first).
• Caution / not generally recommended: significant anaemia, renal/hepatic impairment, malnutrition, cardiovascular disease — assess individually.
• Anti-D: Australian guidance was revised so that anti-D is not routinely required before 10 weeks for medical management (a change from the older blanket advice).

Follow-up

Confirm the abortion is complete — either a serum β-hCG showing an ≥80% fall at ~1–2 weeks, or an ultrasound. A continuing (ongoing) pregnancy after the regimen needs prompt review, as misoprostol is teratogenic. Contraception can be started immediately — the implant or an IUD can be placed at follow-up (or the IUD at the time of a surgical procedure); start the pill/ring straight away.

Safety-net / red flags (seek urgent care)

• Very heavy bleeding (soaking ≥2 pads/hour for ≥2 hours), or fainting.
• Fever, offensive discharge, worsening pelvic pain (endometritis/retained products).
• Ongoing pregnancy symptoms or a positive test pattern suggesting a continuing pregnancy.

If you don’t provide it

Provision is optional, but every GP should be able to refer without delay (time is gestation-critical). Resources: MS-2 Step (ms2step.com.au / MS Health), the Centre for Excellence in Rural Sexual Health (CERSH), 1800 My Options (Vic) and equivalent state services, and telehealth medical-abortion providers — telehealth models are safe and acceptable and improve rural access. Since the TGA’s July 2023 deregulation, the old MS-2 Step prescriber-certification and pharmacist-registration requirements no longer apply — any appropriately qualified medical practitioner can prescribe and any pharmacy can dispense.