Pain during medical abortion in early pregnancy in teenaged and adult women.

INTRODUCTION: Women experience pain during medical abortion, yet optimal pain management remains unclear. We studied the pain experience and need of analgesics during early medical abortion (≤63 days of gestation) among teenaged and adult women. We also assessed predictive factors of severe pain. MATERIAL AND METHODS: We recruited 140 primigravid women; 60 teenagers and 80 adult women aged between 25 to 35 years old. Teenager group included 19 women under the age of 18 years old (minors). The abortion was performed with mifepristone (200mg) followed by vaginal misoprostol (800μg), mainly self-administered at home among adults. Minors were hospitalized during misoprostol administration. Pain medication consisted of ibuprofen 600mg and paracetamol 1000mg, first doses taken simultaneously with misoprostol and repeated, if needed, up to three times daily. Additional opiates (mainly tramadol or oxycodone) were administered at hospital if needed. Pain was measured using visual analogue scale (VAS, 0-100mm). RESULTS: The maximal pain VAS (median, interquartile range) was 75 (54-91) and 57.7% of all women experienced severe pain (VAS ≥70) during abortion care. 93.5% of women needed additional analgesics in addition to prophylactic pain medication. Teenagers needed additional analgesics more often than adults (5 [3-8] vs 3 [2-6] times, p=0.021); 38.0% of all teenagers (64.7% of the minors) received additional opiates compared to 7.9% in adult women. Severe pain (VAS≥70) was associated with history of dysmenorrhea (adjusted OR 2.60 [95%CI 1.21-5.59, p=0.014]), anxiety at baseline (2.64 [1.03-6.77], p=0.044) and emesis during abortion (5.24 [2.38-11.57], p<0.001). Hospital administration of misoprostol did not lower the risk for severe pain experience (OR 0.84 [95% CI 0.34-2.05], p=0.694). Satisfaction with care was high in study population (median VAS 91 [interquartile range 79-97]) and was not associated with the use of narcotic analgesic nor place of misoprostol administration. CONCLUSIONS: Pain intensity was high for both in teenaged and adult women undergoing medical abortion, yet satisfaction on care was high. More effective analgesics than ibuprofen and paracetamol should be offered to all women undergoing early medical abortion, especially to those with history of dysmenorrhea. Also, routine use of antiemetics might be advisable.