Medical Abortion vs Surgical Abortion: Which Is Right for You?

Deciding to have an abortion is a deeply personal decision that requires careful consideration and access to accurate, reliable information. In Singapore, both medical and surgical abortion methods are available, each with its own benefits, risks and considerations.

Abortion is legal in Singapore under the Termination of Pregnancy Act 1974, which ensures that procedures are carried out safely and with full respect for patient rights. Medical and surgical abortions differ in procedure, effectiveness, emotional experience and suitability; it is important to understand these differences before making an informed choice.

What Is a Medical Abortion (Abortion Pill)?

A medical abortion, commonly known as the abortion pill, is a non-surgical method involving taking two medications – mifepristone and misoprostol – to end an early pregnancy.

First, mifepristone works by blocking progesterone, a hormone essential for sustaining a pregnancy. This causes the uterine lining to break down, making it unable to support the pregnancy. Next, misoprostol is taken to stimulate uterine contractions, which help expel the pregnancy tissue safely from the body.

Procedure Overview

The process of a medical abortion typically involves the following steps:

1. Consultation
   The process begins with a consultation with a healthcare provider. During this visit, eligibility is assessed through a physical examination and a pregnancy test.
2. Mifepristone Administration
   If eligible, the first medication, mifepristone, is given orally at the clinic.
3. Waiting Period
   After taking mifepristone, there is typically a waiting period of 24–48 hours before the next step.
4. Misoprostol Administration
   The second medication, misoprostol, is taken either orally or vaginally, as directed by the healthcare provider, to trigger the expulsion of pregnancy tissue.
5. Follow-up Appointment
   A follow-up visit is scheduled one to two weeks later to confirm the abortion was successful and to address any potential complications.

Benefits of Medical Abortion

A medical abortion offers several advantages, making it a preferred choice for many women:

• Privacy
  The medications can be taken at home, allowing for a more private and discreet experience.
• Non-Invasive
  Since no surgery or anaesthesia is involved, the process is gentler on the body and carries fewer procedural risks.
• Feels More Natural
  For some women, the experience is similar to a heavy menstrual period, which may feel less intimidating and more natural than a surgical procedure.
• Cost-Effective
  Medical abortion is generally less expensive than surgical abortion, as it usually involves fewer clinic visits and lower medical costs.

What Is a Surgical Abortion (In-Clinic Procedure)?

A surgical abortion is an in-clinic procedure that uses a minor surgical intervention to safely remove the pregnancy from the uterus. For early pregnancies, the most common methods are manual vacuum aspiration (MVA) or electric vacuum aspiration (EVA). In later stages of pregnancy, a technique called dilation and evacuation (D&E) is typically used.

Procedure Overview

A surgical abortion is a safe and controlled procedure carried out by a licensed physician at an MOH-approved abortion clinic. The procedure itself usually takes 15 to 30 minutes, with extra time needed for preparation and recovery. Below are the key steps involved:

1. Preparation and Consultation
   Before the procedure, the patient has a consultation and examination, which may include an ultrasound and blood tests. The doctor will explain the process, review anaesthesia options, and answer any questions.
2. Anaesthesia Administration
   To ensure comfort, the patient is given either local anaesthesia (to numb the cervix) or general anaesthesia (to be fully asleep during the procedure), depending on medical needs and personal preference.
3. Cervical Dilation
   The cervix is gently widened using small medical instruments or medication to allow safe access to the uterus.
4. Removal of Pregnancy Tissue
   The physician uses a suction device, either manual or electric, to gently remove the pregnancy tissue from the uterus. The method used depends on the pregnancy stage.
5. Post-Procedure Monitoring
   After the procedure, the patient rests in a recovery area where healthcare staff monitor vital signs and bleeding. Pain relief and aftercare instructions are provided before discharge.

Benefits of Surgical Abortion

Surgical abortion is a safe and reliable option for terminating a pregnancy. It offers several advantages over medical abortion, particularly for those seeking a quick, definitive procedure with close medical supervision.

• Preparation and Consultation
  Before the procedure, the patient has a consultation and examination, which may include an ultrasound and blood tests. The doctor will explain the process, review anaesthesia options, and answer any questions.
• Anaesthesia Administration
  To ensure comfort, the patient is given either local anaesthesia (to numb the cervix) or general anaesthesia (to be fully asleep during the procedure), depending on medical needs and personal preference.
• Cervical Dilation
  The cervix is gently widened using small medical instruments or medication to allow safe access to the uterus.
• Removal of Pregnancy Tissue
  The physician uses a suction device, either manual or electric, to gently remove the pregnancy tissue from the uterus. The method used depends on the pregnancy stage.
• Post-Procedure Monitoring
  After the procedure, the patient rests in a recovery area where healthcare staff monitor vital signs and bleeding. Pain relief and aftercare instructions are provided before discharge.

Medical vs Surgical Abortion: Key Factors to Consider

Choosing between medical and surgical abortion depends on several factors, including your pregnancy stage, health condition, and personal preferences. Below is a comparison to help you understand the differences between the two methods.

• Effectiveness
  Surgical abortion is highly effective, with a higher success rate in a single visit. Medical abortion is slightly less effective, depending on how far along the pregnancy is and whether the medications are taken correctly.
• Timing
  Surgical abortion can be performed up to 24 weeks of pregnancy, depending on local regulations. Medical abortion, on the other hand, is usually limited to within the first seven weeks.
• Procedure
  A surgical abortion is a 15–30 minute in-clinic procedure carried out entirely by healthcare professionals. Medical abortion involves two medications, taken over several days, often in the privacy of your home.
• Pain and Bleeding
  With surgical abortion, anaesthesia is used to control pain, and bleeding is typically lighter, lasting up to two weeks. Medical abortion usually causes heavier bleeding and cramping, similar to a natural miscarriage.
• Follow-Up
  Surgical abortion rarely requires additional treatment or follow-up. Medical abortion, however, requires follow-up visits to ensure the process is complete and to check for complications.

If you are considering an abortion and want to explore your options, it is best to consult with a qualified abortion doctor. They can assess your situation and recommend the safest and most appropriate method for you. Schedule a consultation with our gynaecologist, Dr Jen Shek Wei, to receive personalised guidance and make an informed decision.

Our Gynaecologist

Dr Jen Shek Wei
Consultant Obstetrician & Gynaecologist

MBBS (S’pore), MMed (OBGYN, S’pore)

FRCS (OBGYN, London),FAM(S)

MBBS (S’pore), MMed (OBGYN, S’pore)FRCS (OBGYN, London), FAM(S)

Dr Jen Shek Wei is an abortion doctor with more than 30 years of experience in the field of OBGYN. At his Ministry of Health (MOH)-accredited clinic, he provides medical abortion (abortion pills) with an attentive follow-up to monitor progress and manage any side effects. Throughout the entire process, Dr Jen is committed to offer compassionate and confidential care for his patients during what is often a difficult and emotional time for them.