Understanding Uterine Contractions and Their Role in Medical Abortion

The uterus is a significant organ in medical abortion. It houses the pregnancy tissues and the fetus, which need expelling to end the conception. To make this happen, abortion pills found in an MTP Kit (Mifepristone and Misoprostol), are usually taken in a step-by-step manner. Both these medicines bring the required activity to trigger a pregnancy termination.

The MTP Kit pills effectively act on the uterus to cause contractions, dilating the cervix, and leading to heavy vaginal bleeding that takes out the pregnancy along. In this blog, we will explore more about uterine contractions and how they help in causing a medical abortion successfully.

The Uterus: A Muscular Reproductive Organ

The anatomy of the uterus is important to understand before knowing what the contractions do in a medical abortion. The wall of the uterus is made from a thick layer of smooth muscle fibers. This is known as the myometrium. These muscles are not the same as those found in arms and legs.

➡While other muscles are voluntarily controlled, the myometrium is managed by the hormonal signals and autonomic nervous system. That’s the reason why hormonal imbalance may cause issues with menstrual regularity. This explains how hormonal signals are important in controlling the uterus function.

➡The uterus is in a stable state. But it experiences shedding of the endometrial lining as it encounters mild contractions during the menstrual cycle. This leads to menstrual bleeding.

➡However, in a medical pregnancy termination, these contractions are much stronger. The shedding of the uterine lining is accompanied with the expulsion of the pregnancy portions.

➡The action mechanism of contractions is responsible for the opening of the cervix, which further eases emptying of the womb. Before the Misoprostol effect, the cervix is usually closed that keeps the pregnancy secure.

How Medical Abortion Triggers Contractions?

A medical abortion involves Mifepristone and Misoprostol pills. Each of these medicines play a role in causing contractions in the uterus or preparing the womb for the same.

➡Mifepristone blocks progesterone, a pregnancy hormone that relaxes the uterus during conception. Through antiprogesterone activity, the uterus becomes more responsive to Misoprostol pills.

➡Misoprostol is a prostaglandin. It causes the uterine muscles and fibers to loosen and tighten, leading to contractions. The medicine elements bind to the receptors of the uterus muscles, and enable contractions.

The Mechanics of the Uterus Contraction

The uterine contractions in a medical abortion cause cervical effacement and dilation. Then it results in expulsion of the pregnancy tissue in the following ways:

➡The neck of the uterus or cervix needs to thin out (efface), soften, and then dilate (open or widen). Only then the pregnancy can easily leave the uterus. The contractions act as a tug on the uterus’s lower section, allowing the cervix to gently open.

➡After the cervix dilates and ripens, the contractions in the uterus become more intense. The upper part of the uterus also experiences constant contractions, creating a downward and upward pressure.

➡The pressure and pull caused by the prostaglandins help in pushing out the shed uterine lining, gestational sac, and other pregnancy portions from the vaginal canal via bleeding.

What Do These Contractions Feel Like?

While abdominal cramps are moderate to intense, we usually describe the pain and resultant other side effects in layman’s terms as much as possible. However, uterine contractions are the accurate description.

➡Since the movements in a large muscular vessel-like uterus occur constantly, the effect is felt across the pelvic area.

➡The sensation of pain is like a wave. The pain peaks and stays the same and intense for several seconds, and then declines gradually, returning to the same cycle again.

➡The peak intensity of cramping or contractions is for 2 to 5 hours after the bleeding begins. This is also the time when pregnancy tissues exit heavily.

➡The contractions and their intensity reduce gradually once the gestational sac is removed. Thereby, the pain and cramps become dull and quite tolerable like menstrual-type ache.

Managing the Intensity of Pain and Cramps

Since the physical experiences of uterine contractions during a medical abortion are mostly encountered with cramps and pain, there are medicines and strategies to manage them.

➡Ibuprofen or other relevant NSAIDs are wise choices for pain relief. They block excess prostaglandin production, and make contractions-associated pain more tolerable. At the same time, the medicine does not disrupt the abortion process.

➡You may relax the abdomen and pelvic area externally by using heating pads. Their application can ease the abdominal muscles and improve blood circulation. This can reduce the intensity of the pain and cramps.

➡While it is not recommended to do any sudden or much movements in a medical abortion, gentle stretching and pacing can help if you are not too dizzy or exhausted.

➡If the uterine contractions are intense, you may consider resting and laying on your side, especially in a fetal position. This can take care of the systemic pressure and stress.

When Contractions in the Uterus Are Not Enough

In some cases, or rarely, the uterine contractions are insufficient and not strong enough to expel all the pregnancy tissues. In these scenarios, an incomplete abortion may happen because there are still leftover pregnancy sections in the uterus. Here are some signs of an incomplete pregnancy termination:

➡No bleeding or cramping even after using the recommended Misoprostol dose.

➡Bleeding is extremely heavy without any reduction for more than 24 hours.

➡Severe and persistent pain that does not reduce even after pregnancy passes and pain management techniques are used correctly.

➡Here, the doctor may suggest an extra dose of Misoprostol pills. Or, they may recommend assistance to complete the procedure surgically.

➡4 pills of 200mcg Misoprostol may suffice for a 4-5 weeks of pregnancy. However, 8 to 12 pills of Misoprostol 200mcg are at times required for a pregnancy over 5 weeks but within the first 12 weeks.

Frequently Asked Questions (FAQs)

1. How soon do contractions start after taking the second pill?

Most women experience the start of uterine contractions after one to four hours of administering Misoprostol pills. However, the effect and duration of cramps will depend from person to person, and how further the pregnancy is. Mifepristone usually does not result in contractions.

2. Are the contractions during medical abortion as strong as labor?

The contractions in a medical abortion are intense without a doubt. That is important to empty the uterus. However, the intensity of these movements are less severe than labor contractions. This is because in early pregnancy, the pregnancy development is not like during the time of childbirth. Also, the cervical dilation is not as huge as that during a delivery.

3. Will Ibuprofen stop the contractions from working?

Many people think that taking pain-relief medicines like Ibuprofen can interfere with the medical abortion process. However, that is untrue because Ibuprofen reduces pain linked to the inflammatory response. This does not disturb the termination procedure by stopping or reducing the contractions. If you intend to take Aspirin, avoid it, because it acts as a blood thinner and increases bleeding.

4. Why do I feel contractions in my lower back?

The nerves in the uterus are also connected to the lower spinal region. So, when the contractions in the uterus are strong, these nerves transfer the pain signals to the spinal area. That is why you may feel ache and pain in the thighs and lower back more prominently.

5. What if I do not feel any contractions at all?

After taking sufficient Mifepristone and Misoprostol doses, if there is no cramping in 24 hours, there is a possibility the medicine is not providing enough triggers to cause contractions. Get in touch with a doctor and discuss possibilities to approach the situation. Mostly, you will need an additional dose of Misoprostol. The doctor may also want to run a few tests or an ultrasound to rule out complications.