Women undergoing early abortion may experience dramatic improvements in their quality of life soon after the procedure. In a prospective cohort study of 97 patients, all examined aspects of quality of life improved significantly within one month after abortion.¹ These quality-of-life changes--which included women's global health, emotional and cognitive functioning, and experiences of insomnia and appetite loss--occurred similarly in medical and surgical abortion patients.

The study was conducted in 2000 in an urban, private-practice setting in New York. Abortion-seeking women were given a choice of medical or surgical abortion after receiving information and counseling. Patients choosing surgery underwent manual vacuum aspiration with local anesthesia at their initial office visit. Those choosing medical abortion received 200 mg oral mifepristone at the office visit; 1-2 days later, they self-administered 800 mcg misoprostol vaginally at home. At the end of the first office visit, English-speaking women aged 18 years or older who had terminated a pregnancy of up to nine weeks' gestation were invited to enroll in the study.

The researchers orally administered a validated 30-item questionnaire that is widely used for quality-of-life assessment, predominantly in cancer trials, at three points in time--baseline (at the end of the first office visit), one week later (during a routine follow-up office visit) and one month after baseline (by telephone). At each assessment, patients reported on their quality of life during the previous seven days. The survey responses yielded scores for global health; cognitive, emotional, social, physical and work function; and several specific symptoms (appetite loss, fatigue, insomnia, nausea and vomiting, and pain). At baseline, in addition to recording responses to the survey items, the researchers obtained clinical, demographic and other information from the patients' medical records--including partner knowledge of the pregnancy, which the women had been asked about when they telephoned to schedule their initial office visit. The investigators performed analyses of variance to assess whether mean quality-of-life scores for the entire cohort had changed significantly across the three assessment points; they used chi-square tests and t-tests to compare the medical and surgical groups.

Of the 97 women enrolled in the study, 55 had chosen medical abortion and 42 had chosen surgical abortion. The medical patients had a lower level of education (40% were college graduates, compared with 67% of surgical patients), and a smaller proportion of women in this group had private insurance (55%, compared with 78%). Otherwise, the two groups had similar characteristics. On average, the women were aged 28-29 years; the mean gestational age was 49-50 days. At baseline, approximately eight in 10 women reported that their partner knew of the pregnancy. Eighty-seven percent of the enrolled women participated in both follow-up surveys.

At the baseline assessment, patients reported experiencing numerous functional impairments and symptoms. One month later, their scores for each type of function and symptom signaled significant improvements. For example, on a 0-12-point scale for emotional function (in which a low score is good), the mean score for the total sample decreased from 5.2 to 2.1. For loss of appetite, which was rated on a 0-3-point scale, the score decreased (denoting improvement) from 0.9 at initial measurement to 0.1 at the final survey. On a scale of 2-14 (in which a higher score indicates better quality of life), the mean score for global health increased from 8.8 to 12.0.

At the one-week assessment, most measures of quality of life already showed improvement; however, the medical patients reported a lower level of social function since baseline, and the medical and surgical groups each reported worsened physical function and pain.

The medical and surgical groups differed significantly on several measures at baseline, but on only one measure at the one-week assessment and on none at the one-month assessment. At baseline, surgical patients scored worse than medical patients on three function scales (cognitive, emotional and social) and two symptom scales (fatigue and insomnia). A possible explanation offered by the authors is that "women who had more symptoms or distress during the week before the appointment may have selected a surgical abortion in order to complete the process more quickly." At one week, the medical group had less improvement than the surgical group in nausea and vomiting.

In a secondary analysis, the researchers found only one characteristic at baseline--partner knowledge of the pregnancy--to be associated with quality-of-life scores. Women whose partners knew of the pregnancy reported a significantly lower level of functioning (on emotional, cognitive, social and work scales) and more symptoms (of fatigue, nausea and vomiting, appetite loss and insomnia) than participants whose partners were unaware of the pregnancy. However, by the one-month follow-up, participants whose partner knew of the pregnancy had significantly worse scores on only three measures--the cognitive, social and loss-of-appetite scales.

The authors note that their study is limited by its nonrandomized design. In addition, because the study was conducted in a private-office setting, they acknowledge that the results may not be generalizable to the majority of abortion seekers in the United States, who undergo the procedure in freestanding clinics. Nevertheless, because both the medical and the surgical patients experienced substantial improvements in their short-term quality of life following abortion, the authors argue that their findings "should support improved access to early medical and surgical abortion in physician offices and other settings."--C. Coren

REFERENCE

1. Westhoff C, Picardo L and Morrow E, Quality of life following early medical or surgical abortion, Contraception, 2003, 67(1):41-47.