{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T23:54:10Z","timestamp":1788566050171,"version":"build-2803163510"},"reference-count":30,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2024,11,12]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To explore experiences of pain during medical abortion and provide patient-centred recommendations for improving abortion experience and pain counselling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We invited patients of British Pregnancy Advisory Service who underwent medical abortion up to 10 weeks\u2019 gestation to participate in an online, English language questionnaire from November 2021 to March 2022. Participants answered questions about pain, method preference, abortion experience, advice, and how they would describe pain experienced to a friend. In this secondary analysis, we analysed free-text responses using reflexive thematic analysis techniques. We used descriptive statistics and parametric tests to analyse quantitative responses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 11\u2009906 patients invited to participate, 1596 (13.4%) completed the questionnaire, including at least one free-text comment. Participants used a range of descriptors for medical abortion pain across three broad themes: pain severity, pain quality and comparisons to other reproductive pain. Some found the commonly used analogy to period pain misleading. Many felt unprepared for the level of pain they experienced, which they attributed to provider comparisons to period pain, as well as a lack of detailed, realistic anticipatory pain counselling. Qualitative and quantitative results suggest pain experiences impact method preference. Participants recommended better counselling for pain and abortion preparation, including first-hand accounts of medical abortion at home and a wide and accessible range of descriptions of pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Abortion providers should use patient-centred recommendations to better prepare patients for pain during medical abortion. Setting realistic expectations can improve abortion experience and support informed method choice. Further research is needed to develop and test patient-centred counselling materials.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2024-202533","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T06:30:12Z","timestamp":1734503412000},"page":"137-143","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Expectations and experiences of pain during medical abortion at home: a secondary, mixed-methods analysis of a patient survey in England and Wales"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5006-967X","authenticated-orcid":false,"given":"Hannah","family":"McCulloch","sequence":"first","affiliation":[{"name":"Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Perro","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Taghinejadi","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3283-3803","authenticated-orcid":false,"given":"Katherine C","family":"Whitehouse","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1862-5730","authenticated-orcid":false,"given":"Patricia A","family":"Lohr","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"2025090510341373000_51.2.137.1","unstructured":"Department of Health and Social Care. GOV.UK . Abortion statistics, England and Wales: 2022. 2024. Available: https:\/\/www.gov.uk\/government\/statistics\/abortion-statistics-for-england-and-wales-2022\/abortion-statistics-england-and-wales-2022"},{"key":"2025090510341373000_51.2.137.2","article-title":"Pain management for medical abortion before 14 weeks\u2019 gestation","volume":"5","author":"Reynolds-Wright","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2025090510341373000_51.2.137.3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.contraception.2022.03.003","article-title":"The experience of pain in real-time during medication abortion","volume":"110","author":"Friedlander","year":"2022","journal-title":"Contraception"},{"key":"2025090510341373000_51.2.137.4","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31829d5a33"},{"key":"2025090510341373000_51.2.137.5","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/13625187.2017.1315092","article-title":"Assessment of pain during medical abortion with home use of misoprostol","volume":"22","author":"Cavet","year":"2017","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"2025090510341373000_51.2.137.6","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.7.4.360"},{"key":"2025090510341373000_51.2.137.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.04.027"},{"key":"2025090510341373000_51.2.137.8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s12978-021-01270-0","article-title":"It\u2019s a small bit of advice, but actually on the day, made such a difference\u2026: perceptions of quality in abortion care in England and Wales","volume":"18","author":"Whitehouse","year":"2021","journal-title":"Reprod Health"},{"key":"2025090510341373000_51.2.137.9","doi-asserted-by":"publisher","DOI":"10.1177\/1062860613484295"},{"key":"2025090510341373000_51.2.137.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2023-202198"},{"key":"2025090510341373000_51.2.137.11","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1111\/1471-0528.16668","article-title":"Effectiveness, safety and acceptability of no\u2010test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study","volume":"128","author":"Aiken","year":"2021","journal-title":"BJOG"},{"key":"2025090510341373000_51.2.137.12","unstructured":"GOV.UK . 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Abortion care. NICE guideline [NG140]. Recommendations. NICE. 2019 Available: https:\/\/www.nice.org.uk\/guidance\/ng140\/chapter\/Recommendations#choice-of-procedure-for-abortion"},{"key":"2025090510341373000_51.2.137.26","doi-asserted-by":"crossref","DOI":"10.1080\/26410397.2022.2149379","article-title":"Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine","volume":"31","author":"Footman","year":"2023","journal-title":"Sex Reprod Health Matters"},{"key":"2025090510341373000_51.2.137.27","doi-asserted-by":"crossref","unstructured":"Footman K . Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales. Health Policy 2023;132. doi:10.1016\/j.healthpol.2023.104799","DOI":"10.1016\/j.healthpol.2023.104799"},{"key":"2025090510341373000_51.2.137.28","unstructured":"General Medical Council . The seven principles of decision making and consent. 2020. 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