Women's real-time pain and stress during medical abortion: An ecological momentary assessment study

Felnhofer, A.; Feneberg, AC.; Weiss, L.; Kothgassner, OD.; Kafka, JX.; Fiala, C.

Abstract

Introduction: Knowledge on women's pain and stress experiences during medical abortion is scarce and evidence mainly relies on retrospective reports, which are prone to recall bias. Hence, our objective was to study real-time self- reported pain and stress throughout the medical abortion process, their fluctuation over time, and to examine whether age, parity, gestational age, adverse childhood events (ACE), and contextual factors (e.g., analgesics intake, bleeding) were associated with pain and stress. Material and Methods: This one-group, single center, exploratory cohort study (con- ducted 2020–2023) used ecological momentary assessment (EMA). A population- based sample of women ≥18 years of age presenting for first trimester medical abortion at ≤9th week of gestation was approached after mifepristone intake. Sixty women aged 30.40 ± 6.61 years were included in this study. EMA commenced with mifepristone intake and entailed four prompts per day over a consecutive 7-day pe- riod. Main outcomes included self-reported pain and stress measured using visual analog scales (VAS). Secondary outcomes were clinical and demographic data as well as psychological measures. Data were analyzed using multilevel models. Results: Reported pain and stress varied not only throughout the abortion process but also between women, showing an increase on Day 3 (misoprostol intake) and a grad - ual decrease thereafter. While age, gestational age, and parity were not significantly related to pain, higher self-reported stress, more bleeding, more analgesic intake, and a higher number of ACEs were associated with higher pain levels. Higher stress levels, in turn, were associated with more ACEs, parity, analgesics intake, treatment-related events, and weekdays. Conclusions: Our results highlight large interindividual variations in women's pain and stress experiences during first trimester medical abortion and thus emphasize the need for individualized counseling and pain treatment. Screening for ACEs, along with using event-based EMA protocols for future pain-management research, may promote tailored care.