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F.A.Q.

IT


CONTRACEPTION

WHAT IS IT?

Contraception is the temporary suspension of fertility, aimed at preventing or planning procreation.

The choice of a contraceptive depends on many different factors and can vary according to life stages and individual needs.

In some regions, it is possible to access contraceptives and related medical assistance for free. For this reason, we recommend going to the nearest public family planning clinic. The regions that are supposed to provide free contraceptives (for people under 26 or those who have recently undergone an abortion) are six: Apulia, Emilia-Romagna, Piedmont, Tuscany, Lombardy, and Marche.

If you have trouble accessing contraceptives, contact us!

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ORAL CONTRACEPTIVES

The advice of your gynecologist is essential before starting a hormonal contraceptive, to make an effective and informed choice, guided by your personal and family medical history and a general medical examination.

Combined pill

It is an oral contraceptive that combines estrogen with progestin hormones. The pill must be taken daily (preferably at the same time) for 21 consecutive days, after which a 7-day break usually follows, during which menstrual bleeding occurs.

The monophasic pill contains the same amount of hormones in each tablet, while the biphasic and triphasic pills have different hormone concentrations depending on the week. Blister packs contain 21 or 28 pills: in the latter case, the last 7 are placebo pills to be taken during the week-long break.

Estrogens inhibit the secretion of gonadotropins (FSH), which are responsible for the development of ovarian follicles. The progestin component inhibits the secretion of luteinizing hormone (LH), preventing the release of a mature egg into the fallopian tubes. Additionally, the pill acts on both the uterine mucosa and the endometrium, making it harder for sperm to ascend and for a fertilized egg, if present, to implant.

When taken correctly, the pill is about 99% effective (https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception), but it does not provide any protection against sexually transmitted infections.

A medical prescription is required to start taking the pill, both to choose the type of pill that best suits you and to assess any possible contraindications.

These may be related to lifestyle (for example, smoking), but not only: risk factors can include diabetes, a predisposition to cardiovascular diseases, and family medical history (such as breast cancer). Possible side effects, like weight gain, increased hair growth, or spotting (bleeding between periods, which is normal during the first months of use), may indicate the need to adjust the hormone dosage.

It is crucial to contact a doctor immediately if you notice signs of a blood clot (swelling, warmth, bluish-red discoloration, and pain in the limbs) or a pulmonary embolism (dizziness, difficulty breathing, rapid heartbeat, coughing).

Mini-pill

It is an oral contraceptive that, unlike the combined pill, contains no estrogen: it contains progestins only (of which there are different types).

The contraceptive action affects the uterine mucosa, the fallopian tubes, and the endometrium, making them inhospitable environments for sperm ascent and egg implantation.

The inhibition of ovulation, on the other hand, varies depending on the amount of progestin in the dose.

The mini-pill has the advantage of reducing the occurrence of some side effects typical of the combined pill, especially the risk of thrombosis. Therefore, it can be prescribed to a wider range of people, for example, those over 35 or who smoke.

However, the pill must be taken every day at the same time: the allowable delay is 2 to 3 hours, depending on the type of mini-pill. Taking it beyond this window does not guarantee full contraceptive protection and may require the use of emergency contraception and/or barrier methods in the following days.

When taken correctly, the mini-pill is about 99% effective, but it does not provide any protection against sexually transmitted infections.

Are there any risks when taking the pill or mini-pill alongside other medications?

It is important to remember that taking certain medications, such as some antibiotics (particularly three active ingredients: rifampicin, rifabutin, griseofulvin) and gastroprotective drugs, can affect absorption and reduce the contraceptive effect.

Some cortisone-based medications and antidepressants can also interact with the pill—not affecting contraceptive coverage, but potentially impacting the effectiveness of the other medication and leading to contraindications.

If you are starting one of these types of treatments, consult your doctor and, if necessary, combine the use of the pill with a barrier contraceptive method.

What to do if you forget to take the pill or mini-pill?

If you forget a pill within 12 hours of your usual time, simply take the missed pill and continue as normal.

If you forget a pill within 12 hours of your usual time, simply take the missed pill and continue as normal. For the mini-pill, follow the instructions provided in the leaflet.

After 12 hours, contraceptive effectiveness will be reduced.

Depending on the week of intake, the instructions may vary. Follow the package leaflet and/or consult a doctor.

In case of vomiting or severe diarrhea within 3–4 hours after taking the pill, it will be necessary to follow the same procedure as for a missed pill.

Allergies: Pill and Mini Pill

Oral contraception (pill and mini pill) contains lactose, so in case of intolerance, it is preferable to choose a hormonal contraception method that does not pass through the gastrointestinal tract (ring, IUD, etc.) to avoid the risk of malabsorption.

BARRIER METHODS

Barrier contraceptives are those that create a covering of the genitals (and more), preventing direct contact of mucous membranes and fluids, and thus the meeting of sperm and the egg.

For this reason, they are the only contraceptives that protect against sexually transmitted infections.

Barrier methods have an expiration date, after which they can break more easily.

Once used, they should be thrown in the regular trash and never in the toilet.

Condom and femidom (also known as the “female condom”):

The condom is a sheath to be placed over the glans and unrolled down to the base of the penis. Make sure to put it on with the rubber ring facing outward.

There are different sizes of condoms: choose one that fits properly to avoid slipping during intercourse, or being too tight and therefore more prone to breaking.

Condoms can have different thicknesses, colors, and flavors, and may have a delay effect (to postpone ejaculation) or stimulating effect (thanks to small bumps or a cooling gel).

The femidom consists of two rings of different diameters connected by a soft membrane. One of the rings must be positioned inside, the other remains outside, over the labia majora.

If you wear a femidom, make sure that penetration occurs inside the sheath and not between the contraceptive and the vaginal wall.

Femidoms have the advantage of being able to be inserted several hours before intercourse, but unfortunately they are not easy to find in pharmacies or supermarkets and are more expensive than condoms.

Both contraceptives are single-use and must be worn correctly before the start of intercourse.

During insertion, be careful with rings, nails, or other sharp objects that could damage them, compromising their effectiveness.

They can be used with water-based or silicone-based lubricants, but not with oil-based lubricants, as these can damage latex.

Both also have latex-free alternatives.

Diaphragm

The diaphragm is a dome made of silicone or latex to be inserted internally, near the cervix.

It is usually used with the addition of spermicidal substances.

Unlike condoms and femidoms, it does not provide equally effective protection against sexually transmitted infections, nor against unintended pregnancies, as it is difficult to position.

The diaphragm, optionally coated with spermicide on the concave side, should be inserted before intercourse and ideally removed after 6–8 hours to allow the spermicide to act.

It must still be removed within 24 hours.

Once removed, it should be carefully washed and stored in its case.

It has a variable lifespan, from 6 months to 2 years.

It does not require a prescription, but a gynecological visit can help choose the type of diaphragm most suitable for one’s anatomical shape.

Dental Dam

The dental dam is a small square of latex, commonly used as a dental tool, but it is also a valuable ally for preventing sexually transmitted infections: during oral sex (cunnilingus or anilingus; for fellatio, condom use is recommended), it creates a protective barrier between the mouth and the vulva or anus.

It is single-use and can be used with water-based or silicone-based lubricants, but not with oil-based lubricants, as these can damage latex.

⚠️ The dental dam is not a contraceptive method.

IMPLANTABLE CONTRACEPTIVES

Intrauterine Device (IUD) or Coil

The IUD is a small T-shaped plastic device with two threads, which allow its correct positioning to be checked once in place.

Currently, there are two types of IUDs on the market: the copper IUD, in which the plastic frame is wrapped with a spiraled copper wire, or copper and silver, and the hormonal IUD, which releases the progestin levonorgestrel into the uterus.

The contraceptive effect of the copper IUD is based on the release of copper ions, which block the mobility and survival of sperm and trigger a mild inflammatory response that makes the endometrium unsuitable for egg implantation. In contrast, the contraceptive effect of the hormonal IUD is based on the action of levonorgestrel, which thickens the cervical mucus, hindering sperm passage, and suppresses the growth of the endometrium, preventing implantation of a fertilized egg.

It can be purchased in pharmacies with a non-reimbursable medical prescription, at a price ranging from €75 for the copper IUD to €250 for the hormonal IUD, and is inserted within 7 days from the start of menstruation by a gynecologist, in a procedure lasting a few minutes that does not require any anesthesia.

Its duration is variable: generally 3 to 5 years, but for some copper IUDs it can extend up to 10–12 years.

It has a very high effectiveness (failure rate less than 1%), but does not provide any protection against sexually transmitted infections.

It is considered safe for the vast majority of AFAB people; however, there are contraindications to its use.

Not recommended in cases of:

  • Suspected or confirmed pregnancy

  • Sexually transmitted infection at the time of insertion

  • Acute or past pelvic inflammatory disease (unless, in the latter case, there has subsequently been an uncomplicated intrauterine pregnancy)

  • Uterine abnormalities

  • Septic abortion or postpartum endometritis in the past 3 months

  • Suspected or confirmed tumor of the uterus or cervix

  • Any abnormal uterine bleeding of unknown origin

  • Presence of conditions that may promote genital infections

  • Hypersensitivity or allergy to any of the device’s components

In addition to these general contraindications, there are some specific ones for the different types of IUDs:

  • The copper IUD is contraindicated in cases of copper allergy, Wilson’s disease, and for people with very heavy menstruation;

  • The hormonal IUD is contraindicated in cases of suspected or confirmed breast or liver cancer, and in the presence of liver disease.

According to the scientific literature, never having given birth is not a contraindication for using an IUD, although many gynecologists recommend it only for those who have had at least one vaginal delivery.

The possible (rare) side effects of the IUD include pelvic infections, which occur within 20 days of insertion, displacement or expulsion from the uterus (5% in the first year, then decreasing), and uterine perforation (less than 1 case per 1,000).

In addition to these adverse reactions, the copper IUD may cause an increase in menstrual bleeding and spotting, while the hormonal IUD may also cause decreased menstrual flow up to amenorrhea, spotting, migraine, breast tenderness, acne, ovarian cysts, and vaginal dryness.

In the rare cases of IUD failure, there is also an increased risk of ectopic pregnancy and miscarriage.

Subcutaneous implant (implant)

The subcutaneous implant is a 4 x 0.2 cm device implanted under the skin, capable of releasing progestin hormones directly into the bloodstream.

It works, like other progestins, by inhibiting ovulation and modifying the cervical mucus.

The implant has a duration of 3–5 years and loses its effectiveness completely once removed.

A prescription and a medical evaluation of health status are required before proceeding with implant insertion, which must be correctly performed by a medical professional to avoid rejection.

Injectable contraceptive

Injectable contraceptives can be administered either as a combination of estrogens and progestins or in progestin-only form.

Their mechanism of action is similar to that of other hormonal contraceptives, and the injection lasts for about three months

In Italy, the only contraceptive injection currently available is with MAP (medroxyprogesterone acetate) at 150 mg. However, the drug is not registered as a contraceptive in our country, so it must be used under the specific responsibility of the healthcare provider, who prescribes it in agreement with the patient. If needed, it can also be prescribed by a general practitioner

In addition to the side effects of other hormonal contraceptives, injectable progestins can also increase the risk of irregular and heavy bleeding, as well as amenorrhea. Moreover, infertility may persist for up to 8–9 months after the last injection.

Transdermal patch

The transdermal patch is a hormonal contraceptive that, unlike oral contraceptives, has a long duration of action: once applied, it slowly releases estrogens and progestins.

The level of estrogens released by the patch is higher than that of many pills and the vaginal ring, and it may therefore be contraindicated for those prone to cardiovascular diseases and for smokers.

It is recommended to undergo a medical evaluation before using it.

The patch must be applied once a week (avoiding contact with the adhesive side), worn for 21 consecutive days, and then removed for a 7-day break, during which menstrual bleeding occurs.

The patch should always be applied on the same day of the week, but it is not necessary to stick to a specific time. If the patch comes off or is damaged during the first week, it is important to replace it with a new one within 24 hours, or to use an additional barrier method.

If the patch comes off during the second or third week, it will be sufficient to apply a new patch within 48 hours.

Thanks to its transdermal action, there are no risks associated with gastrointestinal disorders.

Vaginal ring

It is a soft plastic ring inserted into the vagina that releases a very low dose of hormones (estrogens and progestins), which prevent ovulation and are absorbed into the bloodstream through the vaginal mucosa.

It must be inserted into the vagina and worn for three weeks, followed by a seven-day break during which menstrual bleeding occurs.

It should then be reinserted on the same day of the week, at the same time.

The ring should not cause discomfort during sexual intercourse; however, it can be removed and reinserted within three hours after intercourse without compromising contraceptive effectiveness.

Episodes of vomiting or diarrhea do not pose a risk to contraceptive coverage, but interactions with other medications should be taken into consideration.

PERMANENT CONTRACEPTIVES

Contraceptive salpingectomy

Salpingectomy is a type of permanent contraception that involves the removal of the fallopian tubes.

The procedure is performed via laparoscopy and leaves two tiny scars on the abdominal area.

Unfortunately, in our country, it is very difficult to access salpingectomy unless one already has children or has specific clinical conditions. We discussed this [here](https://www.youtube.com/watch?v=S8B8pm-22yk

With this type of contraception, it is no longer possible to have children through sexual intercourse, but pregnancy can still be achieved through in vitro fertilization and medically assisted reproduction.

The menstrual cycle is not affected by the procedure.

Vasectomy

Vasectomy is a permanent contraceptive method in which the vas deferens, located in the scrotum, are cut and sealed.

In this way, sperm produced by the testicles are prevented from joining the seminal fluid to form semen.

Generally, the procedure is performed under local anesthesia, is outpatient, and does not require any hospital admission: discharge occurs on the same day as the procedure.

EMERGENCY CONTRACEPTION

What is emergency contraception?

Emergency contraceptives are all methods that prevent an unwanted pregnancy after an unprotected penetrative sexual intercourse or in case of failure of the chosen contraceptive method.

It is advisable to take them as soon as possible after the at-risk intercourse.

Which emergency contraceptive methods exist?

  • The “five-day-after” pill (EllaOne), containing ulipristal acetate, is effective up to 120 hours after unprotected intercourse.

  • The “morning-after” pill (Norlevo), containing levonorgestrel, is effective up to 72 hours after unprotected intercourse.

  • The copper IUD is effective if inserted within 120 hours of unprotected intercourse.

How do the morning-after and five-day-after pills work?

Hormonal emergency contraceptives work only before the egg implants, thereby preventing fertilization from occurring.

The contraceptive effectiveness of the five-day-after pill is three times higher than that of the morning-after pill if taken within the first 24 hours after at-risk intercourse, and twice as high if taken within 72 hours.

⚠️ In case of vomiting within three hours of taking the morning-after pill, it is necessary to take another tablet immediately.

Do I need a prescription to get the morning-after or five-day-after pill?

No, it is sold over the counter: a prescription is never required for adults.

With AIFA resolution no. 219 of February 1, 2016, published in the Official Gazette No. 52 of March 3, 2016 , the prescription requirement for the drug Norlevo, i.e., the morning-after pill, was removed for adults. As for minors, the prescription requirement for the drug EllaOne, i.e., the five-day-after pill, was removed on October 10, 2020.

If the pill is denied to me, what are my rights and what can I do?

Emergency contraception, being a non-abortive drug, is not regulated by Article 9 of Law 194, and therefore its sale cannot be ethically or morally objected to.

If a healthcare provider or pharmacist refuses by invoking conscientious objection (Art. 9 194/1978), they are committing an illegal act (punishable under criminal law).

In caso lə farmacista si rifiutasse di darti il contraccettivo d’emergenza senza prescrizione, puoi presentare una copia della determina AIFA del 1 febbraio 2016 (scaricala cliccando qui); se insiste, scrivici!

What can I do if the pharmacy says they are out of stock?

Unfortunately, it is common practice for objecting pharmacists to pretend they have run out.

Saying they do not have emergency contraception is not illegal, but if you request it, they are obliged to order it.

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As a minor, can I request emergency contraception?

As established by the AIFA resolution of October 10, 2020, the five-day-after pill (EllaOne) can be administered to minors without parental presence and without a prescription.

For the morning-after pill (Norlevo), a medical prescription is still required.

What are the side effects?

Very common side effects include: nausea, lower abdominal pain, irregular bleeding up to the next menstrual cycle, headache, and fatigue.

Common side effects also include: vomiting, diarrhea, breast tenderness, dizziness, changes in the menstrual cycle—which may occur earlier or later than expected, and may be heavier or lighter.

Rare side effects, which may occur in sensitive individuals, include: itching, skin rashes, hives, painful menstruation, facial swelling, and possible allergic reactions.

⚠️ In case of vomiting within three hours of taking the morning-after pill, it is necessary to take another tablet immediately.

VOLUNTARY TERMINATION OF PREGNANCY

What is voluntary termination of pregnancy (abortion), and what are the time limits?

Voluntary termination of pregnancy is the medical procedure aimed at ending a pregnancy intentionally.

Voluntary termination of pregnancy (VTP) is allowed in Italy under Law 194/78 within the first 90 days of gestation (12 weeks) for health, economic, social, or family reasons. After 90 days, VTP can be performed in cases of fetal malformations and/or serious risks to the physical or mental health, or to the life, of the pregnant person. In these cases, it is referred to as therapeutic abortion. For more information, visit the THERAPEUTIC section.

Gestational days, by standard practice in our country, are not counted from the presumed day of conception, but from the first day of the last menstrual period.

There are two methods of abortion: medical and surgical. The first can be performed within the first 9 weeks of pregnancy, the second within the first 12 weeks.

What should I do, and who should I contact first?

A named pregnancy test and a certificate confirming the pregnancy and your intention to terminate it are required.

To do the test, you can go:

  • to a pharmacy

  • to a diagnostic laboratory

  • you can do a urine or blood test with a prescription from your doctor

  • you can have an ultrasound with a prescription from your doctor

⚠️ Some hospitals or family planning clinics may require additional blood tests or an on-site ultrasound in order to book the abortion.

To get the certificate, you can go:

  • to a hospital

  • to a public family planning clinic

  • to a doctor of your choice

To obtain the certificate, after the tests, you will have a consultation with the doctor, who will discuss with you the reasons for your decision to terminate the pregnancy; but this must be done respecting your dignity, your choices, and your person.

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According to Article 5 of Law 194/78, the doctor may ask you to wait for 7 days from the moment the certificate is issued, after which you can proceed with the termination. Remember that in the meantime you can already book the procedure at the hospital.

Keep in mind that you can request an urgency certificate, thus avoiding the one-week reflection period. The assessment of urgency is at the doctor’s discretion, and the latest WHO guidelines on abortion discourage unnecessary delays. For this reason, it is good practice to attest urgency if there are no other issues. If the doctor you ask for the certificate does not seem opposed to your choice, remind them of this!

What should I bring on the day of the abortion?

  • A named pregnancy test (printed, linked to your personal data), which can be obtained through some pharmacies that offer this service, at a diagnostic laboratory, or via blood/urine tests.

  • A certificate confirming your intention to terminate the pregnancy, with the date of the presumed start. You can get it at a public family planning clinic, the gynecology department of a hospital, or from a doctor of your choice (including your general practitioner).

  • A photo ID and your health insurance card.

  • Comfortable clothing and a change of clothes, especially if you are having a medical abortion.

I am a minor, what can I do?

Minors can also access abortion, but the consent of both parents is required.

If you do not want to inform your parents of your decision, or if you fear they might prevent you from having the abortion, the doctor who assisted you during the consultation for the abortion certificate will send a report to the guardianship judge, who, after meeting with you, authorizes the procedure without notifying your parents.

For more information, visit the access to abortion section.

I am not an Italian citizen, what can I do?

If you are not an Italian citizen, even without documents or a residence permit, you can access abortion and no one can report you to the authorities.

For more information, visit the access to abortion section.

SURGICAL ABORTION

Surgical abortion: what procedures are available?

Surgical abortion in Italy can be performed up to the 90th day of gestation (12 weeks) and is carried out in a day hospital. It can be performed under local or general anesthesia: the person seeking the abortion should be given the option to choose. According to the WHO, local anesthesia is recommended because it is associated with a lower risk of complications compared to general anesthesia.

⚠️ In many hospitals, it is not possible to choose between the two types of anesthesia, and often only general anesthesia is provided.

How is it performed?

Surgical abortion is carried out in hospitals or healthcare facilities authorized to perform this procedure.

Steps of the procedure: After admission and before entering the operating room, prostaglandin-like medications are administered to induce cervical dilation. The time needed for cervical dilation can vary from 30 minutes to a few hours.

The uterine contents are emptied in the operating room under anesthesia via vacuum aspiration (D&A, dilation and aspiration): this is currently the most common method, used for early pregnancies.

The operation does not involve cuts or incisions, is quick and minimally painful, and if there are no complications, the person can go home after a few hours. It consists of aspirating the pregnancy products by inserting a cannula into the uterus connected to an electric vacuum pump, which removes the uterine contents once activated.

If necessary, the procedure can be completed with a curettage, which involves using a tool called a “curette” to gently scrape the uterine lining to remove anything that could not be aspirated.

At the end of the procedure, the person is observed for a few hours.

⚠️ CURETTAGE (D&C, dilation and curettage) as a method of surgical abortion is now considered outdated because it is more painful and carries a higher risk of uterine damage. The WHO also discourages it in cases of incomplete abortion (e.g., incomplete medical abortion), since prostaglandins can be used safely instead (see the MEDICAL ABORTION section).

What should I do after surgical abortion?

In the hours immediately after the abortion, it is possible to eat and drink.

In the first few days after the procedure, you may experience bleeding (spotting), and it is recommended to take some precautions:

  • Do not use internal tampons, only external ones.

  • Avoid vaginal douching; clean only externally.

  • Avoid penetrative sexual intercourse (for at least one week).

  • Avoid penetrative sexual intercourse until pain or bleeding stops (this may take 15–20 days).

  • Avoid baths or swimming until bleeding has ceased. Showering is allowed.

For 5 days starting from the day of the procedure, it is necessary to take an antibiotic twice a day. This should be provided free of charge by the hospital.

Two weeks after the procedure, a gynecological follow-up visit is required.

MEDICAL ABORTION

What is medical abortion?

Medical abortion is the voluntary termination of pregnancy carried out using specific medications. In Italy, it can be performed within the first nine weeks of gestation (63 days).

It involves taking two different active substances: mifepristone (better known as RU486) and a prostaglandin, administered 48 hours apart.

Where is RU486 dispensed?

According to the new guidelines issued by the Ministry of Health on August 12, 2020, medical abortion—within the first 9 weeks of pregnancy—should be possible both in hospitals and in all adequately equipped public outpatient facilities (including family planning clinics) in a day-hospital regimen.

In practice, not all regions have updated their resolutions, and within regions, not all facilities have adjusted their operating protocols

Therefore, the service is not guaranteed uniformly across Italy: it is necessary to check the protocol in effect at the facility where you want to request the abortion.

How does it work?

Mifepristone works by blocking the action of progesterone.

To increase the effectiveness of the abortion, another substance is used: the prostaglandin, which is administered 36–48 hours after taking RU486 in an outpatient clinic, family planning center, or day hospital. Its function is to induce uterine contractions and expel the pregnancy products.

Before the procedure, painkillers can be requested.

The outcome of the abortion can be checked via ultrasound 14 days after taking the second pill.

⚠️ The mifepristone-misoprostol combination is the most widely used method for inducing medical abortion and was included by the World Health Organization in 2006 in the list of essential medicines for reproductive health.

In 2022, the World Health Organization issued guidelines identifying medical abortion as a safe procedure that can even be done at home up to the 12th week of pregnancy. Beyond the 12th week, medical abortion is still possible, but outpatient care is recommended to monitor potential complications, which can increase as the pregnancy progresses.

What are the possible side effects of medical abortion?

The possible side effects include: cramps—which increase near the time of expulsion and decrease once it occurs—nausea, vomiting, and diarrhea. Bleeding, which is heaviest at the time of expulsion, varies in amount and duration, with blood loss persisting for at least a week and, in rarer cases, longer.

Severe complications are rare and must be treated in a hospital:

  • Heavy bleeding: bleeding that lasts for more than 2 hours and fills more than 2 maxi pads per hour (dizziness or lightheadedness may indicate excessive blood loss).

  • Fever: over 38°C for more than 24 hours, or a temperature above 39°C at any time, may indicate an infection.

  • Persistent pain that is not relieved by painkillers.

  • Foul-smelling or discolored discharge, which may also indicate infection.

If you suspect a complication, you should see a doctor immediately. These complications are often treated with antibiotics if an infection is present, with additional prostaglandin, or with aspiration if the abortion is incomplete.

If you notice very heavy bleeding or have a high fever, go to the emergency room immediately.

THERAPEUTIC ABORTION

What is therapeutic abortion?

A therapeutic abortion is any type of abortion (medical or surgical) performed for medical reasons.

It can also be performed beyond the legal limit of 90 days.

How can I have an abortion after 90 days of pregnancy?

Access to abortion in the second trimester is possible under certain specific medical circumstances, generally in cases of risk to the pregnant person’s physical and/or mental health or in cases of severe fetal malformations.

There is no universal list of conditions that automatically allow abortion beyond the legal limit; it is up to the doctor to assess whether the condition represents a risk to the pregnant person.

If the procedure occurs between the 22nd and 24th week of pregnancy, Law 194 requires the doctor to safeguard the survival of the fetus in every possible way after expulsion.

The procedure is similar to that of a standard surgical abortion and is called D&E (dilation and evacuation), but it requires greater cervical dilation;

in some cases, prostaglandins (Cytotec) or small sticks made from special dried seaweed (laminaria) may be used to help with dilation. The procedure lasts 5 to 20 minutes and can be performed under local or general anesthesia.

It is recommended to be accompanied to the hospital because, due to anesthesia, it is not possible to drive for 24 hours after the procedure.

What are the contraindications and complications?

After the procedure, it is common to experience cramps similar to menstrual cramps, nausea, diarrhea, and mood swings due to hormonal changes.

All these symptoms can be easily relieved with an over-the-counter painkiller such as ibuprofen.

Call your doctor in case of: symptoms of infection (fever, chills), increasing abdominal pain, heavy vaginal bleeding (more than one pad per hour), persistent pain or vomiting.

Complications are very rare and mainly involve infections (prevented with a free post-operative antibiotic), small tears in the uterine tissue that can be easily sutured, or retained pregnancy tissue that may require further aspiration.

Therapeutic abortion is a safe procedure, and its risks are significantly lower than those of childbirth.

How might I feel after a therapeutic abortion?

Not everyone feels the same way after an abortion, so there are no general rules.

For a clearer idea, visit the psychological health and abortion section.

Post-operative advice: all the recommendations applicable to standard surgical abortions apply, with the additional advice to rest for at least 2 days.

TELEMEDICAL ABORTION

What is telemedical abortion?

Telemedical abortion is a medical abortion carried out with remote support from a doctor or healthcare provider, via phone, video call, or email.

The United Kingdom has been piloting telemedical abortion since spring 2019, and the possibility of making it permanent is under discussion.

Are there telemedical abortion services in Italy?

In Italy, by law, RU486 can be administered only in hospitals and family planning clinics, so there is not yet any telemedical abortion pilot program.

However, the non-governmental organization Women on Weboffers support for this service.

Why is this service necessary even in Italy?

A safe telemedical abortion service protects the life and health of people who want to terminate an unwanted pregnancy but cannot access the national health system.

Unfortunately, in Italy, many obstacles prevent safe and free access to abortion, with conscientious objection being the primary barrier.

Access to abortion is a human right.

Essential healthcare and medical abortion pills are listed as essential medicines by the World Health Organization.