Medical Abortion (‘Abortion Pill’): What to Know

A medical abortion (also called a medication abortion) uses doctor-prescribed drugs to end an early pregnancy. You might have heard people liken this to “taking an abortion pill” in conversation, but that term is a bit misleading.

A medical abortion usually involves taking two medications, the first pill by mouth, the second pill by mouth, or through the vagina. It’s an option for those who are less than 11 weeks into their pregnancy – meaning up to 11 weeks (or 77 days) since the first day of your last period. Some doctors who do abortions only offer the procedure up to the ninth week of pregnancy.

Unlike a surgical abortion, a medical abortion doesn’t involve getting surgery or anesthesia (medicine that helps you “sleep” during an operation). Instead, you take the abortive medications in a health care setting (like a doctor’s office) or at home. You’ll need to follow the doctor’s directions on how and when to take the drugs exactly.

Where Can You Get a Medical Abortion?

Depending on where you live, you may be able to find a doctor who does medical abortions at certain:

  • Community health centers

  • Private practices

  • Hospitals

Most clinics that do surgical abortions also offer medical abortions.

Who Shouldn’t Get a Medical Abortion?

It’s not safe for a pregnant person who:

  • Is too far into their pregnancy

  • Has a pregnancy outside of their womb (also called an ectopic pregnancy)

  • Has a blood clot disorder or serious anemia

  • Has adrenal failure

  • Is taking steroid medications long-term

  • Takes any meds that could affect the drugs needed to end the pregnancy

  • Has an IUD (intrauterine device) – a doctor would need to remove this first

  • Is allergic to abortive medications

  • Can’t get to an emergency room if needed

  • Can’t see the doctor for a follow-up appointment

If you’re not sure whether one or more of these things apply to you, it’s important to ask your doctor.

What Happens Before a Medical Abortion?

The doctor who provides abortions will talk with you about your health history to figure out if a medical abortion would be safe for you. They should also talk with you about the benefits and risks of the procedure. You can ask them any questions you have about the procedure.

If you decide to move forward, the doctor will want to confirm that you’re pregnant. If you are, they’ll also figure out how many days you’ve been pregnant. You might need to get an imaging test called an ultrasound. Some states require it, although not for medical reasons.

The doctor might also:

  • Give you a blood test

  • Offer to test you for sexually transmitted diseases (STDs)

  • Discuss the type of birth control you’d like to use after your abortion

Some states require a pregnant person to wait, usually for 24 hours, between their doctor’s counseling and the abortion. In other states, you can get an abortion on the same day.

What Happens During a Medical Abortion?

The usual first medication you take is called mifepristone. Typically you take this at the doctor’s office, but they may let you take it at home. Mifepristone keeps the pregnancy from growing in your womb. It does this by blocking a hormone called progesterone. It’s less common, but some doctors may have you take a drug called methotrexate instead of mifepristone.

Next, you’ll take the usual second medication, misoprostol, 1 to 2 days later at home. Misoprostol brings on cramping and bleeding to empty your womb (uterus). If you’re between 70 and 77 days into the pregnancy, your doctor will have you take a second dose of the drug 4 hours after the first dose. Some doctors tell you to take a second dose even if you’ve been pregnant for less than 70 days.

Some doctors also have you take misoprostol alone, instead of after mifepristone.

If you decide to get the procedure, be sure that you want to end your pregnancy. Stopping the abortive drugs before your procedure is complete could cause the unborn baby to develop severe birth defects in the womb.

What Symptoms Can a Medical Abortion Bring On?

You can expect to have vaginal bleeding, pain, and cramps during the process:

Vaginal bleeding. This is normal, and it means the medication is working. You may bleed heavily, especially in the first few hours after taking misoprostol. You’ll probably notice clots, and you might see some pregnancy tissue (especially if you’re over 8 or 10 weeks pregnant). After this tissue passes out of your womb, you’re likely to have less bleeding. The bleeding may last for several weeks, but it should be lighter than a period after a few days.

Call your doctor or abortion clinic if you soak through two menstrual pads in an hour for 2 straight hours and you’re still bleeding. Also call the doctor if you don’t have any vaginal bleeding after taking the medications, because that might mean the drugs aren’t working.

Pain and cramps. It’s also normal to have mild or strong belly pain and cramps after you take misoprostol. The pain usually gets better after any pregnancy tissue leaves your uterus.

You can take ibuprofen to ease the pain, unless you’re not allowed to take it for health reasons. Some doctors prescribe stronger pain meds as needed. You may also get some relief by putting a heating pad on your belly – just make sure it’s not burning hot.

Call the doctor right away if your pain is severe and using meds or heat doesn’t help.

Misoprostol can also bring on side effects like a mild fever, nausea or vomiting, and diarrhea. It’s common for these to quickly go away without treatment.

Call the doctor if you have any of these:

  • A fever above 100.4

  • Chills

  • Vomiting or diarrhea that doesn’t go away after a few hours

What’s Recovery Like?

It’s different for everyone. Some people can get back to their normal routine within a couple of days.

Be sure to skip doing things that bring on pain. Also, don’t have sex or put a tampon, douche, or any other item into your vagina for 1 to 2 weeks after a medical abortion. This helps lower your chances for infections and allows your body to recover.

While you’re recovering, different emotions might come up, including ones like relief, sadness, stress, or feelings of guilt. If the emotions become intense or overwhelming, think about talking to a mental health specialist (like a therapist or counselor). They have ways to help you process what you’re going through and feel better.

What Happens at Your Follow-Up Doctor Visit?

This appointment helps your doctor confirm that you’re not pregnant anymore. You might see the doctor who gave you your medical abortion, or another doctor who’s closer to your home.

How Effective Is Medical Abortion?

The procedure works for up to 98% of people who are up to 10 weeks pregnant. It’s less effective for people between 10 and 11 weeks. Because of that, doctors often recommend taking a second dose of misoprostol, which can boost its effectiveness back up to 98%.

For about a handful out of 100 pregnant people, the medication doesn’t work. If that happens to you, your doctor may offer the choice of taking more medication or getting a surgical abortion to complete the process.

Some possible signs that your medical abortion didn’t work are:

  • You don’t have vaginal bleeding after you take the medications.

  • You still have pregnancy symptoms like tender breasts and nausea more than a week after you got the procedure.

  • You keep bleeding for more than 2 weeks after the procedure.

  • You don’t have a period within 6 weeks of the medical abortion.

Talk to your doctor if you notice any of these signs.