Ending a pregnancy is a highly personal and private decision that is made for many reasons. Early gestation pregnancies -10 weeks or less from your last menstrual period- can often be terminated with medication. This is called a medical abortion.
Medical abortions are suitable for pregnancies that are 10 weeks or less in gestation.
The abortion pill is a combination of two medications, mifepristone, and misoprostol that result in a termination of pregnancy.
Bleeding and cramping are normal and expected side effects of medical abortion.
It is important to know that prolonged and excessive bleeding, severe abdominal pain, and fever can be signs of incomplete abortion.
It is important to maintain your two-week follow-up with your healthcare provider.
What is the abortion pill (medical abortion)?
The abortion pill will end a pregnancy. This is called a medical abortion. Two different medications, misoprostol, and mifepristone are most often used together for the desired result. It is important to speak with a healthcare provider to determine if you are physically eligible for abortion pills. Contraindications include:
- A pregnancy that is beyond 10 weeks gestation.
- Presence of an IUD (Intrauterine device) as birth control.
- Medication allergies to those used in medical abortion.
- Suspected ectopic pregnancy- when a fertilized egg attaches outside of the uterus.
- Bleeding disorders.
- Taking anticoagulant medication such as aspirin.
- Taking corticosteroid medications.
How does the abortion pill work?
Medical abortion is most often achieved by using two medications that are given one right after the other. Each medication has a different effect on the body that results in pregnancy termination
Mifepristone works by blocking progesterone. Progesterone is the hormone that is responsible for thickening the lining of the uterus for a growing embryo. Without progesterone, the embryo will not be able to maintain implantation. This will result in bleeding, shedding of the uterine lining, and loss of pregnancy. Mifepristone is given orally.
Misoprostol induces uterine contractions or cramping. The cramping will force the products of conception-fetal and placental tissue from the uterus. Misoprostol-only medication regimens are sometimes used for medical abortions. However, studies have shown that a medication combination has better results. Misoprostol can be given by various routes including:
- Orally - most common
- Buccally - dissolved within the cheeks of the mouth
- Sublingually - under the tongue
How is the abortion pill given?
The FDA-approved regimen is 600mg of mifepristone taken orally followed by 400mcg of misoprostol taken orally 48 hours later.
Other evidence-based regimens include the other routes for misoprostol administration. Studies have shown that these alternative route methods may decrease adverse effects and increase termination effectiveness. These are options to speak about with your healthcare provider.
Generally, symptoms of miscarriage occur within 3 to 4 hours of the misoprostol dose. If there are no signs or symptoms of miscarriage, an additional dose of misoprostol can be given.
Abortion pill side effects
Discomfort and pain are to be expected with abortion pills. The degree of pain felt is varied between individuals. Bleeding and cramping are necessary and probable side effects. They indicate that your body is shedding the uterine lining and eliminating the products of conception. Speak with your healthcare provider about over-the-counter pain medications that can be safely used while taking the abortion pill.
Bleeding is most often much heavier than a typical period. However, soaking through two absorbent pads per hour for two hours is considered excessive. Call your healthcare provider or go to the hospital. Emergency evaluation and care may be necessary.
Misoprostol will cause cramping to occur. Cramps may be similar to or worse than what you experience during a period. The purpose of the cramping is to contract the uterus so that the products of conception are pushed out of the body. Cramping should stop once the products of conception are passed a few hours after misoprostol is taken.
Other symptoms can occur with mifepristone and misoprostol. These include:
- Thermoregulatory effects-chills
All symptoms, including bleeding and cramping, should last for a few hours post-misoprostol administration. Continued or worsening symptoms could indicate an incomplete abortion.
How to know if the abortion pill worked?
Medical abortion is successful in 85-98% of women with the biggest variable being the number of weeks pregnant you are at the time of the abortion. It is important to be aware of the signs and symptoms of an incomplete-or unsuccessful- medical abortion. Signs and symptoms include:
- Prolonged or excessively heavy bleeding
- Severe cramping or abdominal pain
- Abdominal tenderness
- Elevated Temperature above 100.4 F°
- Foul-smelling discharge
Serious complications such as sepsis and hemorrhage can develop if an abortion is incomplete. It is important to speak with your healthcare provider or seek emergency treatment if you are experiencing any of the above symptoms. In certain instances, a surgical abortion may be required.
What to expect after the abortion
You may have concerns about how a medical abortion may impact your physical health including your menstrual cycle, sex life, and future pregnancies. It is important to remember that bleeding can continue for up to 45 days after a successful medical abortion. Often this bleeding can start and stop.
Will it affect my periods?
Once the pregnancy has been terminated, the body prepares for the next menstrual cycle. Periods should resume in 4 to 6 weeks following a medical abortion. Menstruation return may take longer If your periods are normally irregular.
How long after an abortion pill can you have sex?
Research suggests not putting anything in the vagina for a couple of weeks. Infection post-medical abortion is still a risk. It is safe to resume sex 2 weeks after a medical abortion. It is important to note that all contraceptive methods can begin immediately after a successful medical abortion.
Will the abortion pill affect future fertility or pregnancy?
Limited research has been conducted on whether the abortion pill plays a role in future fertility or pregnancies. Some research has shown that there is no link between medical abortion and the risk of preterm labor in future deliveries.
Follow up appointment
A 2-week follow-up with a pelvic exam and possible ultrasound to confirm termination and ejection of all products of conception is generally recommended. An in-person follow-up could be replaced by a telemedicine visit if you and your provider are confident that a successful abortion took place.
Telemedicine has made abortion care more accessible and private. Studies have shown that women seeking abortion care through telemedicine are more compliant with medication protocol and follow-up care.
It is important to care for yourself emotionally as well. It is normal to feel a range of emotions surrounding an abortion. Seek care from a mental health professional if you feel it could be beneficial.