Abortion pills (also known as medical abortion or chemical abortion) are growing in popularity as a way to terminate a pregnancy. Currently in the US, abortion pills account for over 50% of reported abortions (1). These numbers are only projected to grow. In some countries in Europe, more than 90% of abortions are done via pills (2), and it looks like the United States is moving in that direction.
In the past, surgical abortions were the more common procedure. This procedure requires going to a clinic in-person and having a medical professional remove the pregnancy via surgery. There are various methods of surgical abortion available depending on the stage of pregnancy.
As abortion pills grow more popular, many women are choosing to order their abortion pills online and self-manage their abortions at home. This reality makes it even more important for all women of reproductive age to be well-informed about the medical abortion process.
Abortion providers should provide a medical evaluation with a licensed professional before providing you with abortion pills, whether via telehealth or in-person. The FDA also requires all abortion providers to “provide any necessary surgical intervention or have made arrangements for others to provide for such care. Health care providers must be able to ensure that patients have access to medical facilities for emergency care, and must agree to other responsibilities, including reviewing and signing the Patient Agreement Form with the patient and providing each patient with a copy of the signed Patient Agreement Form” (3). If you are ordering abortion pills online, be aware of illegitimate providers. Make sure your provider is credible and offers a visit with a clinician, in-person or via telehealth, as well as adequate follow-up procedure and access to emergency care.
Note: While managing your abortion at home is possible, exercise caution to ensure your safety. We recommend confirmation of pregnancy via clinical evaluation or ultrasound before taking the protocol, as you may not be pregnant, carrying a viable pregnancy, or able to progress naturally. Also note that the FDA does not recommend purchasing mifepristone online or from a foreign country. Doing so bypasses important safeguards put in place to protect your health (4).
Certain conditions or circumstances prohibit you from safely ingesting abortion pills. An evaluation from your provider should determine if any of these conditions affect you. For the general population, there is 1-5% chance of failure (5) (unsuccessful abortion), in which case the procedure would need to be completed via surgery. There are also various other possible risks and complications (see section on complications from self-managed abortion).
The purpose of this article is to give you an outline of the facts on medical abortion. Knowledge is power! The more you know, the better you are equipped to make a well-informed decision for your health.
What are Abortion Pills, Actually?
Mifepristone, the first medication, blocks the hormone progesterone in your body. Progesterone mainly functions to prepare the lining of your uterus for a fertilized egg to implant and grow. Every month, during the ovulation phase of your menstrual cycle, your body begins producing progesterone. If you don’t get pregnant during that cycle, progesterone levels decrease. This causes your uterine lining to grow thin and break down, which leads to your menstrual period.
If you do become pregnant during your cycle, progesterone production continues and increases throughout the remainder of your pregnancy. Progesterone thickens the lining of your uterus for early pregnancy. As the pregnancy continues, it maintains the thickened lining to provide nutrients to nourish the growing embryo. (It also prevents your body from ovulating while you are pregnant, suppresses uterine contractions to help avoid preterm labor, and prepares your breasts for breastfeeding.) Without progesterone, a pregnancy cannot survive.
Ingestion of mifepristone blocks progesterone from the pregnancy. This begins the abortion process. 24-48 hours after taking mifepristone, misoprostol is taken to complete a medical abortion. Misoprostol causes uterine contractions and bleeding to expel the pregnancy through the vagina. According to the FDA, the approved dosage for medication abortion is as follows:
- Day 1: 200 mg of mifepristone
- 24-48 hours after mifepristone: 800 mcg of misoprostol
- 7-14 days after misoprostol: follow-up with a healthcare provider
Medical abortion is not FDA-approved past 10 weeks gestation. This means, once you have passed 70 days since the first day of your last menstrual period, it is no longer safe for you to take abortion pills. Additionally, the FDA prohibits certain people from taking abortion pills, including anyone:
- Experiencing an ectopic pregnancy (a pregnancy outside the uterus)
- Having problems with the adrenal glands
- Currently being treated with long-term corticosteroid therapy
- Allergic to mifepristone, misoprostol, or similar drugs
- Taking anticoagulants (blood thinners) or who has bleeding problems
- With inherited porphyria
- With an IUD (intrauterine device) in place
If you fall into any of these categories, or you are past 10 weeks of pregnancy, medical abortion is not a safe option for you. For this reason, it is important to be assessed by a medical provider before purchasing abortion pills.
At-Home & Self-managed Abortions: FAQ’s
If you are considering an at-home pregnancy termination, you should know what to expect. Although every person is different and has a unique experience with abortion, some symptoms and side effects are more common than others. Some women have a mild experience with their abortion; others are more severe.
What will I feel after taking the first pill?
Most likely, you will not not feel much difference after taking mifepristone. As mentioned before, the function of mifepristone is to block progesterone. Most people do not feel symptoms from mifepristone.
What will I feel after taking the second pill?
Misoprostol causes uterine contractions (feels like cramping) and bleeding. The intensity of your pain will depend on various factors and is different for every person. The further along you are, the more intense your cramping will likely be. You will probably pass blood clots too. Additionally, past 8 weeks gestation, the fetus may be visible when passed. (Be aware that this may cause emotional trauma if seen.)
You should expect bleeding for 9-16 days, with heavy bleeding for an average of two days. Some women experience bleeding for over 30 days, with excessive bleeding being the most common post-abortion complication (6). Other commonly reported adverse reactions to medication abortion include:
- Abdominal pain/cramping (expected for all patients)
- Heart palpitations
You may experience some of these side effects; you may not. However, it’s important to be aware of the possibilities. An abortion can be an emotional experience for some people, and unexpected side effects may make that harder. If you know to expect something, you can prepare to manage it if necessary.
How should I care for myself during/after an abortion?
It is important to care for your physical and mental health following an abortion. Knowing what to expect and how to care for yourself can help relieve some of the impact of an abortion.
Some ways to take care of yourself physically include:
- Avoid aspirin medications (can increase bleeding)
- Anti-nausea medication for symptoms
- Heating pad on the abdomen
- Drink clear fluids
- Eat healthy foods and soups
- Get plenty of rest
- Avoid strenuous exercise and lifting heavy objects for at least one week
- Take any prescribed antibiotics
- Avoid inserting anything vaginally for at least 2 weeks (includes tampons and penetrative sex)
Be gentle with your body. Sometimes, complications arise after an abortion. If you notice any signs of after-abortion complications, seek medical care immediately. (See below for potential abortion complications.)
If you are experiencing a negative emotional response to your abortion experience, you do not need to ignore your feelings. Our ClearPast program exists to help women process and heal emotionally from any pain related to an abortion experience. Call our office today at (508) 438-0144 to learn more.
What if I change my mind?
The medical abortion process takes 1-2 days to complete, as the two medications are taken 24-48 hours apart. Sometimes, in the midst of that process, women change their minds and want to continue their pregnancy.
If you have not taken the second set of pills yet, it is possible to stop the effects of the first set of pills (mifepristone). Remember how mifepristone blocks progesterone to the pregnancy? Well, the reversal regimen essentially provides your body with enough progesterone to negate the effects of mifepristone. A licensed medical provider can prescribe a bio-identical progesterone to outnumber the mifepristone–the first pill–and eliminate its effects (7).
This process has a 68% success rate if started within the first 24 hours from the time the first set of pills were taken, and no known birth defects are caused by mifepristone (8). If you have already taken the second set of pills (misoprostol), the reversal process is not recommended. Misoprostol does have associations with birth defects, which is why the reversal protocol is not recommended if misoprostol has been taken.
To learn more or find an abortion pill reversal provider near you, visit abortionpillreversal.org.
Complications from Self-Managed Abortions
Every medical procedure can have complications, and abortion is no different. Although complications are not expected, they are possible. Your abortion provider should describe the potential risks to you. These include:
- Heavy bleeding requiring surgery or transfusion
- Prolonged heavy bleeding which can indicate incomplete abortion or other complications
- Severe bacterial infections and sepsis (can lead to death)
- Ruptured ectopic pregnancy (can be life-threatening)
- Ruptured uterus
- Allergic reaction (anaphylaxis)
Pay attention to any warning signs! These can include:
- Heavy bleeding or passing of large blood clots
- Bleeding that lasts longer than 14 days
- Fever over 100 degrees
- Vomiting that lasts longer than 4 hours
- Sudden abdominal swelling or rapid heart rate
- Vaginal discharge that has increased or has a foul odor
- Pain, redness, or swelling
Your health matters. An abortion is a time to take extra special care of yourself. If you experience any warning signs or suspect complications, seek immediate medical care. Regardless of complications or not, you should have a follow-up appointment with your abortion provider one to two weeks after your procedure.
If you are considering abortion, our nurses can help you assess if an abortion, chemical or surgical, is necessary. If your pregnancy is determined to be viable, they will provide an opportunity for you to learn about all of the pregnancy options you may be eligible for. We provide a safe space to learn about your options and get connected to resources. (Please note that our clinic does not provide or refer for surgical or medical abortions.) Schedule an appointment today or call our office for more information.
Worcester 508-438-0144 | Springfield 413-351-0070
Reviewed by Maya, BSN RN