While many women and men have heard of abortion pills as a means of terminating a pregnancy, many people are unaware of how a medication abortion actually works. Abortion pills are growing in popularity and in some cases are accessible online and/or via telehealth. As such, it’s important to understand how the regimen works as well as the risks and effects on your body.

The Food and Drug Administration (FDA) has approved the use of mifepristone and misoprostol as a two-drug regimen within 10 weeks gestation. So what are these abortion pills? How do they work? 

What Are Abortion Pills?

Abortion pills, also known as medication abortion, provide a non-surgical option for terminating a pregnancy. This method involves the use of two drugs, mifepristone and misoprostol, taken in succession to terminate a pregnancy.

Mifepristone blocks progesterone, a hormone the body produces to sustain and nourish a growing pregnancy. Progesterone is necessary for a pregnancy to survive. Following this, misoprostol induces uterine contractions to expel the pregnancy from the uterus through the vagina.

As of the date this article was written, these medications are FDA-approved within the first ten weeks of pregnancy. If it has been more than 70 days since the first day of your last menstrual period, it is not recommended to use the medication abortion regimen. 

Abortion Pills Explained

The medication abortion regimen begins with mifepristone and ends with misoprostol. These medications work in tandem to terminate a pregnancy. Abortion pills are not the same as emergency contraception, or what is commonly known as the “morning-after pill,” which is designed to prevent pregnancy.   

Mifepristone, commonly referred to as the “first pill,” inhibits the hormone progesterone, essential for sustaining pregnancy. This prepares the body for the subsequent action of misoprostol.

Misoprostol, known as the “second pill,” induces uterine contractions to expel the pregnancy tissue. The typical regimen involves taking mifepristone first, followed by misoprostol 24-48 hours later.

How They Work

Mifepristone is a progesterone receptor antagonist.

By blocking progesterone, mifepristone causes the uterine lining to thin and detach, destabilizing the pregnancy. As progesterone is essential for maintaining the pregnancy, this process stops the blood supply to the fetus, resulting in the termination of the pregnancy.

Following the administration of mifepristone, misoprostol is taken to induce uterine contractions.  Misoprostol acts as a prostaglandin analog, which stimulates the smooth muscle in the uterus to contract and expel the pregnancy tissue. Misoprostol causes intense cramping and bleeding. It is typically used 24-48 hours after mifepristone.

It’s imperative to follow up with a provider on day 7-14 after a medical abortion. If the abortion was incomplete, a D&C surgery or an additional dose of Misoprostol may be required to complete the process.

Risks & Side Effects

Common side effects of the abortion pill may vary but generally include cramping, bleeding, and nausea. In some cases, women experience more severe reactions, such as heavy bleeding and infection. These require immediate medical attention.

The FDA determined that only specific providers have approval to prescribe Mifepristone due to the risks of serious and sometimes fatal infections or bleeding. For your health and safety, do not obtain abortion pills from anyone who is not an approved provider, and NEVER purchase online from an unknown source.

The prescriber is required to inform patients of the risk of serious events such as:

• Severe bacterial infections and sepsis, with or without fever which can result in death
• Heavy bleeding requiring surgery or transfusion
• Prolonged heavy bleeding which can indicate an incomplete abortion or other complications
• Ruptured ectopic pregnancy
• Ruptured uterus
• Allergic reaction (anaphylaxis)

Women should expect bleeding for 9-16 days with heavy bleeding for an average of 2 days.

• 8% of women report bleeding for more than 30 days.
• After 8 weeks gestation, be aware that the fetus may be visible when passed. This can cause emotional trauma. 

85% of patients report 1 or more adverse reactions, the most common being:

• Nausea
• Weakness
• Fever/chills
• Vomiting
• Headache
• Diarrhea
• Dizziness
• Abdominal pain/cramping is to be expected
• Anxiety, fainting, and heart palpitations have also been reported  

Accessing Abortion Pills

Obtaining abortion pills requires careful consideration of the source and ensuring credibility to guarantee safety and efficacy. Never acquire abortion pills from an unverified provider or unknown online source. Your safety is a top priority.

You should also get an ultrasound to confirm gestational age before purchasing abortion pills or taking the medication abortion regimen. Medication abortion is FDA-approved until 10 weeks gestation. If you are unsure how long you have been pregnant (for example, you experience irregular periods), it’s essential to confirm gestational age before a medication abortion. (At Clearway, we offer free ultrasounds to determine gestational age. Schedule your appointment today.)

The further along you are in your pregnancy, the possibility exists that you will see the fetus when you are passing blood and tissue during your abortion. This can be emotionally traumatic for many who manage their abortions at home.

Always consult a healthcare provider if symptoms are atypical or persistent to mitigate complications.

When to Contact a Doctor

Contacting a doctor is crucial when necessary.

If you experience heavy bleeding that soaks through more than two sanitary pads per hour for two consecutive hours, contact your healthcare provider immediately. Additionally, signs such as severe abdominal pain unrelieved by medication, high fever lasting more than 24 hours, or foul-smelling vaginal discharge should prompt immediate medical attention.

Other situations warranting medical consultation include a lack of bleeding within 24 hours after taking misoprostol or continued pregnancy symptoms after a week. These may indicate incomplete abortion or an ectopic pregnancy, requiring urgent evaluation.

Remember, protecting your health is paramount; never hesitate to reach out to a healthcare provider with any concerns or unusual symptoms. Prompt communication ensures appropriate management of potential complications and peace of mind during the process.

Abortion Pill Reversal (Progesterone Therapy)

You do not need to take the first set of abortion pills in the prescribing office if you do not feel ready. Never take both medications at the same time. Many women need time to ensure they are making the right decision before starting their abortion process. Even if you already have your pills, you can pause to consider if you feel confident in your decision. 

There are steps you can take to reverse the abortion process if you have not taken the second set of pills. This process is called Abortion Pill Reversal, and you can read more about the science behind it at APRScience.org. All studies and clinical trials have shown that APR is effective in approximately two out of every three cases if the protocol is taken within 24 hours from mifepristone. The APR protocol is still safe for the pregnant woman even in the cases when the pregnancy does not continue. 

Abortion Pill Reversal works by increasing the pregnant woman’s progesterone concentration levels. Giving high doses of bioidentical progesterone works to overcome the progesterone-blocking effects of mifepristone. This allows the pregnancy to continue in about 2/3 of pregnancies. Below are some facts about Abortion Pill Reversal:

• There are no known birth defects caused by the first set of pills (Mifepristone).
• Birth defects are associated with the second set of pills (Misoprostol), which is why APR is NOT recommended after the second set of pills is taken.
• APR has a 68% success rate if the process is started within 24 hours from the time the first set of pills were taken.

If you are considering abortion pill reversal, time is essential! Contact the APR Hotline today at (877) 558-0333.

Considering Medical Abortion?

If you are considering abortion, know that your pregnancy decision is yours alone. You have the medical autonomy to make it. Accessing good information and quality medical care are two ways to empower yourself to make the best possible decision for you and protect your reproductive health. Our experienced team of licensed nurses, licensed doctors, and patient advocates are here to answer your questions and support you as you navigate this decision.

Some common reasons reported by our patients for considering abortion include:

• Still in school or just started a new career

• Someone close is pressuring an abortion decision

• Feeling unprepared to be a parent (for various reasons)

• Doesn’t want anyone to find out about the pregnancy

• Didn’t plan on having any more children

At Clearway, we can answer some of the important questions in regards to this decision:

• Do you have a viable pregnancy? 

• How far along are you?

• What happens in an abortion?

• What kind of abortions are available to you?

• Are there any long-term or short-term risks to consider?

• What other options and/or resources are available?

An abortion is a significant medical decision. Give yourself a moment to gather all the information that you need and talk with those who are closest to you as you decide.

Schedule your free pregnancy confirmation and pre-abortion consultation at Clearway Clinic. Our team is here to answer your questions.

Reviewed by Lynn B., BSN RN 

Please note: We do not provide, prescribe, or refer for abortions.