A medication abortion, also called medical abortion or abortion with pills, consists of a two-drug regimen that ends a pregnancy. Medication abortions need to be done within nine weeks from the first day of a woman’s last period.
In the United States, the most common kind of medication abortion involves the drugs mifepristone (also known as Mifeprex, RU-486, or the “abortion pill”) and misoprostol. The mifepristone is taken orally at the doctor’s office or clinic, and the misoprostol is used later, usually at home.
In 2011, 36 percent of women who were up to nine weeks pregnant chose a medication abortion. The rates vary by region and by clinic.
Some of the reasons women choose medication abortion include a desire to avoid an invasive, surgical procedure; a perception that it is better, easier or more “natural” (“like a miscarriage”); and a feeling that it is more private. Most important, studies show that the overwhelming majority of women surveyed are satisfied with whatever method they choose.
One woman describes why she choose a medication abortion:
This was a very personal and private procedure, which enabled me to have some control over this difficult situation. The bleeding and cramping last longer [than an aspiration abortion] and are somewhat unpredictable. The hardest thing is the waiting between taking the medication and finishing the abortion. Aspiration would have been faster. However, for me it was better because I’m more private. I was comfortable being in my own home. Even though I did have side effects, this was an easier procedure, both emotionally and physically.
A medication abortion is different from using emergency contraceptive pills (ECP, otherwise known as morning-after pills) such as Plan B, which can be taken up to three days after unprotected intercourse to prevent conception, or ella, which can be taken up to five days after unprotected intercourse. Find out more about emergency contraception.
Medication abortion with mifepristone/misoprostol is very safe. Less than one percent of women having a medication abortion have any serious complication.
Medication abortion is about 95 to 98 percent effective. In 2 to 5 percent of cases, women will need a vacuum aspiration procedure to complete the abortion. This may be because the drugs didn’t work and the pregnancy continues (about 1 percent of the time) or because of heavy or prolonged bleeding.
What to Expect
Mifepristone works by blocking progesterone, a hormone that is needed to sustain a pregnancy. Without progesterone, the embryo detaches from the uterine lining. Misoprostol, a prostaglandin that is either inserted into the vagina or allowed to dissolve inside your mouth (between your cheeks and gums or under your tongue), causes the cervix to become soft and the uterus to cramp. The embryo is then expelled in what seems like a heavy period.
After taking the mifepristone at the doctor’s office or clinic, you may experience bleeding, nausea or fatigue. Even if you have bleeding, it is very important to take the misoprostol as instructed.
Most clinics recommend that you use the misoprostol 24 to 48 hours after the mifepristone, at home or wherever you feel most comfortable. The waiting time is important and increases the likelihood that the medications will work.
Cramping and bleeding, possibly heavier than your normal period, will usually begin within a few hours. You can take over-the-counter pain relievers such as aspirin, Tylenol or ibuprofen for the pain; a heating pad or hot water bottle helps relieve the cramping. Other common side effects include nausea, vomiting, diarrhea, fever, chills or fatigue. It is normal to have more bleeding than a normal menstrual period and pass blood clots.
You may also see light pink or whitish wispy tissue, which is the gestational sac. The embryo is less than half a centimeter long at this stage and is often embedded in a blood clot. Severe lower abdominal cramps typically mean that pregnancy tissue is passing out of the uterus. The cramping may occur in waves. (Read more about controlling pain and coping techniques.)
Generally, cramping will subside after the tissue passes (about four hours, but each woman’s body is different). The bleeding will gradually decrease over the next few days, and light spotting often continues for one to three weeks.
Though complications are rare, if you have heavy bleeding — meaning enough to soak through two or more thick full-size sanitary pads per hour for two consecutive hours — have sharp abdominal pain or pain in your lower back, or have a fever of 100.4°F or higher that lasts for more than four hours, call your provider or the clinic. Also see “Symptoms to Watch for After an Abortion.”
Most clinics require a follow-up visit to confirm that the abortion is complete. The clinician will do a physical examination, ultrasound or blood pregnancy test. Sometimes these services can be managed by phone without having to return to the clinic.
If the pregnancy is continuing, you will need to have a vacuum aspiration abortion. If the embryo has stopped growing but some pregnancy tissue still remains in the uterus (sometimes called an incomplete abortion), the clinician may give you more misoprostol, empty the uterus with suction, or ask you to return for another visit.
You will likely get your next period within about four to six weeks after using the misoprostol. This first period after a medication abortion may be heavier or it may have more clots than normal. A small percentage of women have an episode of extra heavy bleeding about three to five weeks after the misoprostol. Learn more about general aftercare.