Patient education: Medication abortion (The Basics)

What is medication abortion? — 

Abortion is a way to end a pregnancy. It is also called "pregnancy termination."

With medication abortion, you take medicines to end the pregnancy. You can do this at home or in a clinic or hospital.

What happens during a medication abortion? — 

It depends on how far along you are in pregnancy. The exact process also depends on the clinic and the doctor doing the abortion.

Here are the usual steps:

●You will usually get a medicine called mifepristone (brand name: Mifeprex). This comes as a pill. Most of the time, you take this medicine in the clinic or doctor's office. Sometimes, this medicine is not available, and it will not be part of your abortion plan.

●Then, around 1 or 2 days later, you take another medicine called misoprostol (brand name: Cytotec). This can be done at home or in a clinic or hospital. Where you take it often depends on how far along you are in pregnancy.

Misoprostol can come as pills that you swallow or as tablets that go in your vagina, inside your cheek, or under your tongue. Your doctor or nurse will tell you exactly how to take it. You might need to take more than 1 dose.

●The medicines cause your body to end the pregnancy. When this happens, you will bleed from your vagina and have cramping. You will probably also see large blood clots or pieces of tissue.

If you are early in pregnancy, you might bleed and cramp as quickly as 4 to 6 hours after taking the second pill. Later in pregnancy, it can take longer, around 24 hours.

Can I get a medication abortion without seeing a doctor or nurse? — 

It depends. If you are 11 to 12 weeks pregnant or less, you might not have to go to a clinic or doctor's office. Other ways to have a medication abortion include:

●"Telemedicine" – This means talking to a doctor or nurse on the phone or online, instead of in person. They will ask questions to make sure you can have a medication abortion at home. Then, they will arrange a way for you to get the medicines, and explain how to take them. You might pick up the medicines from a pharmacy or get them through the mail.

●"Self-managed" abortion – This involves getting mifepristone and misoprostol yourself, often over the internet. There is no direct contact with a doctor, nurse, or clinic. Information about how to get a prescription is available online (table 1).

What happens after a medication abortion? — 

You should expect to have:

●Pain and cramping in your lower belly – This usually happens after you take the second medicine (misoprostol). It usually lasts for a few hours, but can last longer. It should start to get better after your body passes the pregnancy. If you are at home, taking an "NSAID" medicine like ibuprofen (sample brand names: Advil, Motrin) can help relieve pain. If you are in a hospital or clinic, the staff will talk to you about your options for pain relief.

●Bleeding from the vagina – Bleeding can be very heavy for a few hours after you take misoprostol. Light bleeding might go on for a few weeks.

Some people have other symptoms, such as fever, nausea, vomiting, or diarrhea. Depending on how far along the pregnancy was, your breasts might feel full or leak milk. It can help to wear a supportive bra and use ice on your breasts until this goes away. Your doctor might also have other suggestions.

What are the risks of medication abortion? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●The medicine not working to end the pregnancy

●Losing too much blood (hemorrhage)

●Infection

●Tear in the uterus

These risks are rare. But if any of these things happen, your doctor will tell you if any other treatments are needed.

When should I call the doctor? — 

Call your doctor, nurse, or clinic for advice right away if:

●Your bleeding is heavy enough to soak through 2 pads an hour, for at least 2 hours, and you are still bleeding.

●Your pain is severe (it makes you double over or makes it hard to move) even with pain medicines, or gets worse after your bleeding has decreased.

●You have a fever higher than 100.4°F (38°C).

●Bad-smelling discharge comes out of your vagina.

In some cases, abortion does not work completely to get rid of all the pregnancy tissue. This is not very common. But if it does happen, you will need to take additional medicine or have a procedure to remove any leftover tissue. Signs that an abortion was not complete include:

●Not bleeding after a medication abortion

●Still having pregnancy symptoms, such as nausea and tender breasts, 1 week or more after the abortion

●Bleeding that does not decrease

●Not having a period in the first 2 months after the abortion (unless you are on hormonal birth control)

Call your doctor, nurse, or clinic if you have any of these signs. You should also call if you have a positive pregnancy test 4 weeks or more after your abortion.

What else should I know? — 

If you do not want to get pregnant again, talk to your doctor or nurse about birth control options. It is possible to get pregnant very soon after having an abortion, even before your next period. There are many different types of birth control. Your doctor or nurse can help you choose the right type for you.

More on this topic

Patient education: Deciding to have an abortion (The Basics)
Patient education: Procedural abortion (The Basics)
Patient education: Choosing birth control (The Basics)
Patient education: Hormonal birth control (The Basics)
Patient education: Long-acting methods of birth control (The Basics)
Patient education: Intrauterine devices (IUDs) (The Basics)
Patient education: Permanent birth control for women (The Basics)
Patient education: Emergency contraception (The Basics)

Patient education: Abortion (pregnancy termination) (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)
Patient education: Long-acting methods of birth control (Beyond the Basics)
Patient education: Emergency contraception (Beyond the Basics)