Medical Abortion

What is a medical abortion?

A medical abortion (or medication abortion) is a procedure that uses prescription pills to end a pregnancy in the early stages. The most common regimen involves taking two pills — mifepristone and misoprostol. Mifepristone blocks progesterone, the hormone needed to support a pregnancy. Misoprostol causes cramping and bleeding to empty your uterus.

A medical abortion is a nonsurgical way to terminate a pregnancy in the first trimester. If you’re beyond the first trimester, your provider may discuss procedure options with you. Terms for procedure abortions are in-clinic abortion, aspiration abortion and dilation and curettage (D&C) abortion.

Why is a medical abortion performed?

Having a medical abortion is a highly personal decision based on your own circumstances. Someone may choose to have a medical abortion because they’re concerned about passing along a congenital or inherited disease. Some may want to end an unwanted pregnancy. Providers sometimes use the same pills to treat a miscarriage that hasn’t expelled yet, known as a missed abortion. Your provider might refer to this as completing a miscarriage. A medical abortion may also be an option if carrying the pregnancy could be life-threatening.

Everyone’s situation is different. Reaching out to a healthcare provider who understands your medical history and healthcare needs can help as you weigh your options.

When can someone get a medical abortion?

The Federal Drug Administration (FDA) has approved the use of mifepristone and misoprostol for medical abortion as safe and effective up to 10 weeks of gestation, but there’s evidence that it’s safe and effective beyond 10 weeks of gestation. FDA regulations allow certified medical professionals and pharmacies to distribute the medications for medical abortion in healthcare settings and by mail. Access by mail makes it possible for people receiving care via telehealth to receive their medications.

Laws governing abortion vary by state. State laws determine whether it’s legal for a person to receive a medical abortion in that state. In states where medical abortions are legal, state law governs:

• Which providers can prescribe or administer the medicine (some states require providers to be physicians only).
• The type of visit (some states require one or more in-person visits to get the medications or prohibit the use of telemedicine for abortion purposes).
• What happens during the visit (some states require a pregnancy ultrasound).

Who should not get a medical abortion?

As with any procedure, it’s important to discuss your medical history with your healthcare provider to ensure it’s safe. A medical abortion isn’t a safe option if you:

• Are too far along in your pregnancy.
• Are allergic to the medications used.
• Have a pregnancy outside of your uterus (ectopic pregnancy).
• Use long-term corticosteroids.
• Have an intrauterine device (IUD). (A medical abortion is an option if you have it removed.)
• Have a blood clotting disorder, significant anemia or chronic adrenal failure.
• Don’t have access to emergency care.

How common are medical abortions?

Over half of all abortions performed in the United States are medical abortions. This means that most people who choose to terminate a pregnancy do so in the early stages.

What do you do to prepare for a medical abortion?

You’ll meet with a healthcare provider for an evaluation. While the specific steps depend on the state where you’re having the procedure, preparation may involve:

• Confirmation of pregnancy.
• Urine (pee) or blood tests.
• An ultrasound to determine how far along the pregnancy is.
• An explanation of the procedure, risks and side effects.

What happens during a medical abortion?

A medical abortion involves taking pills by mouth or through your vagina. First, you’ll take mifepristone to end the pregnancy. Then, you’ll take misoprostol to empty your uterus. Follow the instructions as prescribed.

• Mifepristone (Mifeprex® or RU-486) works by blocking the hormone progesterone. Without progesterone, your uterine lining will thin, and the pregnancy won’t stay attached. You take this pill by mouth.
• Misoprostol (Cytotec®) causes your uterus to contract, bleed and expel the pregnancy. The medicine comes in pill forms you can take buccally (dissolve in the cheeks of your mouth) or vaginally. You should take the oral forms of misoprostol within 24 to 48 hours of taking mifepristone. You can take misoprostol that you insert vaginally 0 to 48 hours after taking mifepristone.

Most people start to feel the most effects from the medicine shortly after taking the second pill (misoprostol). You can expect:

• Bleeding and cramping that start one to four hours after taking the second pill.
• Heavy cramping and bleeding with blood clots over the next several hours.
• A low-grade fever or chills that last about a day after taking the second pill. Some people feel tired, nauseated or dizzy, and have diarrhea.

How long does a medical abortion take?

A medical abortion takes about two to six hours after you’ve taken the second pill, although it may take longer in some cases. Plan to rest during this time. It’s a good idea to have someone you trust with you so they can provide care and comfort.

Does medical abortion pain feel like labor pain?

A medical abortion feels most like strong period cramps. The intensity of the cramping and pain are different from person to person. You can use a heating pad and take most over-the-counter (OTC) pain relievers to help. Most people use NSAIDS, such as ibuprofen.

Ask your healthcare provider which medications you should take to manage pain, and when you should take them. For example, it may be a good idea to take a pain reliever half an hour before taking the misoprostol.

What can you expect after a medical abortion?

Vaginal bleeding and cramping are the biggest side effects. While the heaviest bleeding typically occurs several hours after taking the second pill, you may have period-like bleeding for several days afterward. You may have light to moderate bleeding for several weeks.

You should also expect to have a follow-up visit or call with your healthcare provider to ensure the pregnancy ended.

How long do you bleed after a medical abortion?

The amount of bleeding varies from person to person. It also depends on how far along you were in your pregnancy. Expect heavier bleeding for one to two days. Bleeding will typically lessen over two to three weeks. You may need to wear sanitary pads until the bleeding stops. Using pads helps you see clots and gauge blood loss so you can share this information with your provider.

What happens during the follow-up appointment after a medical abortion?

Your healthcare provider will want to talk to you or see you for a follow-up appointment within two to five weeks. Your provider may ask that you take a home urine pregnancy test, complete lab work, or have an ultrasound to confirm that the medication worked and you’re no longer pregnant.

What are the benefits of a medical abortion?

A medical abortion is a safe and effective way to end an early pregnancy. With a medical abortion:

• You can end a pregnancy early (as soon as you know you’re pregnant or as soon as you learn of an early miscarriage).
• Passing a pregnancy may feel more natural (as opposed to having a procedure).
• You can be at home (or someplace that feels comfortable and safe) for the cramping and bleeding.
• You can have the support system you choose with you.

What are the risks of a medical abortion?

Medical abortions are considered safe and effective. Complications are rare. But it’s important to take all medications as prescribed. Skipping a dose or not following instructions can pose health risks.

Risks of a medical abortion include:

• Failure to end the pregnancy or retained pregnancy tissue.
• Heavy bleeding that won’t stop. (This could lead to a need for a D&C.)
• Diarrhea and digestive pain.
• Allergic reaction to the medications.
• Infection (signs to look out for include an unpleasant vaginal odor and fever that lasts more than 24 to 48 hours).

There are no long-term health risks associated with medical abortion.

How effective is a medical abortion?

When using the combination of mifepristone and misoprostol, it’s about 98% effective. It’s a safe and effective way to end a pregnancy.

How long does it take to recover from a medical abortion?

Recovery times vary. Most people start feeling better the day after taking the last pill. You may be able to resume normal activities within a day or two. Pay attention to your body and take it easy if you need to. Avoid any activities that cause you pain.

Recovery isn’t always just physical. You may feel a range of emotions — from relief to sadness, stress or guilt. These feelings are normal. It may be helpful to speak with a mental health professional, like a therapist, about how you’re feeling. If you need help processing, ask your provider for recommendations on mental health professionals who can provide support.

How soon after a medical abortion can you have sex?

Wait at least two to three weeks to have intercourse after a medical abortion. This is to prevent vaginal infections. You shouldn’t insert anything into your vagina during this time, including tampons.

When can you get pregnant again after a medical abortion?

You’ll be able to get pregnant again within two weeks after the abortion. Your normal menstrual cycle should return within four to six weeks after a medical abortion — although your first period may be slightly irregular because of hormonal changes related to the procedure.

Medical abortion shouldn’t affect future pregnancies unless there were complications.

When should I call my healthcare provider?

Work closely with your healthcare provider throughout the process of your medical abortion. Ask any questions you have to ensure you understand what’s involved during the procedure and after.

Contact your healthcare provider if any of the following occur afterward:

• No bleeding 24 hours after taking misoprostol.
• Severe bleeding — soaking more than two thick pads within an hour.
• Signs of an infection (fever that lasts more than 24 hours and foul-smelling vaginal discharge).
• Severe abdominal or back pain.
• You don’t get your period after two months.
• You have symptoms of pregnancy.

A note from Cleveland Clinic

Medical abortions are a safe and effective way to end a pregnancy. The decision to have one is highly personal. If you need this procedure, know that you’re not alone in the process. Your healthcare provider can guide you so you understand exactly what’s involved before, during and afterward. They can connect you with resources you may need to process any emotions you’re feeling throughout the experience. Your healthcare team is there to make sure you’re comfortable and receiving the care you need.