The Abortion Pill: How Medication Abortions Work
Abortion pills, scientifically known as mifeprex (mifepristone) and misoprostol, can medically terminate a pregnancy. Medication abortions are often the go-to method during the first trimester. "Reasons someone might choose a medication abortion include wanting to avoid a procedure in the clinic with more instrumentation, or the desire to complete the abortion at home or in a more private space," explains Rebecca Taub, M.D., a fellow with Physicians for Reproductive Health and an Ob-Gyn in Washington.
Here's everything you need to know about how abortion pills work and what to expect when you undergo a medication abortion.
What Is the Abortion Pill?
According to the U.S. Food and Drug Administration (FDA), women can safely use mifeprex and misoprostol during the first 70 days of pregnancy. More specifically, the abortion pills can be taken within 10 weeks of the missed menstrual period. The FDA has approved a Risk Evaluation and Mitigation Strategy (REMS) for the medication, meaning it should be taken under supervision of a qualified healthcare provider, clinic, medical office, or hospital.
According to the FDA, you might not be a candidate for the abortion pill if you're anemic, you're taking medication for a blood-clotting condition, you have an IUD, or the pregnancy is older than 10 weeks. You should also avoid abortion pills if you're experiencing an ectopic pregnancy, in which the fetus grows outside of the uterus.
How To Take Abortion Pills
So how does the abortion pill work? First, your healthcare provider will conduct blood or urine tests to confirm the pregnancy, if you haven't already done so. Then she will perform a medical exam and ultrasound to make sure the pregnancy isn't ectopic. Finally, she'll explain the medication abortion procedure and give written instructions. "But these details differ based on where you live and your doctor, so please consult your medical provider to get the specifics," advises Dr. Taub.
Two separate pills are required for a medication abortion: mifeprex (mifepristone) and misoprostol.
Mifeprex: The first dose is 200 mg of mifeprex taken orally. Mifeprex blocks the pregnancy hormone progesterone, which is needed to support healthy gestation. The pill causes the lining of the uterus to thin and shed.
Misoprostol: Within 72 hours, you'll take 800 mcg of misoprostol buccally (in the cheek). Misoprostol stimulates uterine contractions to expel the embryo and gestational sac, thus ending the developing pregnancy.
Many women take mifeprex in the clinic and misoprostol at home, although this varies according to preference and state law. You might also be given antibiotics to prevent infection. Pregnancy should terminate within a few days of taking misoprostol.
About two weeks after taking abortion pills, you'll return to your healthcare provider for a follow-up visit. An incomplete abortion may lead to infection, so it's important to get checked out. Those with a failed abortion may need to take another dose of abortion pills. Alternately, you might need to undergo an in-clinic surgical abortion, which is especially likely if the pregnancy is beyond 10 weeks old. Surgical procedures include manual vacuum aspiration (MVA) and dilation and evacuation (D&E).
How Effective is the Abortion Pill?
The abortion pill is about 94-98% effective in the first eight weeks of pregnancy, meaning it fails about two to six out of 100 times, according to Planned Parenthood. Medication abortions also becomes less successful as a pregnancy progresses. For example, they're about 95% effective eight to nine weeks into the pregnancy and 92% effective nine to ten weeks into the pregnancy.
Abortion Pill Side Effects
How long do you bleed after abortion pill, and what are the common side effects? The first pill, mifeprex, doesn't usually cause symptoms, although light bleeding and nausea are possible. On the other hand, misoprostol creates intense side effects as the embryo expels from the body.
Within a few hours of taking misoprostol, you'll experience bleeding that resembles a heavy period – usually accompanied by large clots that can reach the size of a lemon, according to Planned Parenthood. The bleeding will probably last four or five hours. You may also get cramping, nausea, abdominal pain, fatigue, dizziness, diarrhea, or mild fever. Anti-nausea medication and ibuprofen may help control these abortion pill side effects.
Most people feel better within a few days of taking abortion pills. However, a small percentage report more serious symptoms. The main concern is an incomplete abortion, which may lead to infection. Rarely, women may experience blood clots in the uterus, extremely heavy bleeding, or an allergic reaction.
Call your doctor immediately if you have super-heavy bleeding (soaking through more than two pads in two hours) or no bleeding 24 hours after taking the second abortion pill. Also let your doctor know about blood clots that last for more than a few hours, high fever (greater than 100.4 degrees), and abdominal issues that extend past 24 hours of taking the pill.
Recovering After the Abortion Pill
Your menstrual period should return within two months of pregnancy termination. You'll probably need to abstain from sexual intercourse for one or two weeks, and you might be advised against using tampons. Mifeprex and misoprostol won't affect your future fertility or pregnancies.
Women may experience a wide range of emotions after taking the abortion pill, including relief, guilt, anger, sadness, and more. All of these responses are normal. Speak to your doctor or a mental health professional for help sorting through these emotions.
How to Get Abortion Pills
State laws vary in regards to the abortion pill. In states that allow medication abortion, you'll need to visit a clinic like Planned Parenthood, an Ob-Gyn office, or your healthcare provider. You don't necessarily need to be 18 years old to get a medication abortion, although parental consent is required in many states. Contact your local Planned Parenthood for more information about where to get the abortion pill, or visit websites like the Safe Place Project.
How Much Does the Abortion Pill Cost?
The cost of the abortion pill varies based on region, medical office, and your health insurance plan. Women can expect to pay anywhere from $300 to $1,000 for a round of pills.
Is Plan B an Abortion Pill?
Even though they're both taken after sex, the abortion pill isn't the same as emergency contraception (also known as the morning-after pill or Plan B). The abortion pill is taken once conception already occurred, and it terminates an existing pregnancy. Plan B is taken within 72 hours of having unprotected sex, and it stops a pregnancy from forming in the first place.