The Abortion Pill: How Medication Abortions Work

How does the abortion pill work? Where can I get the abortion pill? Is it the same thing as Plan B? We've broken down the answers to your most commonly asked questions. 

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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, 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 the 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 they will perform a medical exam and ultrasound to make sure the pregnancy isn't ectopic. Finally, they'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 people 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).

Methotrexate with vaginal misoprostol: Methotrexate is not a commonly used medication for elective abortions, however, it is used for ectopic pregnancies. It must be used within seven weeks from the first day of the last period and can take upwards of a month to complete the abortion. Typically, the methotrexate is given as a shot or vaginally in a clinical setting and then the vaginal misoprostol is taken in the privacy of one's home.

Vaginal misoprostol: Vaginal misoprostol can be given on its own, but it is only effective during the first nine weeks of pregnancy. After nine weeks of gestation, vaginal misoprostol becomes less effective.

How Effective is the Abortion Pill?

The abortion pill (mifepristone and misoprostol) 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 become less successful as pregnancy progresses. For example, they're about 95% effective eight to nine weeks into the pregnancy and 92% effective 9 to 10 weeks into the pregnancy.

Methotrexate with vaginal misoprostol is 90% effective if taken within 49 days of gestation.

Abortion Pill Side Effects

How long do you bleed after the 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, people 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.

Some people 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.

It is important to check your local state laws on abortion. There are currently 13 states that have "trigger laws" in place that would automatically outlaw abortion if the US Supreme Court overturns the landmark Roe v. Wade case that gives citizens the right to an abortion. Those states currently include Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming.

As each state is different, making abortion illegal at a state level will impact patients in different ways. For example, in some states, it may become illegal to obtain medication abortion pills through the mail. In other states, it may become illegal to leave the state to obtain an abortion in a state where abortion is legal.

How Much Does the Abortion Pill Cost?

The cost of the abortion pill varies based on region, medical office, and your health insurance plan. In 2017, the national mean for a medication abortion was $551 for the first trimester and $1,670 for the second trimester. The cost range was as low as $549 and as high as $5,386, but the average was in the $500 range.

As the political landscape around abortion becomes more volatile, issues around access and cost may quickly change. It is important that you check your insurance coverage for any updates in coverage.

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.

If you choose to use Plan B as an option, it is important to understand that as abortion laws quickly change around the US, access to Plan B may also change depending on where you live. Check your local state laws and talk to your doctor about how to access this safe contraceptive.

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