A medical abortion is commonly known as abortion with pills. Some people also refer to this method as self-induced abortion, self -managed abortion or do-it-yourself (DIY) abortion.
If you use abortion pills you will experience bleeding and possibly cramping. The symptoms are very similar to your menstrual period and a miscarriage (natural abortion).
There are two methods to have an abortion with pills: using Mifepristone and Misoprostol or using only Misoprostol.
Mifepristone is a medication that blocks the flow of progesterone which is a hormone that develops the pregnancy. Without progesterone the product of the pregnancy cannot grow. Mifepristone also softens the cervix (inferior part of the uterus) which will intensify Misoprostol’s effect. Consider that using only Mifepristone is not enough to cause an abortion, you need to use Misoprostol too.
Misoprostol is a medication that causes the uterus to move (contractions). This movement expels the pregnancy along with blood. You can use Misoprostol without Mifepristone, but it is more effective to use both medications.
Mifepristone and Misoprostol are listed as essential medications according to the World Health Organization and they are indicated for safe abortion.
Are abortion pills safe for me?
Medical abortion is safe for the majority of women. There are only a few medical conditions and treatments that can be a contraindication to use abortion pills.
- If you have been using long term steroids such as Prednisone or Dexamethasone it is not recommended that you use Mifepristone, but you can have an abortion with Misoprostol only.
- If you use anticoagulants such as Heparin and Warfarin.
- If you have a bleeding disorder such as Porphyria.
- If you are allergic to Mifepristone, Misoprostol or prostaglandins abortion with pills is not recommended. The only way to know if you are allergic is if you have used these before and had an allergic reaction. It is impossible to know before using the pills if you will be allergic or not.
- If you have an ectopic pregnancy (outside the uterus) abortion pills will not harm you, but they will not terminate the pregnancy. If you know you have an ectopic pregnancy you need medical care to safely induce an abortion.
Abortion Pills are safe:
- If you have an IUD (intra-uterine device) you can have a medical abortion safely and effectively, however you may feel more pain. If possible, it is recommended to get it removed before using abortion pills.
- If you have had a vaginal delivery or c-section before.
- If you have had a surgical or medical abortion before.
If you are not sure if abortion pills are safe for you, contact us! We can help you determine if this method is for you.
Remember safe2choose is only trained to support women who will use abortion pills in the first 10 weeks of pregnancy. If your pregnancy is more advanced, we will do our best to refer you to another organization that is properly trained to support you.
How many abortion pills do I need?
It is important you buy the recommended dose of pills. If you do not use the correct amount the abortion may not be successful.
The number of pills you need depends on which method of medical abortion you will be using. If you are 10 weeks pregnant or less you need:
12 pills of Misoprostol (200 mcg each one)
1 pill of Mifepristone (200 mg each one) and 4 pills of Misoprostol (200 mcg each)
It is very important for you to know that the number of pills do not change according to your weeks of pregnancy as long as you are in the first 10 weeks of pregnancy. This means, for example, that a woman who is 4 weeks pregnant needs the exact same amount as a woman who is 9 weeks pregnant.
What should I expect during an abortion with pills?
As we mentioned, after using abortion pills you will have symptoms similar to a menstrual period or a miscarriage.
Mifepristone usually does not cause any visible symptom. This means that if you take it but do not see any changes, it is perfectly normal. Symptoms will appear after using Misoprostol.
It is imposible to know beforehand how much time after Misoprostol you will begin to feel symptoms, as they can take some minutes or several hours to appear. Most women feel cramps and all should experience bleeding. The most intense symptoms occur anytime during the first 24-48 hours after using Misoprostol.
During a medical abortion, a bleeding as abundant as your menstrual period or more is expected. This can lasts several hours. Some women (not all) expel blood clots too. After the first heavy bleeding, your blood flow will decrease, but can continue, coming and going, for several days or even weeks after. The bleeding will decrease as time goes by until it disappears. If abortion pills worked, the pregnancy will be terminated in a couple of days, but the bleeding afterwards means your body is expelling all the tissues in your uterus. Once it finishes, the abortion is complete.
Misoprostol can cause temporary side effects such as fever, diarrhea, nausea / vomiting, headache and/or chills. If you do not experience any of these side effects it is perfectly normal. If you do, these will disappear in the next 48 hours or less. Contact us to know how to manage side effects.
We recommend you take 800 mg of Ibuprofen 1 hour before using the Misoprostol pills. Ibuprofen is much more effective when you take it before you start to feel pain as oppose to taking it when you start to feel pain. This medication will also help you manage the side effects. Using Ibuprofen will not decrease the efficacy of the procedure.
After this, you may take additional doses of 400 mg every 3 hours depending on how strong the pain is. Do not exceed 3200 mg of Ibuprofen in 24 hours.
If you cannot use Ibuprofen contact us so we can recommend other safe alternatives.
How do I know if abortion pills worked?
If you used high quality medication according to the recommended instructions and you had a bleeding as abundant as your menstrual period or more for several hours, it is very likely the abortion was successful. If you had pregnancy symptoms, they tend to disappear around 5 days after using abortion pills. If pregnancy symptoms decrease and go away, this is another good indication that the abortion pills worked.
If 48 hours have passed after you used the last dose of Misoprostol and you have not bled or your bleeding is a much less amount than your period it is likely the abortion is not happening. In most cases it is possible to try again with abortion pills. Contact us if this is your case so we can support you.
If you had the expected symptoms of a medical abortion it is not necessary to use any test to confirm that you are no longer pregnant. However, if you prefer to do it consider the following information:
- Blood and urine tests will continue to be positive at least 4 weeks after using abortion pills even if the pregnancy was terminated.
- An ultrasound can confirm whether you are still pregnant (if the embryo is still in your uterus) or not. In many cases, even if you are not pregnant anymore they will incorrectly suggest you use more medication or have a surgical intervention to remove all the tissue in your uterus. This is not necessary because most often the uterus is capable of expelling all the tissues naturally on its own. Remember an abortion with pills can take around 2 weeks or more to complete itself so having remaining tissue in the uterus during this time is normal.
Contact us if you are not sure if your abortion is evolving normally.
Do I need medical care after using abortion pills?
If your symptoms are as expected and you do not have any warning signs, you do not need to get medical care. In addition, it is not necessary to get a pregnancy test or an ultrasound afterwards, nor is it necessary to have a surgical intervention such as a D&C.
If you have one of the following symptoms, this is considered a warning sign that you might be experiencing a complication and you should immediately seek medical attention :
- If you fill two pads or more (completely soaked front to back, side to side) in 1 hour or less and this last for 2 hours or more.
- A fever of 38 degrees Celsius (100.4 degrees Fahrenheit) that does not decrease after taking Ibuprofen. (If you think you have a fever always confirm with a thermometer.)
- A fever of 38 degrees Celsius (100.4 degrees Fahrenheit) that does not decrease 12 hours after using Misoprostol. (If you think you have a fever always confirm with a thermometer.)
- Pain that does not get better after taking Ibuprofen.
- The color or smell of your blood is very different from your regular period or has a bad smell.
- If you have redness, itchiness or swollen hands, neck and face it is likely you are having an allergic reaction to the medications. You can use an antihistaminic, but if you find it difficult to breathe then the allergic reaction is very serious and you need medical care immediately.
It is important to understand that medical staff has no way of knowing you used Mifepristone or Misprostol if you used them how we recommend.
It is equally important to know that complications from an abortion with pills are the same exact complications that one could experience due to a miscarriage (spontaneous or natural abortion). This means that it will seem as if you are having a miscarriage and they should treat you for that. Even though they will not know you used the pills, they will know that you were pregnant.
When will my menstrual period return after an abortion?
During an abortion (surgical or medical) your cycle will restart, as if you have had your menstrual period. You will ovulate again approximately 10 days afterwards. This means that you can get pregnant again if you have sex.
Your next period can come back in approximately 4 to 6 weeks after using abortion pills.
- “Safe abortion: technical and policy guidance for health systems.” World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/70914/;jsessionid=B7AEEBE4F34809D869F73B1ABA7F6221?sequence=1
- “Clinical updates in reproductive health.” Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf
- “Providing medical abortion in low-resource settings: An introductory guidebook. Second edition.” Gynuity. https://gynuity.org/assets/resources/clinguide_maguide2nd_edition_en.pdf
- “Self-management of medical abortion: a
qualitative evidence synthesis.” Reproductive Health Matters. https://www.tandfonline.com/doi/pdf/10.1016/j.rhm.2016.06.008?needAccess=true
- “Is self-use of medical abortion a viable option? A systematic review of global evidence with a special focus on India.” Ipas Development Foundation.
- “Safety of Medical Abortion Provided Through Telemedicine Compared With In Person.” Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; and Ibis Reproductive Health. https://www.ncbi.nlm.nih.gov/pubmed/28885427
- “Right to sexual and reproductive health indivisible from other human rights – UN experts”. UN Human Rights. https://www.ohchr.org/EN/AboutUs/Pages/WhoWeAre.aspx
- “Is access to abortion medicines a human right?” AidAccess. https://aidaccess.org/en/page/543/is-access-to-abortion-medicines-a-human-right
- “Medication Abortion.” Guttmacher Institute. https://www.guttmacher.org/state-policy/explore/medication-abortion