Abortion with Pills: Preparation, risk, effectiveness, and everything you need to know

Medical abortion

The abortion pill, also known as abortion medication or a medical abortion, refers to the use of two separate medications to terminate a pregnancy: Mifepristone and Misoprostol.

It is the intentional termination of pregnancy (abortion) caused by drugs and is performed until the 77th day of pregnancy (13 weeks) – counted from the first day of the last menstrual period.

The first medication (Mifepristone) terminates the pregnancy. Then, a second medication (Misoprostol) is used to expel the contents from the uterus.

There is also another method for an abortion with pills, which consists of taking Misoprostol alone.

What type of evaluation is needed before an abortion with pills?

Most people do not need any medical evaluation prior to an abortion with pills. If you know the date of your last menstrual period (LMP) and your pregnancy test is positive, it is safe to proceed with abortion pills. Some things that may be done to prepare include:

  • a urine pregnancy test;
  • a blood pregnancy test;
  • an ultrasound to confirm the gestational age of the pregnancy or to exclude the possibility of an ectopic pregnancy; and
  • a physical exam by a clinician.

How do I start the abortion with pills?

You begin by taking a medication called Mifepristone. The hormone progesterone is needed for a healthy pregnancy to develop. Mifepristone blocks progesterone at the uterus and thus stops the pregnancy from growing.

The second medication, Misoprostol, is taken up to 48 hours later. This medication causes menstrual cramping and bleeding to empty the uterus. It’s like having a very heavy period with cramping, and the process is very similar to a miscarriage. Misoprostol should cause bleeding within 24 hours of using it, and if this does not occur, sometimes, it will require a follow-up with a clinician.

Why do women use abortion pills?

The abortion method you choose depends entirely on your preferences and circumstances. Abortion pills allow you to manage the process in the comfort of your own home. You also have the option to have a support person with you or to go through the process alone. Because of the similarity between abortion with pills and a miscarriage, many consider it more “natural” and less intrusive.

safe2choose counselors can help you determine which type of abortion is right for you.

How effective is abortion with pills?

Medication abortion is very effective. When Mifepristone is combined with Misoprostol, 95% of people will have a successful abortion. When Misoprostol is used alone, 85% will have a successful abortion.

What are the contraindications?

If you have any of the following conditions, you will not be eligible to use abortion pills:

  • a pregnancy outside the uterus (ectopic);
  • inactive adrenal glands (adrenal insufficiency);
  • a genetic blood disease called porphyria;
  • bleeding disorders or if you’re taking blood-thinning medication that makes it difficult for your body to stop bleeding;
  • long-term use of corticosteroids (such as asthma pumps or prednisone pills);
  • severe red blood cell deficiency (severe anemia);
  • known sensitivity or allergy to any of the drugs used for abortion; and
  • poorly managed kidney or liver disease.

What should you expect during and after an abortion with pills?

How you feel during and after an abortion depends on the individual. On the day you take your second pill, you should plan to rest and be in a comfortable environment. You may feel tired for a day or two, but you should quickly return to normal.

If you feel up to it, you can return to work, school, driving, and most other routine activities the next day. However, avoid strenuous activity for several days. You should begin to feel better as the days go by, but if you continue to feel unwell, contact your doctor or health-care facility.

Over the hours and days following a successful abortion, the discomfort and bleeding should improve. Your pregnancy symptoms (breast tenderness, nausea, fatigue) should gradually improve as well if the pills were successful.

Side effects from the medications, including chills, fever, and nausea, should go away fairly quickly. If you have nausea, vomiting, diarrhea, or fever for more than 24 hours after taking Misoprostol, contact a clinician immediately. This may be a sign of infection.

For mothers who are breastfeeding, the drugs in the abortion pill can pass into breast milk. However, these are often amounts that should not affect your newborn. If you are breastfeeding, you may want to talk to your clinician, who can help you decide what is best for you and your baby.

What steps should be taken after an abortion?

  • Normal menstruation should resume four to six weeks after treatment.
  • Your period may be heavier or clots may form.
  • For one week, use sanitary pads instead of tampons (or a menstrual cup).
  • Do not douche (you should never douche anyway).
  • You can return to sexual activity if and when you are feeling ready. Keep in mind, it is possible to get pregnant right away after a medication abortion.

Are there any long-term side effects?

The abortion pill is indeed effective and safe. It is an extremely common method of abortion, and millions of women have used it safely.

There is no risk to your future pregnancies or your overall health unless you develop a rare and serious untreated condition. Abortion does not increase the risk of developing breast cancer or impair fertility. It does not cause birth defects, premature birth, low birth weight, ectopic pregnancy, miscarriage, or infant mortality in subsequent pregnancies.

Serious, long-term mental problems following abortion are as rare as those following childbirth. They are more likely to occur in women who need to terminate their pregnancy for health reasons, in those who are not supported in their decision to have an abortion, and in those who have a history of mental health problems. The majority of people experience relief after an abortion.

There are many misconceptions about the impact of abortion. Your clinician or our counselors can provide you with reliable information about the side effects of the abortion pill and any other concerns or questions you may have.

  1. “Ending Pregnancy with Medications.” Mount Sinai, www.mountsinai.org/health-library/special-topic/ending-pregnancy-with-medications. Accessed July 2023.
  2. Harris, N. “The Abortion Pill: How Medication Abortions Work.” Parents, 2022, www.parents.com/pregnancy/everything-pregnancy/the-abortion-pill-what-you-need-to-know-about-medical-abortions/. Accessed July 2023.