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Ending pregnancy with medicines

Abortion pill

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More About Medication Abortion

Some women prefer the use of medicines to terminate a pregnancy because:

• It may be used in early pregnancy.
• It may be used at home.
• It feels more natural, like a miscarriage.
• It is less invasive than an in-clinic abortion.

Medicines can be used to end an early pregnancy. In many cases, the first day of your last period must be less than 11 weeks ago. If you are over 11 weeks pregnant, you may need to have an in-clinic abortion. Some clinics will go beyond 11 weeks for a medicine abortion.

Be very certain that you want to end your pregnancy. It is not safe to stop the medicines once you have started taking them. Doing so creates a very high risk for severe birth defects.

Who Should Not Have a Medication Abortion

You should not have a medication abortion if you:

• Are over 11 weeks pregnant (time since the start of your last period).
• Have a blood clotting disorder or adrenal failure.
• Have an IUD. It must be removed first.
• Are allergic to the medicines that are used to end pregnancy.
• Take any medicines that should not be used with a medication abortion.
• Do not have access to a health care provider or an emergency room.

Getting Ready for a Medication Abortion

The provider will:

• Do a physical exam and ultrasound
• Go over your medical history
• Do blood and urine tests
• Explain how the abortion medicines work
• Have you sign consent forms

What Happens During a Medication Abortion

You may take the following medicines for the abortion:

• Mifepristone - this is called the abortion pill or RU-486
• Misoprostol
• You will also take antibiotics to prevent infection

Often, you will take mifepristone in the provider's office or clinic but some providers may allow you to take it at home. This stops the hormone progesterone from working. The lining of the uterus breaks down so the pregnancy cannot continue.

The provider will tell you when and how to take the misoprostol. It will be about 6 to 72 hours after taking mifepristone. Misoprostol causes the uterus to contract and empty.

After taking the second medicine, you will feel a lot of pain and cramping. You will have heavy bleeding and see blood clots and tissue come out of your vagina. This most often takes 3 to 5 hours. The amount will be more than you have with your period. This means the medicines are working.

You may also have nausea, and you may vomit, have a fever, chills, diarrhea, and a headache.

You can take pain relievers such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to help with the pain. Do not take aspirin. Expect to have light vaginal bleeding for up to 4 weeks after a medication abortion. You will need to have pads to wear. Plan to take it easy for a few weeks.

You should avoid vaginal intercourse for about a week after a medication abortion. You can get pregnant soon after an abortion, so talk with your provider about what birth control to use. Make sure you are using an effective contraception before you resume sexual activity. You should get your regular period in about 4 to 8 weeks.

Follow up with Your Health Care Provider

Make a follow-up appointment with your provider. You need to be checked to make sure the abortion was complete and that you are not having any problems. In case it did not work, you will need to have an in-clinic abortion.

Risks to Ending Pregnancy with Medicine

Most women have a medication abortion safely. There are a few risks, but most can be treated easily:

• An incomplete abortion is when part of the pregnancy does not come out. You will need to have an in-clinic abortion to complete the abortion.
• Heavy bleeding
• Infection
• Blood clots in your uterus

Medication abortions are typically very safe. In most cases, it does not affect your ability to have children unless you have a rare serious complication.

When to Call the Doctor

Serious problems must be treated right away for your safety. Call your provider if you have:

• Heavy bleeding - you are soaking through 2 pads every hour for 2 hours
• Blood clots for 2 hours or more, or if the clots are larger than a lemon
• Signs that you are still pregnant

You should also call your provider if you have signs of infection:

• Bad pain in your stomach or back
• A fever over 100.4°F (38°C) or any fever for 24 hours
• Vomiting or diarrhea for more than 24 hours after taking the pills
• Bad smelling vaginal discharge

References

The American College of Obstetricians and Gynecologists website. ACOG guide to language and abortion. www.acog.org/contact/media-center/abortion-language-guide. Updated September 2023. Accessed April 2, 2024.

Lesnewski R, Prine L. Pregnancy termination: medication abortion. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 114.

Mullins EWS, Regan L. Women's health. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clarke's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 39.

Rivlin K, Davis AR. Contraception and abortion. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

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Review Date: 4/1/2023  

Reviewed By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 04/05/24.

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