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The abortion pill: What to expect
There are two main ways abortion can be done: the abortion pill (also called medication abortion) and an abortion procedure (also called in-clinic abortion). Whether you have a medication abortion or an abortion procedure will depend on how far along you are in pregnancy, what the provider you choose offers, and also your own preference. We have more information about how to decide between these two types of abortion.
May be offered through around 14 weeks of pregnancy
The abortion pill is generally available earlier in pregnancy. Each provider will have their own rules about how far along in pregnancy they’ll offer it–some will offer it through around 14 weeks of pregnancy and others will stop offering it much earlier in pregnancy. Later on in pregnancy, your only option will be the abortion procedure.
You can get abortion pills from most in-person abortion providers. You can also get abortion pills online using telehealth. Depending on where you live, there may be some legal risk in getting abortion pills online.
For free and confidential legal information about getting pills online, contact the Repro Legal Helpline. Plan C also has more information about getting and using abortion pills.
Medication abortion is often called the abortion pill, but in reality, it’s not just one pill. And there are multiple ways to use abortion pills to have an abortion. Depending on availability and other factors, you may take two different medications (mifepristone and misoprostol) or only one type of medication (just misoprostol) for a medication abortion.
How does taking the abortion pill work?
Mifepristone and misoprostol medication abortion regimen
If you’re having a medication abortion using two different medications (mifepristone and misoprostol), here’s how it usually works when you get them from an in-person provider:
Step 1: Counseling, maybe an ultrasound, and maybe a waiting period
First you’ll fill out some paperwork. You’ll talk with a health care provider, and you may have an ultrasound to find out or confirm how far along you are in your pregnancy. If you are further along in pregnancy, then medication abortion may not be an option for you.
If the state where you’re getting your abortion has a mandatory waiting period, you’ll have to wait some number of hours between the counseling appointment and the appointment when you’ll take the first medication. If there is a waiting period, and you are going to have to travel a long way for your abortion, ask if virtual counseling is an option when you call to make your appointment.
Step 2: Get the medication at a health center
Your health care provider will give you both medications and explain when and how you'll take them.
The first medication is called mifepristone. Mifepristone blocks the hormone progesterone. Because progesterone is necessary for pregnancy to continue, blocking it starts the process of ending the pregnancy. Mifepristone doesn’t usually cause any symptoms, so you probably won’t feel anything after you take it. Your provider may have you take the mifepristone at the health center, or you may take it at home or somewhere safe.
Your provider will give you the second medication. Usually, you’ll get it when you get the mifepristone, but you may have to go back to the provider to get it. Make sure to follow the instructions the provider gives you because they may differ from one provider to the next.
Step 3: Take the second medication up to 48 hours later
Up to 48 hours after taking mifepristone, you’ll take a dose (which is usually four tablets) of the second medication, called misoprostol.
For this step, you need to be somewhere you can relax and where you’ll have easy access to a bathroom. Misoprostol empties your uterus, expelling the pregnancy. It causes cramping and bleeding.
There are a few different ways to take misoprostol: you can take it orally, by swallowing the pills; you can take it vaginally, by putting the pills inside your vagina; you can take it sublingually, which means that you place the pills under your tongue and let them dissolve; or you can take it buccally, which means putting the pills in your mouth between the inside of your cheek and your gum and letting them dissolve there.
You may take one or more doses of misoprostol depending on how far along you are and how your body responds to the first dose—your provider will let you know. Misoprostol starts working about 30 minutes to a few hours after you take it. When it kicks in, it’s normal to experience bleeding. The bleeding could range from medium to very heavy. You will likely pass some blood clots. You’ll also likely have cramps, which can be severe. You may experience diarrhea or vomiting, and you may also have a mild fever on the day you take the misoprostol.
Your provider may also prescribe anti-nausea medicine for you to take before you take the misoprostol.
You can take over-the-counter pain medication, or your health care provider may prescribe a prescription-strength pain medication. But after a few hours, the symptoms will usually pass. Bleeding will decrease over the next few days. You can go back to work, school, taking care of your kids, or your other normal activities the next day. You can have sex again as soon as you’re ready.
You should get your next period within eight weeks of having a medication abortion. If it’s been eight weeks or longer since your abortion, and you haven’t had a period, contact your abortion provider. You can also contact your abortion provider sooner if you think you may still be pregnant.
It is possible to get pregnant again within two weeks of having the abortion, meaning that you may be able to get pregnant again before you get your next period.
Some health care providers will recommend a follow-up appointment a few weeks after your medication abortion to make sure the pregnancy is over. This appointment could take place via telehealth, a phone call, or in person, depending on the provider.
Misoprostol-only medication abortion regimen
If you’re having a medication abortion using only one medication (misoprostol), the steps are a little different:
Step 1: Counseling, maybe an ultrasound, and maybe a waiting period
First you’ll fill out some paperwork. You’ll talk with a health care provider, and you may have an ultrasound to find out or confirm how far along you are in your pregnancy. If you are further along in pregnancy, medication abortion may not be an option for you.
If the state where you’re getting your abortion has a mandatory waiting period, you’ll have to wait some number of hours between the counseling appointment and the appointment when you’ll get the medication. If there is a waiting period, and you are going to have to travel a long way for your abortion, ask if virtual counseling is an option when you call to make your appointment.
Step 2: Take the pills
There are a few different ways to take misoprostol: you can take it orally, by swallowing the pills; you can take it vaginally, by putting the pills inside your vagina; you can take it sublingually, which means that you place the pills under your tongue and let them dissolve; or you can take it buccally, which means putting the pills in your mouth between the inside of your cheek and your gum and letting them dissolve there. You will take several doses of misoprostol. You may take some doses one way and other doses in a different way.
Different providers may give different instructions, so make sure to read any instructions that are given to you. Most likely, you will take four pills three times, every three hours. So, for example, if you take the first dose of four pills at noon, you’d take the second dose of four pills at 3 pm and the third dose of four pills at 6 pm. You’ll be taking a total of 12 pills over the course of six hours. Your provider may also tell you to take a fourth dose. It’s important to take all of the pills that your provider tells you to take to end the pregnancy.
With a misoprostol-only medication abortion, bleeding will probably start within four hours of taking the first dose. It may be heavy. You may have very strong cramping and pass large blood clots. Some side effects of the medication may include nausea, vomiting, diarrhea, chills, back pain, headache, dizziness, and feeling tired. You may also have a mild fever on the day you take the pills.
You may keep feeling nauseated and tired for a couple of days after you pass the pregnancy. The bleeding should get lighter after you pass the pregnancy, but it may continue for four to six weeks. It may stop and start. Any cramping should also get better over time.
To help with the cramping and other pain, you can take over-the-counter pain medication, or your health care provider may prescribe a prescription-strength pain medication. Your provider may also prescribe anti-nausea medicine for you to take before you take the first dose of misoprostol.
You will need to rest all day on the day you pass the pregnancy. The day after your abortion, you can go back to work, school, taking care of your kids, or your other normal activities if you feel well enough, but don’t do hard physical labor or heavy exercise for a few days. You can have sex again as soon as you’re ready.
After your abortion, you should get your period within eight weeks. It’s possible to get pregnant again within two weeks of having the abortion, meaning that you may be able to get pregnant again before you get your next period.
Some health care providers will recommend a follow-up appointment a few weeks after your medication abortion to make sure the pregnancy is over. This appointment could take place via telehealth, a phone call, or in person, depending on the provider. You may get an ultrasound, a blood test, or a different kind of pregnancy test.
How much does an abortion with the abortion pill hurt?
Just like with the abortion procedure, how much an abortion with the abortion pill hurts varies from person to person. For some people it may be similar to a heavy period and for others it may be more intense. The pain may last longer with the abortion pill than it does with the abortion procedure, as the abortion itself takes longer to be completed with pills than the procedure, which usually takes just a few minutes. If you get a medication abortion, the pain may last for several hours. The cramping should get lighter after the pregnancy is passed, how long that takes is different for different people and may last longer with a misoprostol-only medication abortion. You can take over-the-counter pain medications or your provider may prescribe pain medication for you to take at home. In addition to pain medicine, you may find that using a heating pad reduces pain. Other techniques like breathing exercises and meditation can also help with pain.
For more help deciding between the pill and the procedure, check out our list of pros and cons for each abortion type.
When should you contact your abortion provider after taking the abortion pill?
Your abortion provider should give you information about when and how to contact them after an abortion, but if they don’t, ask them for emergency contact information and for a list of things to watch out for.
Always reach out to your provider if something doesn’t feel right to you after an abortion or if you have questions or concerns. If you're not able to reach your provider, call or text the M+A Hotline.
Common side effects of medication abortion
Mifepristone and misoprostol medication abortion regimen
Within 24 hours after you take the second medication (misoprostol), it’s normal to experience the following side effects:
Cramping
Bleeding
Fever and chills on the day you take the misoprostol
Nausea, vomiting and/or diarrhea
If you’re having a medication abortion using only one medicine (misoprostol)
It is normal to experience:
Cramping, which may continue for days
Bleeding, which can go on for up to 6 weeks, may stop and start, and can be as heavy as a period for a week or two after the abortion
Fever and chills on the day you take the misoprostol
Nausea, vomiting, and/or diarrhea
Dizziness
Headache
Back pain
Feeling tired for a day or two
What to look out for
If you are having a medication abortion using two different medicines (mifepristone and misoprostol), and it’s been more than 24 hours since you took your last dose of medication, contact your abortion provider if you are experiencing any of the following:
No bleeding yet
Passing blood clots bigger than the size of a lemon
Excessive bleeding (This means soaking two pads per hour for two hours in a row. Keep in mind that it's normal for bleeding to be heavy and for you to pass blood clots. But if you’re worried about the amount of bleeding you’re having, you can always contact your abortion provider.)
Fever higher than 100.4 F
Chills
Nausea, vomiting, or diarrhea
Pain that is getting worse or that isn’t going away with over-the-counter painkillers
If you’re having a medication abortion using only one medicine (misoprostol), contact your abortion provider if you are experiencing any of the following:
Passing blood clots bigger than the size of a lemon
Excessive bleeding (This means soaking two pads per hour for two hours in a row. Keep in mind that it is normal for bleeding to be heavy. But if you’re worried about the amount of bleeding you’re having, you can always contact your abortion provider.)
Stomach pain or cramps that don't feel better when you take a pain reliever
No bleeding yet if it's been 24 hours since you took your last dose of the medicine
Fever higher than 100.4 F if it’s been more than 24 hours since you took your last dose of the medicine
Weakness, nausea, vomiting, or diarrhea that lasts longer than 24 hours after you took your last dose of the medicine
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