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Ending pregnancy with medications

Abortion pill

Information

More About Medical Abortion

Some women prefer medical abortions because:

  • You can use it with an early pregnancy.
  • You can do it 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 has to be less than 9 weeks ago. If you are over 9 weeks pregnant, you can have an in-clinic abortion. Some clinics will go beyond 9 weeks for a medication abortion.

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

Who Should Not Have a Medical Abortion

You should NOT have a medication abortion if you:

  • Are over 9 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 medical abortion.
  • Do not have access to a doctor or an emergency room.

Getting Ready for a Medical Abortion

The health care 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 forms

What Happens During a Medical Abortion

You will take 2 medicines for the abortion:

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

You will take Mifepristone in the health care provider's office or clinic. 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 usually 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 bleed for up to 4 weeks after a medical 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 medical abortion. You can get pregnant soon after an abortion, so talk with your health care provider about what birth control to use. 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 health care 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 medical 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

Medical abortions do not usually affect your ability to have children unless you have a serious complication.

When to Call the Doctor

Serious problems must be treated right away for your safety. Call your health care 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 doctor 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

Jensen J, Michell DR. Family planning. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 13.

Lesnewski R, Prine L. Pregnancy termination. In: Pfenninger JL, Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap. 128.

Oppegaard KS, Qvigstad E, Fiala C, Heikinheimo O, Benson L, Gemzell-Danielsson K. Clinical follow-up compared with self-assessment of outcome after medical abortion: a multicentre, non-inferiority, randomised, controlled trial. Lancet. 2015 Feb 21;385(9969):698-704. PMID: 25468164 www.ncbi.nlm.nih.gov/pubmed/25468164.

          Review Date: 2/23/2015

          Reviewed By: Daniel N. Sacks MD, FACOG, obstetrics & gynecology in private practice, West Palm Beach, FL. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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