Ending pregnancy with medications
More About Medical 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 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 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 Medical Abortion
You should not have a medicine 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 may take the following medicines for the abortion:
- Mifepristone - this is called the abortion pill or RU-486
- You will also take antibiotics to prevent infection
You will take mifepristone in the 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 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 bleeding 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. 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 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
- Blood clots in your uterus
Medical abortions are typically very safe. In most cases, it does not 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 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
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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 29.
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;385(9969):698-704. PMID: 25468164
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.
Last reviewed on: 4/14/2021
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.