The Abortion Pill Explained: Mifepristone& Misoprostol, Safety, and Risks

Mar 12

Medication abortion, often known as the abortion pill, is a common method for ending an unwanted pregnancy. And if you’ve ever searched for information about it online, you were probably faced with a lot to take in and quite a few different websites that sell abortion pills (and maybe some difficult medical jargon too).

But like any self-managed medical intervention, it’s important to really understand what these pills do, how they work, and what the process will look like for you and your body. So in this blog, we’re breaking down what the abortion pill does in easy-to-understand language—and hopefully answering some of your questions and concerns in the process.

Medication (or medical) abortion is popular because you can manage your abortion in the privacy of your own home, and it doesn’t require surgery or an in-office procedure, unless you start having complications. Right now, it’s legal in the state of Michigan. And because at-home abortions are often self-managed and increasingly accessible by purchasing pills online without a doctor managing your care, it is important to understand, plan, and manage your own care before the abortion.

By reading this article, you are taking charge of your own health, so you can advocate for yourself before, during and after your abortion experience, and have clarity about your plan. Let’s start by learning how a medication abortion works.

What are mifepristone and misoprostol (the abortion pill) and how do they work in your body?

The abortion “pill” is actually two different medications, taken together to end an early pregnancy in the uterus. The names of these drugs are mifepristone and misoprostol (sometimes known by their brand names, Mifeprex® and Cytotec®), and they each perform a different function in the body.

The first step of a medical abortion is mifepristone. Mifepristone is taken by mouth, and it blocks progesterone receptors in the uterus. The hormone progesterone is necessary to continue and grow the pregnancy, so when it’s blocked, the uterine lining begins to shed and the embryo (or fetus, depending on the gestational age) is detached from the uterine wall. By blocking progesterone, mifepristone stops the growing pregnancy, causing the baby to pass away.

The second step of a medical abortion is misoprostol. Misoprostol is taken by mouth (in the cheek) or vaginally. It causes uterine contractions, cramping and bleeding, and eventually empties the fetus through the vaginal canal. Multiple doses are usually prescribed, because it’s important to completely clear the uterus of all pregnancy tissue (fetal parts and placenta). If pregnancy tissue is left behind, it can cause serious medical complications.

Note: Medical abortion is not the same as the morning-after pill (also known as emergency contraceptive or Plan B). The morning-after pill is taken shortly after unprotected sex and is intended to prevent pregnancy (by preventing ovulation), while medical abortion is taken after a pregnancy occurs and is intended to end the pregnancy.

What are the limitations of medical abortion?

As in any self-managed medical intervention, it’s important to understand the limitations of medical abortion.

It cannot treat an ectopic pregnancy.
It is not approved for pregnancies further along than 10 weeks, since it is not as effective and the medical risks increase.
Medical oversight and clinical follow-up is not always provided.
There are limited pre-abortion safeguards ; it’s easy to obtain abortion pills (especially online), without confirming your pregnancy with an ultrasound, getting STI tested, or getting bloodwork to check for anemia and your Rh Factor.

Does it matter where I get the abortion pill?

It’s important to note that not all pills available online are approved and regulated by the FDA, so you do not know if you are really getting the actual medication. If you choose to buy pills online, make sure they come from an FDA-approved source. It’s also important to learn about safety so you know what is normal, what is not, and when to seek medical help if needed..

What does a medical abortion feel like?

Commonly reported experiences of medical abortion describe it as feeling like strong period cramps with heavy bleeding, but pain levels vary among individuals. Some may experience less pain and lighter bleeding, while some describe the pain as being much more intense. It’s important to monitor your level of blood loss and to have a plan for emergency medical care if symptoms become severe, as these might indicate serious complications.

Most people don’t feel any physical symptoms after taking the first pill, mifepristone, though some people feel unexpected regret after beginning their abortion. Because mifepristone blocks progesterone from being delivered to the baby, some doctors prescribe progesterone to women who regret taking the first abortion pill and want to attempt to continue their pregnancy (learn more).

The FDA recommends that 24-48 hours after taking mifepristone, you’ll take the first dose of misoprostol (be sure to follow your specific medication’s directions). Usually within one to four hours, this causes uterine contractions and essentially induces labor of the deceased fetus. This is when the cramping and bleeding begin, causing your cervix to slowly open, and the contents of the pregnancy to eventually be expelled. This includes uterine blood, blood clots, the fetus and the placenta.

It’s important to confirm that the fetus and all pregnancy tissue is totally emptied from the uterus, as an incomplete abortion can cause infection and even sepsis. Please note, for some women, seeing the fetus can be emotionally upsetting; it’s not uncommon to see a clearly identifiable baby with a head, eyes, and arms, etc. Learn more about fetal development.

What side effects are possible?

In addition to heavy cramping and bleeding, the most common side effects during and after a medical abortion include:

Nausea
Diarrhea
Weakness
Fever/chills
Vomiting
Headache
Dizziness

As with any medical intervention, medical abortion comes with some serious risks. It’s important to understand these risks and discuss them with a healthcare provider before proceeding. They include:

Pregnancy tissue left in the uterus (parts of the fetus or placenta)
Heavy bleeding that doesn’t stop
Failure to terminate the pregnancy
Allergic reaction to the medication(s)
Infection

It is crucial to understand the side effects, plan ahead, and monitor your symptoms so you can promptly seek medical care if complications arise.

How long does a medical abortion take?

Generally, a medical abortion takes 1-2 days to complete from the time you take the first pill. The process usually takes about a day after the second medicine. Cramping and bleeding start within a few hours of taking misoprostol, and the pregnancy usually passes that same day.

After the abortion is complete, many women experience continued bleeding for a few days. Lighter bleeding can continue for a week or two. Those who experience continued heavy or prolonged bleeding should seek emergency medical care.

Eligibility & preparation

Now that you have a better understanding of how the abortion pills work, let’s talk about what that means for you specifically. This next section covers important factors that will help you determine if a medication abortion is safe for you and your body. We’ll also discuss essential tests to ensure that if you do move forward, that you are following FDA guidelines so you have a higher likelihood of having a safe abortion.

The following factors impact how safe and effective the abortion pill might be for you, and if you would medically qualify. A medication abortion is not medically recommended for everyone, and it should not be pursued if the pregnancy is:

More than 10 weeks gestation. The FDA has approved medical abortion only up to 10 weeks because of the increased medical risk beyond that time.
Ectopic. An ectopic pregnancy, occurring in roughly 2% of all pregnancies, is a pregnancy that occurs outside the uterine cavity, such as in a fallopian tube. An ectopic pregnancy is not viable, and medical abortion cannot treat or terminate it. Ectopic pregnancies must be treated immediately by a healthcare provider, as they can quickly become life-threatening.
Not viable. 10–20% of known pregnancies end in miscarriage. If a pregnancy is no longer viable, abortion is not necessary.

These three factors are why a confirmation ultrasound is essential for your safety before a medication abortion. You can schedule a confidential, no cost ultrasound at our clinic in Traverse City, Michigan to confirm how far along you are, and verify the location and viability of the pregnancy.

Medication abortion is also not a safe option if you:

Don’t have access to emergency care. Some side effects can quickly become life-threatening. It’s important to have access to medical care in case of an emergency.
Talk to your doctor if you have adrenal gland issues, are taking blood thinners, or have an IUD, as these are important considerations that impact the safety of an abortion.

These are not complete lists, and you should talk through your unique situation with your healthcare provider.

Thrive Medical Clinic exists as a first step in your journey by providing no-cost pregnancy confirmation ultrasounds and options consultations, where you can learn more about medication abortion, assess eligibility, and navigate your next steps.

What should I do before medical abortion?

Unplanned pregnancies often come with a sense of urgency and overwhelm. But in order to manage your abortion care with clarity, and protect your health and fertility long-term, the following steps are important to take before beginning a medical abortion.

Confirmation ultrasound

A confirmation ultrasound will tell you a few crucial things about your pregnancy:

How far along you are (for sure). The true gestational age impacts not only the level of risks to your health, but also your experience taking the abortion pills. An ultrasound is the most accurate way to determine gestational age. Without an ultrasound, gestational age can be guessed by counting from the first day of your last menstrual period. But this assumes accurate recall, regular 28-day cycles and ovulation on day 14, and no confusion between your period and implantation bleeding. Therefore estimated gestational age without an ultrasound can be off by more than two weeks. It’s also difficult to know for sure which day you conceived, since sperm can live for up to five days in the reproductive tract before fertilizing the egg.
Whether the pregnancy is ectopic. A positive pregnancy test can’t tell you whether a pregnancy is ectopic—which occurs in roughly 1 in 50 pregnancies, and is life-threatening if left untreated. Medical abortion can’t treat an ectopic pregnancy, so it’s important to check with a confirmation ultrasound before an abortion.
Whether it is a viable pregnancy. If it is ending naturally, miscarriage management is needed, not abortion.

Schedule ultrasound

Testing

STI testing and blood work (to determine your Rh factor and whether or not you have anemia) are a few of the tests you should consider before medical abortion, as certain untreated factors can negatively impact your health and future fertility if not treated prior to an abortion. Learn more about these tests.

Safety considerations

Although the FDA considers the abortion pill to be a mostly safe procedure, it’s important to be aware of the risks and have a plan for medical care if needed.

Consider:

Do I have access to emergency medical care?
Are the pills from an FDA-regulated source?
What is my plan for seeking medical support (questions, concerns, guidance) if the need should arise?

patient consulting with her doctor about her options

What now?

Take a breath—that was a lot of information to take in! You’re taking the right steps by learning more about medical abortion and considering the various factors that could affect your abortion experience, health and safety. Medical abortion is self managed, but that doesn’t mean it’s risk-free.

If you’re considering abortion, getting a confirmation ultrasound first is essential. At Thrive Medical Clinic, located in Traverse City, Michigan, we offer no-cost clinical pregnancy testing, confirmation ultrasounds and a safe place to ask questions and gather information—because no one should have to navigate an unplanned pregnancy alone.

Schedule ultrasound

Thrive Medical Clinic is a 501(c)(3) nonprofit medical clinic, with licensed medical personnel on staff. We specialize in pregnancy-confirmation services; we do not provide or refer for abortions, and we are not an OB/GYN clinic. Thrive is the first step—a safe place to navigate an unplanned pregnancy, without pressure or judgement. Learn more about Thrive.