Medication abortion or using pills to end a pregnancy

Medication abortion is an abortion that is caused by taking a drug or combination of drugs to end a pregnancy. In the United States, the Food and Drug Administration (FDA) has approved the specific combination of mifepristone and misoprostol for medication abortion, and it is also approved for use in about 50 other countries around the world.
The World Health Organization’s (WHO) safe abortion guidelines state that misoprostol can be used alone to cause an abortion through 12 weeks after the first day of a woman’s last menstrual period. Though the WHO does not recommend use of misoprostol alone because of lower efficacy and greater side effects than when it is combined with mifepristone, the guidelines note that “in some settings its broader use has been reported to contribute to a decrease in complications from unsafe abortion,” and it “appears to be common where mifepristone is unavailable.”¹
With its drug regulation expertise and experience, the National Women’s Health Network (NWHN) played a leadership role in efforts to ensure that the FDA fairly evaluates the safety and efficacy of medications used for abortion. Since 2000, when the FDA granted approval to mifepristone, women in the U.S. have been able to get medication abortions at clinics and some doctors’ offices. (Misoprostol was already approved and has been available for other uses in the U.S. since the late 1980s.) Due to the politically embattled context of abortion in this country, however, the FDA approval of mifepristone included distribution restrictions, which extensive research and decades of safe use have demonstrated to be medically unnecessary. Yet, these restrictions remain in place, reducing U.S. women’s access to medication abortion.
Meanwhile, women living in countries (like Mexico) where abortion is highly restricted and drug distribution is less regulated have figured out that they can get pills that will end a pregnancy safely, and that they can take them at home without ever seeing a health care provider. As Francine Coeytaux of the Public Health Institute and Leila Hessini of Ipas reported recently in RH Reality Check, “the use of pills to end pregnancy without formal medical guidance has significantly increased access to safe abortion for many women, especially poor, rural, and young women who are chronically under-served. And it allows women to be in control of the process.”²  In most cases, the women are using misoprostol alone, without mifepristone, to cause an abortion.

Evidence and information about self-use of medications for abortion

Studies show that, when a woman takes misoprostol up to 9 weeks since the first day of her last menstrual period, it is 75-90 percent effective in ending the pregnancy completely within 2 weeks.³

In the limited cases when medication abortion does not fully end a pregnancy, the follow-up treatment is usually the same used for miscarriage management, and is commonly available at medical facilities throughout the U.S., even in places where abortion care is not.

Reasons women report having taken misoprostol on their own, or trying to end a pregnancy on their own through other means, include barriers to accessing clinic abortion — such as parental notification laws or bans on insurance coverage of abortion — and a belief that it would be more private and natural and less disruptive to their work and family obligations than a clinic abortion

Ending pregnancy with medicines

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.

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
• Misoprostol
• 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
• Infection
• 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