A medical abortion is the termination of a pregnancy in the first trimester using medication. It’s generally a safe and effective alternative to surgical abortion. Understanding the process of a medical abortion and what to expect can help pregnant people decide whether it’s the right option for them. A medical abortion is sometimes called a medication abortion.
What is a medical abortion?
A medical abortion is a dual-medication process. It usually involves taking mifepristone (also called Mifeprex or RU-486) followed by misoprostol.
Medical Abortion vs Emergency Contraception
While both options involve taking medication, a medical abortion is different from emergency contraception, such as Plan B and ella. Emergency contraception prevents pregnancy within three to five days after unprotected sex. Once someone becomes pregnant, emergency contraception doesn’t work.
A medical abortion terminates an existing pregnancy. Emergency contraceptives are also available over the counter while medical abortions require a prescription.
Medical Abortion Timeframe
Medical abortion is typically used within the first 10 to 12 weeks of pregnancy. It’s more effective than surgical abortion during the first 49 days of gestation. It may also be the preferred option for pregnant people with very high body mass indexes, uterine tumors, or fibroids.
How does medical abortion work?
A medical abortion begins when a pregnant person takes a mifepristone pill their healthcare professional prescribes. This abortion pill blocks progesterone, a hormone the body needs to support a pregnancy. Taking mifepristone causes the lining of the uterus to break down and the pregnancy to end. They also receive antibiotics and a second pill, called misoprostol, which may be a vaginal pessary (a flexible, plastic device inserted into the vagina) or oral medication. Misoprostol triggers cramping and heavy bleeding to empty the uterus.
How Long Does Medical Abortion Take?
The timeline of a medical abortion can vary from person to person. The process begins when the pregnant person takes the mifepristone. If they receive the second medication, misoprostol, in vaginal pessary form, they can insert it straight away, or up to 48 hours after taking the mifepristone. If they receive the oral medication, they need to wait between 24 and 48 hours after taking mifepristone.
Misoprostol works fairly quickly, with most people starting to cramp and bleed within one to four hours of taking it. The cramping and heavy bleeding continues for several hours before settling down to normal period levels for three to seven days. It’s common to experience symptoms like fevers and chills for a day after taking mifepristone before returning to normal.
A pregnancy test or follow-up appointment after taking the pills can confirm whether the termination was successful.
Is medical abortion safe?
The Federal Drug Administration has declared using mifepristone and misoprostol is safe and effective for terminating a pregnancy up to 10 weeks of gestation. However, research suggests it’s safe and effective beyond this time.
Medical Abortion Side Effects
While they’re safe, taking these medications can cause some side effects beyond the expected cramps and heavy bleeding, including:
- Low-grade fever or chills
- Nausea
- Dizziness
- Fatigue
- Light to moderate bleeding for several weeks
- Diarrhea
- Vomiting
- Digestive pain
- Allergic reactions
- Genital infections
Are medical abortions safe for everybody?
Medical abortions may not be safe for people with certain medical conditions, including:
- Blood clotting disorders such as Factor V Leiden
- Significant anemia
- Chronic adrenal failure
- Allergies to the medications
- Ectopic pregnancies
People also shouldn’t get a medical abortion while they have an IUD in or if they’ve used corticosteroids for an extended period. Anyone unsure whether they are a good candidate should consult a healthcare professional.
“Unfortunately, not everyone has a private doctor who supports their needs when it comes to deciding to have an abortion. That's why medical professionals who provide abortion care should review each patient’s medical history during the visit,” explained Melissa Grant, the COO of reproductive and sexual health provider Carafem. “Discussing any medical risks and benefits of the treatment is an essential part of the informed consent process.”
Can having a medical abortion cause infertility?
No evidence suggests that getting a medical abortion will impact future fertility, so anyone who gets one is just as likely to be able to conceive and carry a baby to term in the future.
How effective is medical abortion?
The FDA-approved combination of mifepristone and misoprostol has a high success rate of between 95 and 98 percent, depending on how far along in the pregnancy the person takes the pills.
Incomplete Abortions
There’s a small risk of an incomplete abortion after receiving a medical abortion. This occurs when some of the pregnancy tissues and products remain in the body. In minor cases, a health professional may administer two extra doses of misoprostol to trigger more cramping and bleeding. They could also use a vacuum to remove the residual tissue from the body. Prompt treatment of an incomplete abortion reduces the risk of infection.
How much is a medical abortion?
The average price for a first-trimester abortion, most commonly a medical abortion, is $500 to $600. The cost of a medical abortion varies depending on the pregnant person’s location, healthcare provider, and insurance coverage. Some insurance companies cover the cost of medical abortions, but this isn’t always the case, especially in states that don’t legislate this requirement. When insurance covers a medical abortion, the policyholder may need to attend a clinic in their provider’s network.
Financial Assistance Options
There are several options for people who need financial assistance with a medical abortion, including:
- Clinic discounts for people with low incomes
- Financial assistance through the clinic, such as self-payment options
- Coverage through a local or national abortion fund
Does Medicaid Cover Abortion?
Medicaid covers abortions in the following states:
- Alaska
- California
- Connecticut
- Hawaii
- Illinois
- Maine
- Maryland
- Massachusetts
- Minnesota
- Montana
- New Jersey
- New Mexico
- New York
- Oregon
- Rhode Island
- Vermont
- Washington
Only residents of these states can file a claim via Medicaid. It will not cover abortions for people who’ve traveled to these states for an abortion.
What to expect after a medical abortion
A medical abortion can take a physical and mental toll. Cramping can be intense, but most people start feeling better after a day or two. A normal menstrual cycle should return after around four to six weeks, although it’s possible to become pregnant two weeks after the abortion. To prevent vaginal infections, it’s best to avoid penetrative sex, sex toys, and tampons for two to three weeks after a medical abortion.
Recovering mentally from a medical abortion can take much longer than recovering physically. People can feel positive emotions like relief or more challenging ones like grief, shame, and stress. All these emotions are normal and may overlap.
How painful is a medical abortion?
Every person experiences a medical abortion differently.
Grant noted that “The intensity of bleeding and pain can vary from person to person, ranging from lighter than a period with no cramping to very heavy bleeding with strong cramping. Most people will experience something between these extremes, and medical providers can suggest ways to make the experience more comfortable.”
As with menstrual cramps, heat packs and over-the-counter pain medication can help people feel more comfortable during and after a medical abortion.
How long will you bleed after a medical abortion?
Heavy bleeding as the body gets rid of the uterine lining typically lasts for one to four hours. After that point, it’s common to have bleeding similar to a typical period, for another three to seven days. It’s common to experience some bleeding for two to three weeks after a medical abortion.
Severe bleeding, which soaks more than two heavy-duty pads within an hour, isn’t typical and needs medical attention. On the flip side, no bleeding within 24 hours of taking misoprostol also warrants a check-up with a healthcare professional.
Is a follow-up appointment necessary?
“Most people do not need to see a medical provider for follow-up after a medication abortion,” Grant said. “A pregnancy test is recommended five weeks after using the medications to confirm the abortion was successful. Medical providers should give a list of signs that indicate you need to seek care earlier than just taking a pregnancy test. These signs include very heavy bleeding, pain not relieved by ibuprofen, a fever of 100.4°F or higher starting more than 24 hours after the abortion, or no bleeding with ongoing pregnancy symptoms. If you experience any of these, contact a medical provider for advice.”
However, in some cases, healthcare providers may prefer scheduling a follow-up appointment in person or via telehealth. During this check-up, they can assess whether the process went smoothly. They may suggest lab work, a take-home pregnancy test, or an ultrasound to confirm the abortion was successful.
Resources for emotional support
Speaking to a partner, trusted friend or family member, or a mental health professional can help someone who’s had a medical abortion process their emotions. The abortion provider or usual health professional may also suggest resources for emotional support. Some excellent resources include:
- Exhale Pro-Voice (617-749-2498): A text-based support service for people who’ve had abortions manned by trained counselors.
- All-Options Talkline (1-888-493-0092): A toll-free service connecting people with various pregnancy experiences, including people who’ve had abortions, with volunteer peer counselors.
- M+A Hotline (1-833-246-2632): A call or text service for people who need support managing miscarriage or abortion.
- Chicago Abortion Fund: Its post-abortion community circles are free monthly online events that support people who’ve had abortions.
Synonyms: Medication abortion
