Medication Abortion Pills: What They Are and How They Work
Medication abortion pills are a safe and effective way for people to end their pregnancies. Choix has all the information you need to know about the most frequently chosen type of abortion in the U.S. today.
As one of the pioneers in providing confidential, supportive abortion care on your schedule via telehealth, Choix understands that abortion access can be challenging. Our goal is to provide you with the safest and most effective options for abortion care. Even though total numbers of US abortions have been declining, the use of medication abortions increases every year. There are many reasons for the increase in demand for abortion pills is because people want and need safe and effective ways to determine their reproductive future.
What Is an Abortion Pill?
The “abortion pill” (also called medication abortion) is actually not just one, but a combination of two pills (mifepristone and misoprostol) taken to end an early pregnancy. Two decades ago (in 2000!), the U.S. Food and Drug Administration (FDA) approved the first abortion pill in the U.S. called Mifeprex. In 2016, the FDA approved a highly-effective protocol for medication abortion combining Mifeprex (now generic mifepristone) and misoprostol for use through 10 weeks of pregnancy.
How Do Abortion Pills Work?
Mifepristone works by blocking your body’s natural hormone progesterone. Without progesterone, the lining of your uterus thins, preventing the embryo from staying implanted in the uterus and stopping development. Misoprostol is a medication that makes your uterine muscles contract or squeeze the same way they do during your period or childbirth. These contractions cause your uterus to expel the pregnancy and the lining of your uterus out through your vagina.
Are Medication Abortions Safe?
Yes! The FDA-approved protocol is based on decades of research showing that it is safe and effective. The same protocol is endorsed by the American College of Obstetrics and Gynecologists (ACOG), the National Abortion Federation (NAF), and Planned Parenthood Federation of America (PPFA).
When following the evidence-based FDA guidelines for mifepristone and misoprostol, medication abortions are extremely safe, with a very low risk of complications of less than 0.5 percent. Medical abortion hasn’t been shown to affect future pregnancies unless complications develop.
Abortion pills are more effective the earlier in pregnancy you take them. Success rates are higher in people taking them if their pregnancy is eight weeks or less compared to people taking abortion pills when they are ten to eleven weeks pregnant.
When In Pregnancy Can You Get a Medication Abortion?
Choix provides abortion pills via telehealth for anyone age 15 and older in California, Illinois, Maine or New Mexico, 18+ in Colorado without parental notification and 18+ in Virginia without parental consent,in the first ten weeks of their pregnancy. In December 2021, the FDA permanently allowed the prescription and mailing of medication abortion pills, removing the requirement for an in-person appointment before dispensing abortion pills. Telehealth technology makes it easier and more private for you to access safe and confidential virtual abortion care from providers like Choix, 24 hours a day, seven days a week.
What’s the process of having a medication abortion?
Many people considering medication abortion want to know more about what’s involved. Here is a step-by-step list of what you can expect:
Before you take the abortion pill, you’ll check in with a nurse, doctor, health center staff, or telehealth provider to talk about your abortion options.
You will need a urine pregnancy test and to answer questions about your medical history, and you may or not require an exam, and laboratory blood tests depending on where you seek abortion care. You may or may not need an ultrasound (a picture of your uterus with soundwaves taken by a probe placed in your vagina or over your lower abdomen) to figure out how far into your pregnancy you are. These tests also help confirm that your pregnancy is inside your uterus (and not ectopic).
Once your healthcare provider confirms that it is safe for you to have a medication abortion, they will provide you with a prescription for the two medications used in the abortion process: mifepristone and misprostol. Choix patients will also receive a high dose ibuprofen to help reduce symptoms of pain and cramping, as well as ondansetron, to help reduce symptoms of nausea.
Medication Steps: First you will take mifepristone, one pill swallowed with a big glass of water. This medication should not cause any or many side effects. Next you will take the misoprostol as the next step in the process. You will take misoprostol 1-2 days after mifepristone, at a time that works best for you. Misoprostol can be taken vaginally 6 to 48 hours after mifepristone, or it can be taken buccally (between the cheeks and gums) 24 to 48 hours after mifepristone. (This is not a substitute for medical advice.)
Heavy bleeding and cramping will usually begin within 1-4 hours after taking the misoprostol, but can take up to 24 hours to take effect. Usually, it takes 4-5 hours for you to pass the pregnancy tissue. Once you pass the pregnancy, your bleeding and cramping should improve.
You may have cramps for a few days after taking the misoprostol. It is normal to have bleeding and spotting for several weeks after your medication abortion.
You will need to have an in person or virtual follow-up appointment with your medical provider. The timing of this appointment and what happens at the appointment depends on how you feel after your medication abortion, where you received your care, and what state you live in.
You may need to have some follow-up blood work, take a urine pregnancy test, have an in-clinic visit, or have a repeat ultrasound to confirm that the medication abortion is complete.
What Does Taking Abortion Pills Feel Like?
Heavy Cramping and Bleeding with Clots
The medications will cause cramping and vaginal bleeding, usually within one to four hours of taking the misoprostol pills, but up to 24 hours after. The cramping will feel like intense menstrual cramps, possibly more painful than a regular period. You may pass large clots (sticky clumps of blood) or tissue.
Bleeding and clotting can last several hours to several days. It is normal to have heavy enough bleeding to have to change full pads frequently or bleeding into the toilet for several hours, with bleeding decreasing over the following days. If you are farther along in your pregnancy (closer to 10 weeks), you may have more bleeding or cramping.
Your healthcare provider will review warning signs and when you should check in with them.
But you should get in touch if you have:
Heavy bleeding from your vagina that soaks through more than two maxi pads in an hour, for two or more hours in a row
Large clots (bigger than a lemon) for more than 2 hours
Severe belly pain or cramps that don’t get better with pain medication (ibuprofen or acetaminophen)
Less Common: Nausea, Vomiting, Headache, or Diarrhea
Often, misoprostol causes people to have vomiting, diarrhea, or headaches especially if taken by mouth.
Rarely people can develop infections after a medication abortion. You should check with your abortion provider if you have:
Severe back or belly pain
A fever above 100.4 degrees more than 24 hours after taking misoprostol
Continued weakness, vomiting, or diarrhea lasting longer than 24 hours after taking misoprostol.
Rarely, Nothing Happens, Bleeding Is Very Light, Or Pregnancy Symptoms Continue
Because the FDA-approved protocol is 95 percent effective, it is unlikely that the abortion pills won’t work. But, if 24 hours after taking the misoprostol, you have not had any bleeding or cramping, check in with your abortion care provider.
Also, if you suspect that you are still pregnant and the medication abortion was incomplete, because you only had light bleeding and did not expel any pregnancy tissue, consult with your provider.
Why Are More People Choosing Medication Abortion?
We don’t know the exact reasons why more people are choosing medication abortion over surgical abortion. But people may be choosing medication abortion because, compared to in-clinic (surgical) abortions, medication abortions:
Can be started at your doctor’s office or at home and may or may not require in-person visits or follow-up
Are more like a miscarriage, and therefore, some people feel more “natural” or less invasive
Able to be completed without anesthesia or surgery
Additionally, many people are choosing abortion care via teleheath. A telehealth medication abortion can be:
Easier to Access
More affordable (Less expensive than a surgical abortion or medication abortion at a clinic, doesn’t require travel or accommodation, no missed employment wages for appointments)