Understanding a medical abortion

The abortion pill is also known as a medical abortion. ­There are two main types of abortions: medical abortions and surgical abortions. A medical abortion may be commonly called “the abortion pill” but it involves taking two types of abortion pills. These pills will terminate a pregnancy, and are not the same as what is commonly known as the “morning-after pill” or Plan B, which is designed to prevent pregnancy.

The first pill that you will take is mifepristone. The second is misoprostol (also known as Cytotec). The use of the two medications together increase the effectiveness of the abortion, and can reduce the duration of side effects.

You can obtain these medications through doctors and clinics that provide abortion services, like Planned Parenthood. You should never buy them online or on the black market. The cost of the medication depends on location and additional tests or follow-ups that may be necessary. According to Planned Parenthood, abortion procedures can cost up to $800. However, this cost fluctuates depending on the area where you live.

Women who are under 10 weeks into their pregnancy are eligible to take the abortion pill. After 10 weeks, women who wish to terminate their pregnancy may opt for a surgical abortion.

Women with pre-existing medical conditions may not be eligible to take the abortion pill. Women who cannot receive the abortion pill include:

  • women who are not willing to have an aspiration (surgical abortion) if the pill is not effective.
  • women with an ectopic pregnancy or mass on their ovaries
  • women on long-term corticosteroids
  • women with certain genetic diseases
  • women who are not able to understand the procedure or how to follow the directions
  • women who will not have access to emergent medical treatment and facilities
  • women who have a molar pregnancy, in which the placenta develops abnormally
  • women who have heart, kidney, or liver problems
  • women with severe adrenal gland problems
  • women who currently have an IUD (though you can take the pill upon its removal)
  • women with bleeding disorders, or those who are taking anticlotting medications

The abortion pill is very effective. When misoprostol and mifepristone are used together, they have about a 98 percent effectiveness rate. The age of the pregnancy, the medication doses and administration, and whether or not a woman has been pregnant before may impact the effectiveness. The effectiveness rate decreases for each additional week of pregnancy.

While this effectiveness rate is high, it’s possible for a medical abortion to fail to terminate a pregnancy. In these cases, a woman would need to then undergo a surgical abortion.

When you’re taking both medications in a medical abortion, they’ll work together to terminate a pregnancy.

Mifepristone will be the first pill that you take. It works by blocking progesterone and causing the lining of the uterus to break down, terminating the pregnancy. About 24 to 48 hours after you take the first pill, you will take misoprostol, which causes the uterus to contract and expel the embryo and uterine lining.

Women who undergo a medical abortion often experience bleeding and cramping that can last for up to two weeks after the procedure, including passing blood clots. Other common side effects include:

  • nausea and vomiting
  • diarrhea
  • feeling dizzy or heaving a headache
  • short-lasting hot flashes

Most women will abort anywhere from a couple of hours to a day or two after taking the second medication. However, it’s normal to experience light bleeding, spotting, and some cramping for up to four weeks following a medical abortion. Note that you can get pregnant almost immediately following an abortion.

When women decide they want to have an abortion, they may get to choose between a medical abortion with the abortion pill, and a surgical abortion.

Pros of medical abortion include:

  • Medical abortions can occur as early as a woman finds out that she is pregnant.
  • There is no anesthesia required.
  • It’s less invasive than a surgical abortion.
  • Some women feel that it’s more “natural,” like a miscarriage.
  • Medical abortions don’t carry the same risks of uterine perforation.
  • Abortion pills often cost less than surgical abortions.

Medical abortions do have some disadvantages, which include:

  • Medical abortions are not 100 percent effective. Failed medical abortions require women to also undergo surgical abortions, and can result in infections.
  • Bleeding and cramping may last longer than with a surgical abortion.
  • Medical abortions may require more than one visit to the doctor’s office.
  • They cannot end a tubal or ectopic pregnancy.

Your doctor will discuss your options with you, and will likely break down some of the pros and cons.

Though medical abortions are considered safe, it is possible to experience complications from the medications.

Potential risks and complications of a medical abortion include:

  • an incomplete or failed abortion, where the fetus is viable or remains in the womb (this can cause serious infections)
  • an undetected ectopic pregnancy, which can be dangerous and is a medical emergency
  • blood clots remaining in the uterus
  • heavy bleeding

Emergency symptoms of serious complications include:

  • severe pain
  • fever
  • excessively heavy bleeding (defined as going through two or more pads within an hour span)
  • strong-smelling vaginal discharge
  • passing clots for two or more hours that are larger than the size of a lemon

In many cases, you will take the first pill in front of your doctor at your first appointment. You may then return to the office for the second medication between one and three days later. You may experience symptoms like bleeding and cramping for two to four weeks. Your doctor will schedule a follow-up appointment with you to test for pregnancy at the end of this time frame to ensure that the procedure was successful.

After taking the abortion pill, wait at least one week to have sex, even if your doctor has prescribed you antibiotics. This reduces the risk of getting an infection. When you do have sex, use contraception immediately, as you can get pregnant very soon after an abortion.