You can usually carry out part of the procedure at home, which can be more comfortable for some people.
But that can lead to anxiety about whether the pill has worked.
Although a follow-up appointment is the best way to get reassurance, there are a number of signs to look out for that point to abortion pill success.
Most people experience cramping and bleeding within a few hours of taking the second pill, misoprostol.
This is a good indicator that the abortion pill has worked.
Bleeding, or the passing of large blood clots, shows that the fetal tissue is exiting the body. Cramping helps the uterus return to its usual state.
Your healthcare provider will also schedule a follow-up appointment a couple of weeks later to check that the abortion pill worked.
The abortion pill comes in two separate doses. The process usually takes 1 to 2 days to complete.
You may experience symptoms for a few weeks after taking both pills.
You’ll first have an appointment with a nurse or doctor who will ask about your medical history and explain how the process works.
If you haven’t had a recent ultrasound, they will perform one to see how far along the pregnancy is.
At this appointment, the healthcare staff will give you the first pill, mifepristone. In many cases, they will ask you to take it there and then.
The second pill, misoprostol, can be taken between 24 and 48 hours after the first one.
You may be given an oral dose or a slowly dissolving tablet that’s placed in your vagina, under your tongue, or between your teeth and cheek.
Some people return to their healthcare provider to take misoprostol, while others take it at home.
Within 1 to 4 hours of taking the second pill, your body should begin to cramp and bleed.
It’s common to pass the pregnancy within 4 hours, but it can take a few days for some people.
You may also experience lighter bleeding and cramping for a few weeks afterward.
A follow-up appointment with your healthcare provider usually takes place around 2 weeks after taking the pills.
A medical abortion uses two medications in the form of a pill to end a pregnancy.
Mifepristone is the first pill.
It blocks an important pregnancy hormone called progesterone. This results in the breakdown of the uterine lining and stopping the growth of the embryo.
The body soon realizes that the pregnancy can’t continue, so the second medication, misoprostol, helps the body push out the embryo through the vagina.
The body does this by causing the uterus to contract, which leads to a similar level of cramping and bleeding as a miscarriage.
The abortion pill is highly effective, but its effectiveness does decrease the further along the pregnancy is.
For example, the medication works for 94 to 98 percent of people who are 8 weeks pregnant or less.
This reduces to 91 to 93 percent effectiveness for those who are between 9 and 10 weeks pregnant.
And, according to the University of California, San Francisco, only around 3 to 5 percent of people need a surgical abortion after a medical one.
But certain factors can change effectiveness.
An abortion pill won’t work if you have an ectopic pregnancy or don’t take both medications correctly.
Similarly, you shouldn’t have a medical abortion if you have an IUD or certain medical conditions, like a bleeding disorder.
Healthcare staff will check all of the above and provide clear instructions before giving you any abortion medication.
Many liken the feeling of a medical abortion to an early miscarriage.
After taking the second pill, you’ll likely experience abdominal cramps and heavy bleeding for a few hours.
Depending how far along the pregnancy is, you may pass larger tissues that are brown or red in color, and may be able to see the white pregnancy sac.
Misoprostol can also cause:
- fever-type symptoms
Look after yourself by staying in a comfortable place, whether that’s your own home or the home of family or friends.
If you can, take a couple of days off work so you can rest.
Lying down with a hot-water bottle on your abdomen can help relieve any pain. Some find sitting on the toilet to be a more comfortable position.
You’ll also need highly absorbent menstrual pads for the bleeding.
If you need pain medication, avoid aspirin, as it can worsen bleeding. Instead, take ibuprofen (Advil, Motrin). It may help to take pain medication around 30 minutes before the misoprostol.
If you feel that something isn’t right — especially if you’re soaking two or more pads an hour for a few hours or have a fever that lasts longer than a day — seek medical advice.
Hospitals and clinics don’t need to know you’ve taken the abortion pill if you feel unsafe telling them. Your symptoms mimic a natural miscarriage, so staff won’t be able to tell the difference.
As soon as your abortion is complete, your symptoms should begin to reduce.
Bleeding may be lighter, while cramping may not feel so severe. Other side effects like fever or nausea should also disappear.
It may take a couple of days for you to get back into your normal routine, as the process can make you tired.
It’s normal to experience lighter bleeding for a few weeks after taking the abortion pill, so don’t worry if you’re still spotting after your follow-up appointment.
Before the appointment, try to keep track of how much you’re bleeding. Be sure to tell your healthcare provider any concerns you have.
Around 4 to 6 weeks after your abortion, your period should return.
Be aware that your body can start to ovulate
Your follow-up appointment may take place over the phone or in person, depending on your and your provider’s preference.
It’s important to attend this so your healthcare provider can check that your body is healing properly. They’ll also look for any signs of infection.
Your healthcare provider will ask you about the process, including:
- how much bleeding you’ve experienced
- whether you’re still bleeding
- whether you saw evidence that the gestational sac or embryo left your body
Your healthcare provider may also physically check the cervix and uterus, perform lab tests to check for the pregnancy hormone, and perform an ultrasound to determine whether the abortion pill worked.
If you opted for a phone appointment, you’ll often be given a pregnancy test to take at home.
Avoid taking an at-home test too soon after an abortion, as the pregnancy hormone may still linger in your body. It’s best to wait 4 weeks to avoid a false-positive result.
Although the abortion pill is effective in the vast majority of cases, there’s a small chance that it may not work.
Your healthcare provider will be able to determine this at your follow-up appointment.
If you’re still pregnant, your healthcare provider will discuss other abortion options.
You may be able to take another dose of the abortion pill, or you may need a surgical abortion instead.
If you’re having trouble finding a clinic in your state or want more information about the abortion process, the following organizations can help:
Remember that it’s perfectly normal to experience a wide range of emotions after an abortion.
If you need to speak to someone about how you’re feeling, consider a post-abortion counselor.
Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraine, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.