Using “the abortion pill” — or, to be more accurate, abortion pills — is a safe and reliable way to end a pregnancy up to about 12 weeks after the first day of your last period.
You can usually carry out all or part of the procedure at home, which can be more comfortable for some people.
But that can naturally make you wonder about whether it has worked.
Although a follow-up appointment is the best way to get reassurance, there are a number of signs that may let you know the medication has been successful.
In many cases, “the abortion pill” is actually two separate medications — mifepristone and misoprostol — taken in two separate doses.
Cramping and bleeding within a few hours of taking the second medication, misoprostol, is a good indicator that the procedure has worked.
Bleeding or passing large blood clots generally shows that the embryonic or fetal tissue (likely white or gray in color) is exiting the body. Cramping helps the uterus return to its usual state.
The process usually takes 2 to 3 days to complete. You may experience symptoms for a few weeks after taking all medications.
If you’re using telemedicine or seeing a healthcare professional in-person to have a medication abortion, you’ll have an appointment with a nurse or doctor who will ask about your medical history and explain how the process works.
If you’re seeing a healthcare professional in person and haven’t had a recent ultrasound, they will likely perform one to see how far along the pregnancy is.
At this appointment, the healthcare staff will give you the first medication, mifepristone. In many cases, they will ask you to take it there and then.
The second medication, misoprostol, can be taken between 24 and 48 hours after the first one.
You’ll be given a slowly dissolving tablet that can either be placed in your vagina, under your tongue or between your teeth and cheek. Your clinician will advise you on the best method to take this medication.
Some people return to the clinician’s office to take misoprostol, while others take it at home.
Your body should begin to cramp and bleed within 24 hours of taking the second medication.
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 a clinician, if applicable, usually takes place around 2 weeks after taking all medication.
A mediation abortion generally uses two different medications to end a pregnancy.
The first medication, mifepristone, blocks an important pregnancy hormone called progesterone. This results in the breakdown of the uterine lining and stops the growth of the embryo or fetus.
The body soon realizes that the pregnancy can’t continue, so the second medication, misoprostol, helps push out the tissue 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 medication used to complete abortion is highly effective, but its effectiveness does decrease the further along the pregnancy is.
According to Planned Parenthood, the medication works for 94 to 98 percent of people who are 8 weeks pregnant or less.
This is said to reduce to 91 to 93 percent effectiveness for those who are between 9 and 10 weeks pregnant.
According to the University of California – San Francisco, around 3 to 5 percent of people need a surgical abortion after a medical one.
Certain factors can impact the medication’s efficacy.
For example, a medication abortion won’t work if you have an ectopic pregnancy or don’t take all medications correctly.
Similarly, it’s advised not to have a medication abortion if you have an IUD or certain medical conditions, like a bleeding disorder.
Healthcare staff can check all of the above and provide clear instructions before dispensing abortion medication.
People often liken the feeling of medication abortion to an early miscarriage.
After taking the second medication, you’ll likely experience abdominal cramps and heavy bleeding for a few hours.
Depending on 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
Try to 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 of work or other duties so you can rest.
Lying down with a hot-water bottle on your abdomen can help relieve any pain. You may even 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 the pregnancy has ended, your symptoms should begin to reduce.
Bleeding may be lighter, and cramping may not feel so severe. Other side effects like fever or nausea should also disappear.
But it may take a couple of days for you to get back into your usual routine, as the process can make you tired.
It’s common to experience lighter bleeding for a few weeks after taking medication used for abortion, 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 reach out to a healthcare professional if you have any concerns.
Around 4 to 6 weeks after your abortion, your period should return.
Be aware that your body can start to ovulate
If you have a follow-up appointment planned, it may take place over the phone or in-person, depending on your and your clinician’s preference.
Your clinician will use this appointment to determine whether your body is healing properly. They’ll also look for any signs of infection.
During this appointment, they’ll 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
They may also physically check your cervix and uterus, perform lab tests to check for the pregnancy hormone, and carry out an ultrasound to determine whether the medication worked.
If you opted for a phone appointment, you’ll likely be advised to take a pregnancy test at home.
Try to 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 2-4 weeks to avoid a false-positive result.
Although a medication abortion is effective in the vast majority of cases, there’s a small chance that it may not work.
A doctor or other healthcare professional will be able to determine this at a follow-up appointment.
If you’re still pregnant, a clinician can discuss other abortion options with you.
You may be able to take another dose of one or both abortion medications or may need a surgical abortion instead.
If you’re having trouble finding a provider in your area or want more information about the abortion process, the following organizations can help:
Remember that people often experience a wide range of emotions after an abortion. So 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.