Medication abortion ("Abortion pill")

The practice, clinic or hospital will want to see you before the abortion. There they will work out how many weeks pregnant you are. They will also check whether there’s any reason why you shouldn’t take the abortion medications – for example, because you had an allergic reaction to the active ingredients in the past or because you have a health problem like chronic kidney disease or bad asthma. If you’ve got an IUD (coil) in your womb, it will be removed.

Pre-abortion health checks may also include

• a talk with the doctor where they ask about things like your last period, previous pregnancies, illnesses and any current health problems,
• a gynecological examination,
• an ultrasound scan, and
• a chlamydia test.

The doctor who performs the abortion has to tell you all about the different abortion methods, what they involve, and any potential complications. They also have to ask whether you want to talk about your reasons for having an abortion. But you don’t have to.

This is a good time to talk about contraception after the abortion, too, because you could become pregnant again quite soon after.

For a medication abortion, you use two medications with a gap of 24 to 48 hours between them.

The first one contains an active ingredient called mifepristone (brand names: Mifegyne, Mifeprex). It blocks progesterone, which is the pregnancy hormone, so the pregnancy can’t develop any further. It softens and opens the cervix (the opening between the vagina and womb) too.

The second medication contains a prostaglandin called misoprostol. Misoprostol also makes the cervix open up. As well as that, it causes contractions and bleeding in the womb, expelling the embryo together with the lining of the womb.

You don’t usually have to take antibiotics before a medication abortion. They’re only recommended before a surgical abortion.

These are the steps involved:

1. First, you take three mifepristone pills. A doctor has to be with you when you do this. Then you can go home. Some women start to bleed the same day. The bleeding is similar to a normal period.
2. You use the second medication, misoprostol, 24 to 48 hours later. You can swallow it as a tablet, let it dissolve in your mouth or put it in your vagina. This can be done at home. The doctor will give you the medication to take with you. To reduce side effects, doctors recommend taking something to fight nausea too, as well as an NSAID painkiller (like ibuprofen or diclofenac) for the pain. Some women need a stronger painkiller.
3. If the bleeding hasn’t started after three hours, you can use a second dose of misoprostol.

Post-abortion bleeding is heavier than a period and may contain blood clots and pieces of tissue. It is a good idea to use thick sanitary pads. If you have an abortion after your 8th week of pregnancy, you might be able to see an embryo (around 2 centimeters in size).

Many women find it soothing to be in a calm, familiar environment with someone they are close to – especially after they’ve used the second medication. It is also important to be near to a toilet at all times. If you have any problems or questions, you can call the doctor's practice, clinic or hospital.

Post-abortion bleeding typically lasts around nine days. It may be heavier than a normal period. In rare cases, light bleeding can continue for several weeks after that. If this happens, it might mean that the abortion didn’t remove all of the pregnancy tissue. You can get a sick note to give to your employer for the day of the medication abortion and the days following it. It tells the employer you’re unfit for work but not why.

The most common side effects are cramps and pain in the lower belly area, diarrhea, nausea, vomiting, fever and dizziness. These are mainly caused by the misoprostol.

In 30 to 50 out of 1,000 medication abortions, some of the womb lining or the embryo is left in the womb. Signs of this include vaginal bleeding, pain in the lower belly area and fever. The remaining tissue may come out when you have your next period. You can also use another dose of misoprostol to remove it. Sometimes it’s removed surgically.

In rare cases, medication abortions can result in:

• heavy bleeding (in 10 out of 1,000 women)
• pelvic infections (in 1 out of 1,000 women). The symptoms are fever and pain. You can take antibiotics for this kind of infection.

Very rarely, scar tissue develops inside the womb, causing irregular periods and period pain. The medical name for this is Asherman Syndrome. It happens in around 1 out of 10,000 medication abortions – but only if a dilation and curettage (D&C) procedure is carried out because the abortion didn’t remove all of the pregnancy tissue.

It is important to go to a doctor or hospital if you

• bleed for a long time or heavily (more than four fully soaked large pads in the space of two hours),
• have a fever that lasts more than 24 hours, or
• feel very unwell for more than 24 hours after using misoprostol.

If you take anticoagulants or certain NSAID painkillers like diclofenac or acetylsalicylic acid (the drug in medicines like Aspirin) or if you have a blood-clotting disorder or anemia, you should tell the doctor beforehand because there’s a higher risk of the abortion causing heavy bleeding.

Mifepristone can make steroid-based medications – like asthma inhalers – less effective. Then the steroid dose can be increased on the day of the abortion.

According to medical societies, women who are breastfeeding can have a medication abortion. But according to the advice in the package insert for mifepristone, women who are breastfeeding shouldn’t use it because the mifepristone could theoretically get into their breast milk. You can prevent that from happening by not breastfeeding for four days after using the medication.

The bleeding usually stops about ten days after a medication abortion. The most reliable sign that the abortion was successful is when you get your next period. But that often doesn’t happen until a good few weeks after the abortion.

The abortion fails to work in 10 out of 1,000 women. Then they’re still pregnant. If this becomes clear straight away because, for instance, there’s hardly any bleeding, she can use another dose of misoprostol. Or she can have a surgical abortion. If she does go on to have the baby, there is an increased risk of deformities in the child due to the misoprostol.

It is a good idea to have a check-up after a medication abortion because women don’t always notice if they’re still pregnant. A doctor can confirm either way by doing an ultrasound scan. If you don’t want a scan, you can do a special urine-based pregnancy test around two weeks after the abortion. The doctor can tell you more about this. If the test result is negative and you haven’t got any unusual symptoms like fever or pain, there’s no need for a check-up.

It is also possible to have a post-abortion appointment by video chat or telephone and talk to a doctor about the result of the urine test then – if they offer this service.