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What Is A Medication Abortion?



What is a medication abortion?


Medication abortion is an abortion done using pills (instead of a procedure). Medication abortions are also known as abortion with pills or sometimes called “Plan C.” There are two main options when doing an abortion with pills and they are to take both mifepristone and misoprostol or to take only misoprostol. Both methods are very safe and effective. Mifepristone was created in France in the 1980s and was first approved for use with abortion by the FDA in the year 2000. The number of medication abortions has steadily increased since 2000 and now makes up 63% of all abortions in the US. Medication abortions can be accessed online via telehealth or in person at a clinic and both methods are equally safe and effective.


How do I take mifepristone and misoprostol?


When using both mifepristone and misoprostol for a medication abortion, start by swallowing one 200 mg mifepristone pill. Most people do not have side effects after taking mifepristone, but it is normal and not a problem if someone does have bleeding and cramping.


24-48 hours later take misoprostol (200mcg each). Take the misoprostol anywhere in the 24-48 hour window that works with your schedule. The amount of misoprostol depends on how many weeks pregnant you are when you are taking the medications: 

  • Less than 9 weeks - one dose of 4 misoprostol pills

  • 9-12 weeks - 4 misoprostol pills, wait 4 hours, and take 4 more misoprostol pills

  • >12 weeks - 2 misoprostol pills every 3 hours until the pregnancy passes


Misoprostol should not be swallowed and can be taken in any one of the following 3 ways:

  • Held under the tongue for 30 minutes and then swallow what is left

  • Held in the cheeks (like a chipmunk) for 30 minutes and then swallow what is left

  • Inserted in the vagina, lie down or sit on the couch for 30 minutes and then can resume normal activities

If misoprostol is swallowed, it is less effective. Please contact your healthcare provider if you swallowed your misoprostol pills.


For visuals of these instructions, visit our friends at Abuzz Health or the Miscarrige and Abortion Hotline


How do I take misoprostol-only (without mifepristone)?


If mifepristone is unavailable or inaccessible, a medication abortion can be done with misoprostol only. This method is just as safe and 99% effective as taking mifepristone and misoprostol. However, without mifepristone to block progesterone and prepare the uterus, more misoprostol must be taken in order to have a successful abortion with misoprostol-only. Instead of the number of pills mentioned in the section above, someone would take the following:

  • Less than 12 weeks - 4 misoprostol pills every 4 hours for 3 doses (12 pills total)

  • More than 12 weeks - 2 misoprostol pills every 3 hours until the pregnancy passes


Misoprostol is the medicine that makes the uterus contract to push out the pregnancy. It can also cause the side effects of nausea, vomiting, diarrhea, fever, and/or chills. Due to needing to take more misoprostol if they are not taking mifepristone, it causes more pain and can cause more nausea, vomiting, and diarrhea than if mifepristone is available and taken first. 


For visuals of these instructions, visit our friends at Miscarriage and Abortion Hotline.


What can I expect with my medication abortion?


Most people do not have side effects after taking mifepristone. It is okay if you start bleeding and cramping and you can continue to take misoprostol as planned.


Misoprostol causes uterine bleeding and cramping, which is a normal part of the medication abortion process. It can also have the side effects of nausea, vomiting, diarrhea, fever, and/or chills. To help control pain, people can take up to 800mg ibuprofen and 1000mg tylenol every 6 hours as needed. Pain medication can be taken before taking misoprostol or when someone starts to feel pain. Over the counter medications such as dramamine, tums, and pepto bismol can be taken to help with the other side effects.


How long will I have bleeding and cramping?


Every person and every abortion experience is different. Some people describe bleeding and cramping lighter than their periods and some people describe bleeding and cramping pain worse than their strongest periods or similar to early labor. It is impossible to say what exactly someone should expect to feel.


The bleeding and cramping is strongest in the fewer hours after taking misoprostol and should get lighter after the pregnancy passes out of the uterus. Lighter bleeding and cramping can then continue anywhere from 1 to 5 weeks after taking the abortion pills. This bleeding and cramping can come and go in waves - sometimes lighter and sometimes heavier. If the bleeding is ever heavy enough to soak 2 large overnight pads for 2 hours in a row (4 pads in 2 hours), this is too heavy and you should be seen for urgent medical evaluation.


When will my pregnancy symptoms stop?


It is common to have a number of different symptoms early in pregnancy such as nausea, appetite changes, mood changes, dizziness, feeling tired, and breast pain. All of these symptoms except for breast pain, should stop within 1-2 days of a successful medication abortion. Breast pain often takes 1-2 weeks to stop after a medication abortion.


When will my pregnancy test be negative?


A urine pregnancy test will stay positive for at least 4 weeks after a medication abortion. They usually turn negative between 4-6 weeks after taking abortion pills. It takes weeks for the hormone hCG to return to the non-pregnant level.


How to get abortion pills


If you have decided that medication abortion is right for you, you can schedule an appointment with us if you live in California, Colorado, DC, Maryland, Massachusetts, New Mexico, or Oregon. If you live in another state or would like to see your other options, visit Plan C or Ineedana



Written by Christie Pitney, WHNP-BC, CNM, founder of Forward Midwifery

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