Medical Abortion and Future Fertility
Abortion methods should not be confused with methods to prevent pregnancy (contraceptive methods, including emergency contraception). Contraceptive methods work by preventing ovulation (the release of an egg) or by stopping the egg and sperm from meeting. Contraceptive methods, including emergency contraception, cannot be used to terminate or interrupt an established pregnancy. You can visit www.findmymethod.org to learn more about contraceptive methods.
You can get pregnant again as soon as 8 days after a medical abortion. If you have sex, you should consider using contraceptives to prevent an unplanned pregnancy.
For some women, cramping is very strong – much more painful than menstrual cramps (if you have menstrual cramps) and the bleeding is much heavier than a menstrual period. You might pass blood clots up to the size of lemons in the first few hours after taking misoprostol. For other women, cramping is mild and bleeding is like a normal menstrual period.
You should avoid using abortion pills at home if you are more than 13 weeks pregnant; if you are allergic to mifepristone or misoprostol; if you have serious health problems, including blood-clotting problems; or if you believe or know that the pregnancy is growing outside the womb (ectopic pregnancy).
There are two types of abortion pills, and each has a different mechanism of action. Mifepristone blocks the hormone needed for a pregnancy to grow, while the ingredients used in misoprostol work by relaxing and opening the cervix (the opening to the uterus) and causing the uterus to contract, which pushes out the pregnancy.
No, use the same number of pills we recommend for everyone. Studies have shown that the success of the medication doesn’t decrease for large or heavy women. You don’t need to take a different dose or more pills.
Emergency contraceptive pills (ECPs) are a safe and effective means of preventing pregnancy after unprotected sexual intercourse. They work by preventing ovulation (the release of an egg) or by stopping the egg and sperm from meeting. ECPs will not terminate or interrupt an established pregnancy. ECPs are different from medical abortion regimens (which include mifepristone and misoprostol). Both treatments are of critical importance for women’s reproductive health globally.
No, abortion pills do not cause birth defects in future pregnancies.
Seek medical care if you don’t bleed or have little bleeding followed by severe pain (particularly in the right shoulder) that is not relieved by ibuprofen. This can be a sign of an ectopic pregnancy (a pregnancy that is located outside of the uterus). While this is rare, it can be life threatening. You can also contact our friends at www.safe2choose.org to speak to a trained abortion counselor if you are concerned that the abortion was not successful.
Misoprostol causes the uterus to contract and expel the pregnancy.
You don’t need to change the dose or the number of pills if you find out you’re pregnant with twins. The same procedure is used for twin pregnancies.
There are two common types of abortion methods: 1) Medical abortion: Medical abortions use pharmacological drugs to terminate the pregnancy. Sometimes the terms “non-surgical abortion” or “abortion with pills” are also used.
2) Surgical abortion: In surgical abortion procedures, a qualified professional will empty the uterus through the cervix to terminate the pregnancy. These procedures include manual vacuum aspiration (MVA) and dilatation and evacuation (D&E).
No, having an abortion with pills will not make it harder to get pregnant in the future.
Seek medical care if you soak through 2 regular pads per hour for 2 hours in a row after you think you have passed the pregnancy. Soaking through means that the pad is saturated with blood front-to-back, side-to-side, and through-and-through.
Mifepristone blocks the hormone needed for a pregnancy to grow.
No, each pregnancy is a unique event. If you used the abortion pill before, you don’t need a higher dose if you use it again for a different unwanted pregnancy.
Take 3-4 pills (200 mg) every 6-8 hours to help alleviate your pain. Remember that you can also take ibuprofen before using misoprostol, too.
Yes, you can use misoprostol safely at home. When you take misoprostol pills, try to make sure that you’re in an area (like your home) where you have privacy and can lay down for a few hours after you take the pills. Having someone with you who can look after you and bring you hot tea or something to eat can be very helpful.
If you have an intrauterine contraceptive device in the uterus (e.g. the coil or the progesterone IUD), you must get it removed before your medical abortion.
After the misoprostol has dissolved, you can eat as you like. Dry food (e.g. crackers or toast) may help with the nausea, while green leafy vegetables, eggs, and red meat can help recover the minerals lost during the abortion.
Do not eat or drink anything for 30 minutes while you allow the misoprostol to dissolve. After 30 minutes have passed, you can drink water to swallow the remnants of the pills and, in general, as much water as you need to feel hydrated.
If you are breastfeeding a baby, the misoprostol pills may cause diarrhea in the baby. To avoid this, breastfeed the baby, take the misoprostol pills, and wait 4 hours before you breastfeed again.
After the misoprostol has dissolved, you can drink any liquid you like (except alcohol).
Yes, you can drink water to help you swallow the mifepristone.
If you are living with HIV, just make sure you’re stable, you’re on antiretroviral medicines, and your health is otherwise good.
Alcohol should be avoided during the treatment to avoid affecting the efficiency of the medication. Alcohol may also cause increased uterine bleeding in some cases and decrease the effectiveness of other medicines taken to reduce pain or infection (for women dealing with complications). In general, it is recommended to avoid alcohol until you confirm the abortion is complete and you are feeling in good health.
There are two ways to use misoprostol: placing the pills in your vagina or under your tongue (sublingually). HowToUse suggests that you only use misoprostol under your tongue because it is more private (the pills dissolve faster and do not leave visible traces in your body) and has less risk of infection.
If you have anemia (low iron levels in your blood), identify a health care provider who is no more than 30 minutes away that can help if you need it. If you are very anemic, consult a doctor before using the abortion pill.
Most women will pass the pregnancy within about 4 – 5 hours and feel better in less than 24 hours. It is normal to continue to see light bleeding and spotting until your next period in about 3 – 4 weeks.
Both the combination of mifepristone and misoprostol and misoprostol-only are effective options. However, if available and affordable to you, the combination of mifepristone and misoprostol should be your preferred choice.
No, using abortion pills early in pregnancy is safe even if you had a previous C-section delivery.
It is normal to feel sick to your stomach, have diarrhea, chills, or even feel like you have a fever during this time. Most women report they know when they have passed the pregnancy because the bleeding slows down, and they start to feel much better.
98 women in 100 will have a complete abortion if mifepristone and misoprostol are used. About 95 women in 100 will have a complete abortion if only misoprostol is used.
There has been no link found between mifepristone and birth defects. However, misoprostol does cause a slightly increased rate of birth defects. If you take misoprostol and you are still pregnant after taking the pills, you might have a natural miscarriage. If you do not have a miscarriage and carry the pregnancy to term, the risk of birth defects increases by 1% (one baby in 100).
Some women may need to have a surgical procedure if they’re still pregnant after taking the pills. Remember! Treatment for an incomplete abortion is widely available around the world. You have the right to this service, even if abortion is legally restricted in your country.
Mifepristone and misoprostol are used together because the pills complement each other. The medicine used in misoprostol works by relaxing and opening the cervix (the opening to the uterus) and causing the uterus to contract, which pushes out the pregnancy.
No, it is not safe to use abortion pills if you know that you are at risk for ectopic pregnancy. Because you had a tubal ligation, we know there is scarring in your tubes (Fallopian tubes). That’s probably why your last pregnancy was an ectopic pregnancy. The Fallopian tubes are where a female egg is fertilized with a male sperm. The pregnancy starts to grow and move along the tube to the womb. If your tube is scarred, the early pregnancy can get trapped in the tube. As the pregnancy grows, it can cause the tube to break open. If the tube breaks open, this can cause major bleeding inside you, which is life threatening. You are at risk for another ectopic pregnancy. You should not use the abortion pills on your own until a healthcare provider is sure that the pregnancy is in the womb, not in your tubes.
If you use misoprostol pills under your tongue, no one will be able to tell you used abortion pills, as you will swallow everything after 30 minutes. If someone asks, you can say you had a natural miscarriage. If you use misoprostol vaginally, the coating of the pill may not dissolve completely for a day or two. If you need to seek urgent medical care within 48 hours since you used misoprostol vaginally, the healthcare provider may see the white coating of the pill in your vagina. This is why HowToUse suggests using misoprostol under your tongue and not inside your vagina.
First, you must know that most women will not be aware of this condition unless they have had an ultrasound. Ectopic pregnancies are not viable so even in countries where abortion is not legal women could have access to a legal procedure to terminate this pregnancy.
- Clinical practice handbook for safe abortion. Geneva: World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1
- FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. FIGO; 2017 https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12181
- Medical management of abortion. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGOhttps://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1
- Royal College of Obstetricians and Gynaecologists. Best practice in comprehensive abortion care. RCOG. 2015. London, Royal College of Obstetricians & Gynaecologists. Best Practice Paper No. 2. https://www.rcog.org.uk/globalassets/documents/guidelines/best-practicepapers/best-practice-paper-2.pdf