Understanding The Abortion Pill aka Medical Abortion

Whenever we talk about abortion (or you see one on TV), it’s usually the surgical kind, where a doctor operates to remove a pregnancy. That’s one option, and it used to be the only one. But since 2000, there’s been another option in the U.S: medical abortion, also known as the “abortion pill.”

You’ve probably heard of it, but do you know how it works, what taking it involves, and when it is—and isn’t—recommended? Allow us to fill you in.

What is isn’t:

First, let’s clear up a common misunderstanding: it’s nothing to do with the morning-after pill. Emergency contraceptives like Plan B and Ella contain the same hormones as birth-control pills in a concentrated dose that stops your body from releasing an egg so you can’t get pregnant. Abortion pills end an existing pregnancy.

So, what is a medical abortion, exactly?

It actually involves two pills. The first, mifepristone, is taken in a doctor’s office or healthcare clinic and the second, misoprostol, is taken 24-48 hours later at home. (Either inserted into your vagina or dissolved between your gum and cheek.) The first medication blocks progesterone, which a pregnancy needs in order to progress, the second causes the uterus to contract and expel its contents.

Between one and four hours after taking the second pill, you’ll experience cramps and heavy bleeding (including clots), which will last for around four hours. (Have Tylenol or ibuprofen to hand for the pain, but not aspirin – it thins the blood, which will make you bleed more.)

You’ll need to go back to your doctor a week later to make sure the pills worked, but will probably continue to have lighter, period-type bleeding for another week after that and spotting for a couple more weeks.

What if something goes wrong?

Contact your doctor or clinic if anything seems out of the ordinary. If you throw up within an hour of taking mifepristone, you might need a second dose. If you haven’t started bleeding within 24 hours of taking misoprostol, ask a medical practitioner for advice.

Occasionally, people have side effects that signal an infection. If you have nausea, vomiting, diarrhea, or abdominal pain that lasts more than 24 hours after the second pill, particularly with a fever, you need to be checked out ASAP. The same applies if you’re still passing very large clots or bleeding through more than two pads an hour after the initial intense cramping.

If you haven’t fully expelled the pregnancy by your follow-up appointment, you’ll need an aspiration abortion, where a doctor uses (gentle) suction to remove what’s left in your uterus. That’s unlikely, though: taken as prescribed, abortion pills work more than 95% of the time.

Are there any risks to my health?

Medical abortions are safe, but they’re not right for everyone.

Tell your doctor or healthcare provider if you have an existing medical condition, especially anemia or high blood pressure, or if you’re taking any medications or herbal medicines, as they might make the drugs less effective.

Long-term, a medical abortion won’t affect your fertility, reproductive health, or the health of any babies you have in future.

How does it compare to a surgical abortion?

The cost is similar (up to $800) but a medical abortion takes longer, with more bleeding, cramping, and pain. But it’s also less invasive, with no medical instruments, sedation, or anesthesia. There isn’t a medical professional on hand (except by phone), but you can have a friend, family member, or partner by your side.

You can only have a medical abortion in the first 10 weeks of pregnancy but it can be carried out more quickly: as soon as you miss your period.

For what it’s worth, a study by the World Health Organization found that people who’d had a medical abortion would be seven times more likely to choose one again, as opposed to a surgical abortion. Should you need help weighing up that choice, your doctor, or your local branch of Planned Parenthood can give you more information.