Medical Abortion (Abortion Pill): What to Know

Medically Reviewed by Traci C. Johnson, MD on May 27, 2024
Written by Evan Starkman
8 min read

A medical abortion (also called a medication abortion) uses doctor-prescribed drugs to end an early pregnancy. You might have heard people liken this to “taking an abortion pill” in conversation, but that term is a bit misleading.

A medical abortion usually involves taking two medications, the first pill by mouth, the second pill by mouth or through the vagina. It’s an option for those who are less than 11 weeks into their pregnancy – meaning up to 11 weeks (or 77 days) since the first day of your last period. Some doctors who do abortions only offer the procedure up to the ninth week of pregnancy.

Unlike a surgical abortion, a medical abortion doesn’t involve getting surgery or anesthesia (pain-numbing medicine). Instead, you take the abortive medications in a health care setting (like a doctor’s office) or at home. You’ll need to follow your health care provider's instructions to make sure the drugs are effective.

Depending on where you live, you may be able to find a doctor who does medical abortions at certain:

  • Community health centers
  • Private practices
  • Hospitals

Most clinics that do surgical abortions also offer medical abortions.

Some telehealth services also offer online video appointments with doctors who prescribe abortion medication and answer your questions.

If you choose to do a medical abortion at home, it’s important to have access to “safe, nonjudgmental, and supportive care within the formal medical system” in case you need it, says Nisha Verma, MD, Darney-Landy Fellow at The American College of Obstetricians and Gynecologists.

Verma says research shows it’s possible to safely manage a medical abortion without a doctor directly supervising you, as long as you have access to:

  • Accurate information
  • Reliable abortion medications (the drugs mifepristone and misoprostol)
  • Support in case of a rare complication

Medical abortion is subject to the same laws as other types of abortion. Restrictions vary by state.

Abortion doctors are required to follow the laws of the states where they’re licensed to practice medicine. If they break those laws, they could risk losing their license and possibly face criminal or civil penalties.

Laws that set up restrictions against the abortion medications mifepristone and misoprostol have an uneven impact on people of color and people living on low incomes, says Elisabeth Smith, the director of state policy and advocacy at the Center for Reproductive Rights.

It depends on where you live. There are state-by-state restrictions on the online sale of abortion medications.

If you live in a state that allows you to order abortion pills drugs online, it’s very important to buy them from reliable sources. Here’s how to tell legitimate sellers apart from counterfeit ones:

Check your state’s board of pharmacy. Pharmacies, including online ones, are regulated at the state level. Visit the website for your state’s board of pharmacy. It can give you specifics on rules, regulations, and any internet pharmacies approved in the state, says Mary Ann Kliethermes, PharmD, director of medication safety and quality at the American Society of Health-System Pharmacists. 

Use NABP-accredited online pharmacies. The National Association of Boards of Pharmacy (NABP) reviews internet pharmacies. Ones that earn NABP accreditation follow federal and state laws as well as pharmacy practice standards.

To get started, visit the NABP’s “Buy Safely” page. There, you can enter an internet pharmacy’s website and find out if it’s approved or not. Lots of online pharmacies have sprung up in recent years, so you may enter a site that the NABP hasn’t reviewed yet, Kliethermes says. The “Buy Safely” page also includes a link to a downloadable spreadsheet of safe pharmacy websites.

Online pharmacies that get approved through the NABP process have website addresses with “.pharmacy” at the end, and this can’t be faked or forged, Kliethermes says.

The NABP also has a “Not Recommended List” of over 35,000 websites to stay away from. The list includes sites that might not be following safety and pharmacy practice standards, or certain laws.

Illegal sellers usually:

  • Don’t require a valid prescription
  • Sell drugs that aren’t approved by the FDA
  • Don’t hold pharmacy licensure in the state where it’s located or in each state to which it dispenses drugs

It’s not safe for a pregnant person who:

  • Is too far into their pregnancy
  • Has a pregnancy outside of their womb (also called an ectopic pregnancy)
  • Has a blood clot disorder or serious anemia
  • Has adrenal failure
  • Is taking steroid medications long-term
  • Takes any meds that could affect the drugs needed to end the pregnancy
  • Has an IUD (intrauterine device) – a doctor would need to remove this first
  • Is allergic to abortive medications
  • Can’t get to an emergency room if needed
  • Can’t see the doctor for a follow-up appointment

If you’re not sure whether one or more of these things apply to you, it’s important to ask your doctor.

A doctor will talk with you about your health history to figure out if a medical abortion would be safe for you. They should also talk with you about the pros and cons of the procedure. You can ask them any questions you have about the procedure.

If you decide to move forward and you see a doctor in person, they’ll want to confirm that you’re pregnant. If you are, they’ll also figure out how many days you’ve been pregnant. You might need to get an imaging test called an ultrasound. Some states require it, although not for medical reasons.

The doctor might also:

  • Give you a blood test
  • Offer to test you for sexually transmitted diseases (STDs)
  • Discuss the type of birth control you’d like to use after your abortion

Some states require a pregnant person to wait, usually for 24 hours, between their doctor’s counseling and the abortion. In other states, you can get an abortion on the same day.

The usual first medication you take is called mifepristone. Typically you take this at the doctor’s office, but they may let you take it at home. Mifepristone keeps the pregnancy from growing in your womb. It does this by blocking a hormone called progesterone. It’s less common, but some doctors may have you take a drug called methotrexate instead of mifepristone.

Next, you’ll take the usual second medication, misoprostol, 1 to 2 days later at home. Misoprostol brings on cramping and bleeding to empty your womb (uterus). If you’re between 70 and 77 days into the pregnancy, your doctor will have you take a second dose of the drug 4 hours after the first dose. Some doctors tell you to take a second dose even if you’ve been pregnant for less than 70 days.

Some doctors also have you take misoprostol alone, instead of after mifepristone.

If you decide to get the procedure, be sure that you want to end your pregnancy. Stopping the abortive drugs before your procedure is complete could cause the unborn baby to develop severe birth defects in the womb.

You can expect to have vaginal bleeding, pain, and cramps during the process:

Vaginal bleeding. This is normal, and it means the medication is working. You may bleed heavily, especially in the first few hours after taking misoprostol. You’ll probably notice clots, and you might see some pregnancy tissue (especially if you’re over 8 or 10 weeks pregnant). After this tissue passes out of your womb, you’re likely to have less bleeding. The bleeding may last for several weeks, but it should be lighter than a period after a few days.

Call your doctor or abortion clinic if you soak through two menstrual pads in an hour for 2 straight hours and you’re still bleeding. Also call the doctor if you don’t have any vaginal bleeding after taking the medications, because that might mean the drugs aren’t working.

Pain and cramps. It’s also normal to have mild or strong belly pain and cramps after you take misoprostol. The pain usually gets better after any pregnancy tissue leaves your uterus.

You can take ibuprofen to ease the pain, unless you’re not allowed to take it for health reasons. Some doctors prescribe stronger pain meds as needed. You may also get some relief by putting a heating pad on your belly – just make sure it’s not burning hot.

Call the doctor right away if your pain is severe and using meds or heat doesn’t help.

Misoprostol can also bring on side effects like a mild fever, nausea or vomiting, and diarrhea. It’s common for these to quickly go away without treatment.

Call the doctor if you have any of these:

  • A fever above 100.4
  • Chills
  • Vomiting or diarrhea that doesn’t go away after a few hours

 

It’s different for everyone. Some people can get back to their normal routine within a couple of days.

Be sure to skip doing things that bring on pain. Also, don’t have sex or put a tampon, douche, or any other item into your vagina for 1 to 2 weeks after a medical abortion. This helps lower your chances for infections and allows your body to recover.

While you’re recovering, different emotions might come up, including ones like relief, sadness, stress, or feelings of guilt. If the emotions become intense or overwhelming, think about talking to a mental health specialist (like a therapist or counselor). They have ways to help you process what you’re going through and feel better.

This appointment helps your doctor confirm that you’re not pregnant anymore. You might see the doctor who gave you your medical abortion, or another doctor who’s closer to your home.

The procedure works for up to 98% of people who are up to 10 weeks pregnant. It’s less effective for people between 10 and 11 weeks. Because of that, doctors often recommend taking a second dose of misoprostol, which can boost its effectiveness back up to 98%.

For about a handful out of 100 pregnant people, the medication doesn’t work. If that happens to you, your doctor may offer the choice of taking more medication or getting a surgical abortion to complete the process.

Some possible signs that your medical abortion didn’t work are:

  • You don’t have vaginal bleeding after you take the medications.
  • You still have pregnancy symptoms like tender breasts and nausea more than a week after you got the procedure.
  • You keep bleeding for more than 2 weeks after the procedure.
  • You don’t have a period within 6 weeks of the medical abortion.

Talk to your doctor if you notice any of these signs.

Abortion medication that comes from a legitimate source has an expiration date that’s printed on the dispensing label from the pharmacy. Don’t use the medication once this date passes, the National Association of Boards of Pharmacy says.

Store your medication between 59 F to 77 F, and don’t let the room’s humidity rise above 60%, says Kliethermes of the American Society of Health-System Pharmacists.

The drug misoprostol is very sensitive to air and moisture, she says. Store it in its sealed blister pack. If you remove one of the pills from the pack, it will decay and crumble within 48 hours.

The median patient cost for a medical abortion was $595 in 2020, an increase from $495 in 2017, according to the University of California San Francisco. 

If you have health insurance, call your insurer and ask if your plan covers some or all of the cost. If you need help paying for the procedure, you might be able to qualify for financial support through certain abortion funds. 

The total price of a medical abortion could include costs like:

  • The medication itself
  • Doctor appointments (these could include counseling visits before the procedure in states that require it)
  • Lab tests
  • Ultrasound imaging test in states that require it