Medication abortion is a safe and effective way to end an early pregnancy using medications. These instructions explain how to take your medications, what to expect during the process, how to manage common symptoms, when to seek help, and what to expect afterward.
Your specific instructions may occasionally differ depending on your pregnancy and medical history. If you are unsure what to do or have questions at any point, please contact our office.
Medication abortion typically uses two medications that work together: mifepristone and misoprostol. Mifepristone is taken first and blocks progesterone, a hormone needed for the pregnancy to continue developing. Misoprostol is taken afterward and causes the uterus to contract and the cervix to soften, allowing the pregnancy to pass.
Follow the instructions below carefully. The timing and way you take each medication are important for the treatment to work effectively.
Mifepristone is taken in our office. Before taking the medication, we will review the treatment plan with you and complete the required paperwork. You will then be given the mifepristone tablet along with a bottle of water to take during your visit.
After taking mifepristone, you can generally continue your usual activities and go home normally. Most people have few or no symptoms at this stage. Some mild cramping or spotting can occur, but the heavier bleeding and cramping associated with medication abortion typically begin after taking misoprostol.
Take your first dose of misoprostol at least 24 hours, but no more than 48 hours, after taking mifepristone. Misoprostol causes the uterus to contract and the cervix to soften, allowing the pregnancy to pass.
Misoprostol can be taken in several different ways. We will discuss these options with you so you can choose the method that works best for you.
Buccal (between the cheek and gum): Place 2 tablets between the cheek and gum on each side of your mouth. Leave them in place for 30 minutes, then swallow any remaining pieces with water.
Sublingual (under the tongue): Place all 4 tablets under your tongue for 30 minutes, then swallow any remaining pieces with water.
Vaginal: With clean hands, insert all 4 tablets high into the vagina. Lying down for about 30 minutes afterward can help keep the tablets in place. The tablets will dissolve and the medication will be absorbed through the vaginal tissue. This route may cause fewer gastrointestinal side effects.
You will also be provided with a refill for a second dose of misoprostol. If you have no bleeding within 12–24 hours after your first dose, you may be instructed to take the second dose. Depending on how far along your pregnancy is, I may recommend taking the second dose even if bleeding has already started to increase the likelihood that the treatment is successful.
Follow the specific instructions provided at your visit, since whether and when you should take the second dose may depend on how far along the pregnancy is and your individual treatment plan.
After mifepristone: Most people have few or no symptoms after taking mifepristone. Some mild cramping or spotting can occur, but the heavier bleeding and cramping associated with medication abortion usually begin after taking misoprostol.
After misoprostol: Cramping and bleeding are expected as the pregnancy passes. Bleeding is often heavier than a normal period and may include blood clots or pregnancy tissue. Cramping can be strong, particularly during the several hours when the pregnancy is passing.
Nausea, vomiting, diarrhea, chills, headache, and a temporary fever can also occur after misoprostol. These symptoms are generally short-lived and improve as the medication wears off.
After the heaviest bleeding and cramping have passed, both should gradually improve. Lighter bleeding or spotting may continue for several weeks.
Managing Pain & Other Symptoms
Before you leave the office, we can prescribe medications to help manage pain, cramping, and nausea at home. We will review how and when to take these medications with you.
Ibuprofen is particularly helpful for uterine cramping and can be taken as directed. A heating pad or hot water bottle on the lower abdomen can also provide significant relief. If you are prescribed additional pain or nausea medication, take it according to the instructions provided.
It can be helpful to plan to be at home somewhere comfortable with easy access to a bathroom after taking misoprostol. Having pads available will also make it easier to monitor your bleeding.
We will usually schedule an ultrasound and office visit sometime during the following week to make sure the pregnancy has passed and that the medication abortion is complete. It is important to keep this appointment even if you feel that everything went as expected.
Some bleeding or spotting may still be present at your follow-up visit and does not necessarily mean that the treatment was unsuccessful.
When will my period return?
Your bleeding after taking misoprostol is part of the medication abortion and is not your next menstrual period. Your regular menstrual cycle will begin again afterward, and your next period will typically occur within about 4–8 weeks. The first period may be somewhat different from your usual period.
When can I become pregnant again?
Fertility can return very quickly after an abortion, sometimes within just a few weeks and before your next period occurs. Having a medication abortion does not generally affect your ability to become pregnant in the future.
When can I start birth control?
Most birth control methods can be started soon after a medication abortion, and you do not need to wait for your next period. If you would like to start or change birth control, we can discuss your options and the best time to begin your chosen method at your visit.
People can have a wide range of emotions after an abortion. You may feel relief, sadness, grief, or a mixture of emotions, and your feelings may also change over time. There is no single “right” way to feel. If you are having a difficult time emotionally or would like additional support, please let us know. We can help connect you with supportive resources.
Some bleeding, cramping, and temporary side effects are expected with medication abortion. Please contact our office if you are concerned about how you are feeling or if something does not seem right.
Call our office if you have:
Very heavy bleeding, such as soaking through 2 full-size pads per hour for 2 hours in a row
Severe or worsening abdominal/pelvic pain that is not improving with your prescribed pain medication
A fever of 100.4°F (38°C) or higher that lasts more than 4 hours, or a fever that begins or persists more than 24 hours after taking misoprostol
Persistent nausea, vomiting, or diarrhea that makes it difficult to keep down fluids
No bleeding within 24 hours after taking misoprostol, particularly after following the instructions for your additional dose
Pregnancy symptoms that are not beginning to improve over the following several days
Any other symptoms that are persistent, worsening, or concerning to you
Seek urgent medical attention for fainting or loss of consciousness, severe weakness or dizziness, difficulty breathing, severe pain with feeling very ill, or bleeding that feels uncontrolled.