This story has been reviewed by Rathika Nimalendran, M.D., a family medicine practitioner and abortion provider based in North Carolina.
Although the abortion pill has been available in the United States for more than 20 years, many people still don’t know that the first-trimester abortion option is safe and effective. The process is non-invasive, doesn’t require anesthesia, and can almost always be carried out from the comfort of your home. And, as of July 2020, a federal judge ruled that the abortion pill can be prescribed by mail during the COVID-19 pandemic in 20 states.
Many reproductive health advocates see the abortion pill as the final frontier of reproductive freedom, but the Food and Drug Administration, politicians, and policymakers have made the medication difficult to access since it first became available in the U.S. Still, in 2017, the abortion pill—also known as medication abortion or medical abortion—made up 39 percent of all abortion procedures in the U.S.
To shed some light on this safe and effective procedure, here’s what you need to know about medication abortions.
What is the abortion pill?
A medication abortion is not just one “abortion pill,” but a combination of two medications prescribed by a physician that work together to terminate a pregnancy and shed the uterine lining. The two medicines used are mifepristone and misoprostol. Mifepristone, which is taken first, works by blocking progesterone, a hormone necessary to sustain pregnancy, causing the embryo to detach from the uterine wall. Misoprostol is taken within a day or two of taking the first pill, usually at home, and works by causing cramping that empties the uterus, kind of like a heavy period.
According to stats from Planned Parenthood, a medication abortion is 98 percent effective up to eight weeks into a pregnancy. From 8 to 9 weeks, it’s about 96 percent effective. Then 93 percent effective from 9 to 10 weeks, but if you’re given an extra dose of medication (which is safe to do) that goes back up to 99 percent effective. Same goes if a person is 10 to 11 weeks, it’s 87 percent effective, but 98 percent effective if you’re given that extra dose.
Who can use the abortion pill?
Medication abortion is a safe (and common) procedure for terminating first-trimester pregnancies. Planned Parenthood and many other clinics provide medication abortions up to 11 weeks after the first day of your last period.
Depending on where you go, you can also opt to take the abortion pill in-clinic as soon as you have a positive pregnancy test (or, more often, once you’re 5 to 6 weeks pregnant). People under 18 are able to have medication abortions, though most states require some sort of parental consent (in some cases, you need consent from two parents) or a judicial bypass (which many lawyers will do pro bono).
How to get the abortion pill.
This part gets tricky because states keep changing their regulations surrounding medication abortion. For the most part, medication abortion is available nationwide at clinics like Planned Parenthood (you can search their site to see if your local clinic provides the procedure). Locally, your regular OB/GYN may also be able to provide a medication abortion. To find a provider nearby, you can call the National Abortion Federation or check online at the Safe Place Project. Both of those resources allow you to search anonymously if you have privacy concerns.
Different states have different laws regulating when and how someone can actually get a medication abortion. A slight majority of states have mandatory waiting periods ranging anywhere from 24 to 72 hours between receiving abortion counseling and beginning any type of abortion procedure. In Texas, a state with some of the most restrictive laws surrounding abortion care, the law requires a mandatory, in-person consultation appointment with a physician at least 24 hours before taking the first pill. But that requirement doesn’t exist in states like Florida, Connecticut, and Delaware, all of which have fewer restrictions. 19 states also require you to be in the physical presence of the doctor who prescribed the medication, but that restriction may have been paused in some states by the Supreme Court, due to the pandemic.
What happens when you take the abortion pill?
Your physician will give you a pregnancy test and, in some states, perform a mandatory ultrasound to determine how far along you are. You’ll get written instructions from your physician on how to take the pills.
Most people don’t experience any side effects after taking the first pill, mifepristone, but it’s not unusual to feel nauseous or start bleeding. Because its job is to cause the uterine lining to shed, misoprostol should cause a lot of bleeding and cramping within one to four hours of taking the first dose. Some people say this cramping feels “like normal period cramps” and don’t experience intense bleeding, but you may feel nauseous and experience intense cramping and heavy bleeding (think, soaking through a maxi pad).
It’s not abnormal to see large clumps of tissue or blood clots after taking the misoprostol (Planned Parenthood says these can be up to the size of a lemon). The bleeding should start to subside after a few hours, usually around four to five, but can take longer. Cramping will continue for a day or two and decrease in intensity with time. If you’re feeling pain or nausea, your doctor can prescribe an anti-nausea medication and you can take ibuprofen. However DO NOT take aspirin, which is a blood thinner and can cause more bleeding.
Bleeding and spotting might continue for two to three weeks after the abortion. Your doctor will have you come back in for a follow up, where you’ll get a blood test and possibly another ultrasound to make sure the abortion was complete and you’re healthy.
What are the side effects of the abortion pill?
Most people compare medication abortion to the feeling of an early miscarriage, meaning the primary physical effects are bleeding and cramping. But other side effects include nausea, vomiting, diarrhea, dizziness, fatigue, and a mild fever up to about 100 degrees. If you have a fever higher than that after you take the misoprostol, you should call your doctor immediately. The risk of infection with a medication abortion is very low but not totally impossible. Your doctor can prescribe antibiotics if you have an infection.
Is the abortion pill safe?
According to the Guttmacher Institute, fewer than 0.4 percent of people who get medication abortions require hospitalization for serious side effects like infection or hemorrhage. The most common adverse outcomes are continued bleeding or that you’re still pregnant (or that you’ve retained some pregnancy tissue). If the abortion didn’t work, you can then decide between taking more medication or having an in-clinic abortion.
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