This story has been reviewed by Rathika Nimalendran, M.D., a family medicine practitioner and abortion provider based in North Carolina.
In 2000, the Food and Drug Administration approved a drug called Mifeprex, a brand of mifepristone. Taken in combination with a medication called misoprostol, it’s used to safely and effectively end pregnancies up to 11 weeks. This non-surgical method of terminating a pregnancy is known as medication abortion. In 2017, medical abortions made up 39 percent of all abortions.
A little recap of how these pills work: A medication abortion begins after you take 200 milligrams of Mifeprex by mouth, usually at a doctor’s office or clinic but increasingly at home during the Coronavirus pandemic. The medication blocks progesterone, the hormone responsible for keeping the embryo attached to the uterine wall. Then you can go home. Depending on how far along you are, 24 to 48 hours later, you’ll take four misoprostol pills (800 micrograms total), vaginally or by dissolving them under your tongue. If your pregnancy is further along, you might take a second set of misoprostol pills four hours later. This second medication dispels the embryo from your uterus, which can feel and look similar to a heavy period. You’ll also have a follow-up appointment in-person or over the phone with your provider one to two weeks later to take an at-home pregnancy test or get a blood test or ultrasound.
Medication abortions are non-invasive and don’t require anesthesia. They’re also 98 percent effective before 8 weeks of pregnancy and only cause serious side effects in about 0.4 percent of people who choose them.
Other first-trimester options include aspiration, a procedure that uses suction to remove what’s inside the uterus, which can be used as early as your first positive pregnancy test or up to 16 weeks from your missed period. There’s also dilation and curettage (D and C), a surgical procedure in which the cervix is dilated before the uterus is emptied that can be used up to 16 weeks from the last period.
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. About half of states have mandatory waiting periods ranging anywhere from 24 to 72 hours after receiving abortion counseling.
To shed light on what it’s like to take the abortion pill, Cosmopolitan.com spoke with three anonymous women about their experiences taking the abortion pill in 2016, the year the FDA expanded access to abortion pills by loosening the regulations on the pills. One was married with two children (the Guttmacher Institute reports that the majority of people who have abortions are already parents), another was an unmarried university student, and the third was married with no children.
How old are you and when did you have a medication abortion?
Woman A: I am 39. I just had the abortion when I was about eight weeks along.
Woman B: I’m 20, and I was nine weeks by the time I got the abortion.
Woman C: I’m 27. I had the abortion when I was eight weeks pregnant exactly.
Did you know right away that you wanted to end the pregnancy?
Woman A: I found out I was pregnant by taking a home pregnancy test. I was feeling weird and tired, and my husband suggested I “go pee on a stick.” When I [went in for the abortion and] got the vaginal ultrasound done, I was eight weeks pregnant, so I was probably five or six weeks along when I first found out. I’m married with two toddlers already, so I was not thrilled to find out I was pregnant. Since I was on the pill at the time (and I took it like clockwork), I was mostly angry. I know it’s not 100 percent effective, but it sucks to find out you’re that tiny percentage who it didn’t work for.
I considered an abortion almost immediately [after my home pregnancy test]. I surprised myself and my husband with that. I think we both thought we’d probably never take that route — [we made the decision] not out of any religious or moral objections [but because] I don’t have the time, energy, or money for another kid right now. Thankfully, my husband is getting a vasectomy in a couple of weeks. It’s his turn to shoulder some of the responsibility for birth control!
Woman B: I’d started feeling really sick all the time and hypersensitive to smells…I was also super-grouchy, and even something as small as someone breathing heavily would send me into a rage. Then my period never came and I tested it.
I’d been with my partner for roughly six months or so. We were the same age, and I knew from the get-go I didn’t want to keep it. I go to university and have anxiety and depression, so I knew it was just not an option. I also wasn’t completely happy with him, so I didn’t want to go through with it. He did, however, and resented me for a while afterward.
Woman C: I found out I was pregnant using a home pregnancy test. As a bigger girl, my periods had always been irregular, and only recently had they evened out. When I missed my period [last month], I didn’t sweat it. If I’d decided to ignore my missed period in [this month], it could have been a while before I knew. When I saw two lines pop up, I was floored. It had actually happened. I was scared, horrified, excited, happy, sad. Up until that moment, I’d had no symptoms [other than the missed periods].
The decision was made while I was still holding the test in my hand. Although I agonized over it up until the moment I took the pills, I knew I couldn’t carry to term. If I’d had one thing set up, like a job, or my degree completed, I would have carried to term. It was an easy decision insofar that I knew it had to be made. But it gutted both me and my husband emotionally. I’m still healing; we both are, and I think I will be for a very long time. Living at home with my mother, three cats, and my sister, who lives in a shelter part-time, means there was no money, time, or room for a baby. My husband is in college and I am nearly finished with my degree in paralegal studies. We’re paying off debt and it would be a while before we were financially stable for a child, especially in New York City. Although we’ve been together 10 years and the pregnancy was unplanned, it was wanted, though we understood that we had nothing to offer a child right now.
What did you know about medication abortion before you had one?
Woman A: I knew what the process was but not how it would feel for me. That was the most nerve-wracking part.
Woman B: I’m quite an anxious person by nature, so I did read up on it a lot. I tried to find as many women’s experiences as possible to try to gauge how I might fare. However, you have to be really careful, as many posts are written by anti-abortion campaigners to try and deter women.
Woman C: I didn’t know much about medical abortion except that it existed. I Googled and got a lot of forum posts that were, frankly, terrifying.
Why did you choose medication abortion?
Woman A: I chose a medical abortion because I calculated back from my last period and knew I was within the window when you have that option. If I’d been far enough along to need a surgical abortion, I don’t think I would have done it. I would probably think of the pregnancy more as a baby. Since I already have two children, I have gone through pregnancy before and always thought of the fetus as “the baby.” The more developed the fetus was, the more difficult it would have been to divorce those in my mind.
Woman B: I didn’t really mind either way! I’m actually overweight as a result of depression, and the pregnancy didn’t help [with my weight]. I wasn’t allowed a surgical abortion at that clinic [because my BMI was too high], so I got a medical one, and I’m glad I did.
Editor’s note: Not all abortion clinics are willing or able to deal with the potential complications of sedating people above certain BMIs, and refer these patients to other facilities that are.
Woman C: I chose medical abortion because I wanted privacy at home. However, upon Googling, all I found l were horror stories [about the abortion pill on different forums], like pain and incomplete terminations, so I switched to surgical. As it would turn out, my BMI was too high for the health center to comfortably go forward surgically.
Did you tell anyone about your decision?
Woman A: I didn’t tell anyone I was going to have the abortion. I wasn’t interested in anyone else’s opinion or input. It was a decision my husband and I made together.
Woman B: I didn’t tell anyone other than my partner and my housemate, as she and I were close and obviously she might have heard or seen me in the toilet because of the after-effects of the medication. She was very supportive. My partner seemed to think I was “killing our child,” and that I was being selfish, but he really wasn’t the right guy for me.
Woman C: When I found out I was pregnant, I told only my husband. The initial shame that I felt when we came to the decision of having the abortion kept me quiet for a few days. After I got over that though, I realized that unplanned pregnancies happen, abortions happen, and there’s nothing to be ashamed of. So I “came out” about it on Facebook [four days beforehand]. It went over really well for the most part. I got support from online friends and those who maybe didn’t agree kept to themselves as far as I saw, which is just fine by me! I told my mother against my better judgment. All of my sisters were teen mothers, as was my mother. My mother and four sisters had multiple children before they were old enough to drink, and so far I’m the only one who’s made it to this age without a child.
My mother also had abortions after her first two children and before me, and still grieves her abortions 30 years later. She did tell me she had her abortions because she felt she had no choice and seemed sad that I would feel I had no choice.
I thought my mother would understand. What actually happened was her crying while pushing me to keep the pregnancy. She’d try and guilt me by saying, “It could be the next Obama!” and, “God gave you this child for a reason,” she then moved on to things like, “When I was pregnant with you we didn’t have anything and we made it.” Her reaction to my choosing abortion was not one of love and acceptance. She questioned my relationship, going so far as to pull me aside and seriously ask me if my husband put me up to this. He didn’t and would never.
What kind of clinic did you go to and how much did the procedure cost?
Woman A: Planned Parenthood in Southern California. My insurance didn’t cover it, but they did cover the check-up and subsequent birth control given to me by Planned Parenthood (Depo-Provera shot). In 2016, the total cost was $659.
Woman B: A British Pregnancy Advisory Service clinic. The procedure was free, as I am in the U.K.
Woman C: A Planned Parenthood in New York City. The procedure cost me nothing. I arrived in NYC a few months ago after three years of living in South Carolina. I went to Planned Parenthood in June to discuss a breast lump (which thankfully turned out to be nothing), but I didn’t have any health insurance at the time. After a meeting with Planned Parenthood social workers, I was offered one year of free care, anything that I needed, due to me having no job and not being enrolled in classes yet.
Did anyone go with you to the clinic?
Woman A: My husband went with me to the clinic, though he couldn’t come any farther than the waiting room. One of the things the Planned Parenthood nurse asked is if this decision was mine, and if anyone was forcing me or pressuring me to do it against my will. So it makes sense that they would need that answer in privacy.
Woman B: My partner went with me, and he was allowed in for certain parts, such as the administering of pills. However, for the preliminary chat, he had to stay in the waiting room just to make sure it was all my choice and I wasn’t being coerced.
Woman C: My husband went with me to the clinic. The Planned Parenthood I usually go to is in Brooklyn, where he can accompany me; however, we were at Planned Parenthood that day and all non-patients were to wait in a waiting room with a locked door separating that from where we patients were.
[Editor’s Note: Due to the Covid-19 pandemic, most clinics are not able to allow anyone else inside at this time.]
What were the steps of your medication abortion?
Woman A: I called Planned Parenthood and made an appointment for about two weeks out. I wish I’d been able to get in sooner. It was tough to have made the decision to terminate and then have to wait for it. I went in on a Wednesday afternoon and was there for about 90 minutes. I had to pee in a cup, then have a vaginal ultrasound to make sure I was really (still) pregnant and to determine how far along I was.
Then I went into another room where a nurse asked me a handful of relevant health questions, another nurse came in to check my blood type and hemoglobin levels, and then I had to watch a short video that explained the procedure and what to expect.
After that, a physician’s assistant came in and went over everything with me one last time and asked if I had any questions. She gave me a bag with an antibiotic, four misoprostol pills, some anti-nausea pills, and perhaps a prescription for Tylenol with codeine (NOTE: Many clinics have stopped dispensing this drug due to the ongoing opioid crisis), and a detailed instruction sheet about what I was supposed to take and when.
All the medicine bottles had colored stickers on them that matched the instruction sheet, so it was very clear and unambiguous. Then the PA administered the mifepristone pill to me. She said that as long as I keep it down and didn’t throw up for 20 minutes, it would [start to] work. I took the pill, checked out at the front desk, and met my husband in the waiting room and cried a bit on my way home.
I was really unsure how I would react, physically, to the mifepristone. Turns out I had no reaction at all. I went to work the next day and felt totally normal. I went out for dinner with my family that night and midway through I felt some vaginal activity, like I was getting my period. I excused myself to go to the restroom and a decent sized clot came out. That evening I continued bleeding and had a bit of cramping.
Friday, I took the day off work, dropped my kids off at daycare, got some ice cream at the market, and went home to take the misoprostol pills. They gave me four pills, and I was supposed to dissolve two [pills] in each cheek, by my lower gums. The Physican Assistant said if they weren’t totally dissolved in 30 minutes to just swallow the rest, which I did. There was a gradual increase in cramps and bleeding, but none of it felt any worse than a bad period. I never took anything for the pain or discomfort.
I thought I might watch TV or something, but all I wanted to do was lie down and close my eyes. The one side effect I did experience was diarrhea. There was plenty of that, which was mildly unpleasant, but nothing too dramatic. No nausea at all. I was definitely passing clots but nothing that was noticeably an embryo or pregnancy sac. I never soaked an entire maxi pad or anything either. I went back for my checkup last Friday and they did another vaginal ultrasound to make sure the pregnancy was expelled. All clear.
Woman B: So the first step was to go and get all my vitals checked. The lady did all sorts of tests (HIV tests, STI checks, ultrasound of the fetus) and checked my blood pressure, weight, height, and more. You don’t have to look at the ultrasound, but I wanted to, just out of curiosity. You then go sit in a waiting room ’til they call you in and basically make sure you’re doing it of your own volition and not being forced; you sign paperwork and forms about your health.
They then prepare all the medication. I got an antibiotic to prevent infection, an anti-nausea pill because the abortion pill can induce vomiting, some codeine, and then the [mifepristone] pill itself. In the U.K., we have one initial oral pill, then a number of pills inserted inside your vagina at the clinic. [Editor’s note: In the U.K., women who have been pregnant for under nine weeks can choose to take the misoprostol during the same appointment in which they take the mifepristone.]
I left almost right away because I wanted to be at home when it happened, not in a taxi. Throughout, I was pretty chill about it, considering. When I got home, nothing happened for about an hour or two. I started feeling like I really needed to poo, almost like a weirdly forceful constipation that was bearing down on my perineum. The most frustrating feeling I’ve ever had. There wasn’t any bleeding for at least three or four hours, but I had half a box of maxi pads on just in case. The codeine they gave me actually put me to sleep and I woke up about four hours after it started, and was bleeding a lot. I went to the loo and passed the fetus. It wasn’t distinguishable as a fetus, but more like gray tissue. I knew what it was immediately, but I felt relief and nothing else. I sat and looked at it on the [toilet paper] for a minute or so, just sort of to get closure, then it was gone. After that, the pain subsided quite a lot, and I was able to clean up and go back to sleep.
Woman C: I was taken to see a nurse who helped me fill out some forms and explained more of the procedure, how to take the pills, what normal bleeding looked like, when to call the 24-hour Planned Parenthood hotline, and when to go to the ER. In the beginning, they ask you if you want to see your ultrasound, and I’d said yes, so it was in her office I saw my little bean, and I was in love. I have the picture and I’ll keep it until the day I die.
Then, I was off to see the doctor. In between these visits was at least a 30- to 40-minute wait. The waiting was the worst part.
I was given a script for anti-nausea medication to be taken prior to the misoprostol, a script for Tylenol with codeine (NOTE: again, this may not be available now), and a script for 800 milligrams of ibuprofen for pain. I was to take one pill in the office called mifepristone, which would stop the production of progesterone, which is needed for a pregnancy to continue. Then, I was to take an antibiotic that night with dinner to stave off potential infection. [Editor’s Note: At this time, research has shown that risk of infection is very low and many clinics are no longer providing antibiotics prior to medication abortions.] No sooner than 24 hours after I took the mifepristone, and no later than 48 hours, I was to take [four pills of] misoprostol, which would begin the process of emptying the uterus. [The pills] tasted terrible. Once I started the process, it was stressed that I must follow through. I could not back out after taking the medicine. After that, all that was left was to wait.
Physically, aside from normal pregnancy feelings of tiredness, I felt fine. There was cramping after the first dose in clinic, but it wasn’t very bad. Felt like normal period cramps. Emotionally I was a wreck. I cried through the entire ordeal. I was so sad even though I knew it was the right thing to do right now. It’s one of the most overwhelming experiences of my life. On the second day, after taking the misoprostol, I got an upset stomach from that and the ibuprofen, and cramps intensified, but not to a level near what I’d heard online or from the staff at Planned Parenthood.
I hung out in the bathroom listening to Les Misérables so I could be in good sad company. I passed the pregnancy within the hour. With that, everything was over. I had moderate bleeding that night followed by light bleeding, which continues today. It could last four to six weeks with spotting. It truly was no more painful than cramps on a medium day. I was floored. Easy and almost painless, I couldn’t have asked for more.
Was there anything about the experience you wish you had known beforehand?
Woman A: I wish I had known if my regular ob-gyn provided abortion services (they don’t). I had to contact them and ask. It was such a simple procedure that I don’t understand why it’s not available through my ob-gyn or even my general practitioner’s office. It also makes me angry that I couldn’t go through this with my regular OB, who I know and trust, and who knows all my medical history. Wouldn’t that be better for women’s health?
Woman B: I wish there’d been more people willing to talk about their experience. It didn’t scar me physically or emotionally at all. I don’t even think about it. There are people who will call me callous or cold-hearted, but I’m really not. It would have been worse to bring a child into the situation I was in.
Woman C: I didn’t expect the grief. It’s overwhelmed me, but it’s still fairly new. And the culture we live in doesn’t promote women speaking about their abortions, let alone the feelings of grief that can come up. I’ve been fairly vocal about it since the procedure was done and every woman I spoke to who had an abortion, regardless of their situation at the time, spoke of grief. It feels like you aren’t allowed to grieve if it was your choice to do this.
Looking back on the experience now, how do you feel about it?
Woman A: Emotionally, it was a hard decision to make. It was painful, and I was angry and sad that I had to make the choice at all. I was using birth control and felt betrayed that it didn’t work. I feel like I made a difficult emotional decision, but intellectually I know it was the right choice. Part of being an adult is that sometimes you have to make the hard choices that don’t feel good but are the best thing in the long run.
Woman B: It was a bloody good job I did. I’m no longer with my partner, my mental health hasn’t improved, and I generally couldn’t have looked after a child. I will never ever regret it.
Woman C: Looking back I don’t regret [the abortion]. I do have regrets though: I regret the situation, we should’ve been more careful with birth control. I regret not having enough to provide.
What do you wish more people knew about medical abortion?
Woman A: I wish people knew how not scary it actually is. The whole process felt very gentle for me (though I’m sure everyone has different experiences), and was not physically traumatic or difficult in any way.
Woman B: You should never ever feel ashamed for the decision to have an abortion. You need to do what is best for your life. More power to you if having a baby is what you want to do, but if you don’t, do not have one just to please anyone or thinking you’ll warm to the idea. It doesn’t hurt as much as people try to scare you into thinking it will, I promise you. Put your needs first.
Woman C: There’s nothing that says you can’t be a mother later if that’s what you want, and it’s actually safer to have an abortion than to give birth.
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