About the Abortion Pill
The Abortion Pill (also called Mifeprex, Mifepristone, or RU-486) provides women with a medical alternative to surgical abortion.
- Mifepristone, in conjunction with misoprostol (also called Cytotec) was approved for use as an abortifacient by the United States Food and Drug Administration (FDA) on September 28, 2000.
- This antiprogesterone drug blocks receptors of progesterone, a key hormone in the establishment and maintenance of human pregnancy.
- Mifepristone induces spontaneous abortion when administered in early pregnancy and followed by a dose of misoprostol, a prostaglandin.
How the Abortion Pill Works
The Abortion Pill procedure involves the oral ingestion of mifepristone after ultrasound verification of a pregnancy ten weeks gestation or less. 24 to 48 hours later, misoprostol is inserted into the cheeks, held in place for 30 minutes, and then swallowed with water. In most cases, a miscarriage occurs within 24 hours.
If bleeding does not occur after 24 hours, the misoprostol insertion is repeated or a surgical procedure can be performed if you prefer. Usually bleeding is like a spontaneous miscarriage and bleeding or spotting may occur for up to two weeks or longer. An ultrasound will be used to verify the successful termination of the pregnancy.
Results and Side Effects
The abortion pill is limited to patients ten weeks pregnant or less, as verified by ultrasound. If the abortion does not occur with medication alone, a surgical abortion must be performed. This situation rarely occurs, but the patient must agree to undergo a surgical abortion if the abortion is not completed with the medication alone.
The primary advantage of the abortion pill lies in the ability to end the pregnancy in the privacy of the patient’s own home. Side effects of mifepristone and misoprostol can include nausea, vomiting, diarrhea, heavy vaginal bleeding, headache, dizziness, backache and fatigue. Occasionally, the cramping may become quite severe, particularly when the pregnancy tissue is being expelled.
No sexual intercourse, tampon use, or douching is allowed for two weeks after your abortion.
Safety of the Abortion Pill
Mifepristone is as safe as a surgical abortion for most women. The medication abortion is a completely noninvasive procedure and does not require sedation or a local anesthetic. However, as with surgical abortion, risk of hemorrhage does exist. In rare cases, the incomplete passage of tissue requires a surgical evacuation.
Serious infection can occur in about 1 per 1,000 women and death from infection occurs in less than 1 per 100,000 women. Therefore, if you develop a flu-like condition including sluggishness, weakness or muscle aches with or without fever, abdominal pain, nausea, vomiting or diarrhea more than 24 hours after taking misoprostol (Cytotec), it is essential that you call us immediately.
As a means of helping to prevent the already low chance of infection, we will provide you with antibiotics. Please tell us if you have any drug allergies or have had any abnormal reactions to any medications. You can help prevent infection by taking your antibiotics as directed and by avoiding tampon use, sexual activity, douching, or placing anything in the vagina for two full weeks after the abortion pill process. Please contact us immediately if you have any signs of an allergic reaction or have other abnormal reactions to your medications during the abortion pill procedure.
Efficacy & Acceptability
Approximately 1.75 million women in the U.S. and millions more worldwide have chosen the Abortion Pill. It is effective approximately 92-95% of the time. This means, for every 100 woman who use the abortion pill between 5 and 8 women will need a surgical procedure to terminate the pregnancy or to stop heavy bleeding.
Misoprostol (or Cytotec) is a prostaglandin drug. It had previously received FDA approval for use in the prevention of ulcers in high-risk patients taking non-steroidal, anti-inflammatory drugs.
About Your First Visit
Plan to spend 1 to 2 hours with us in the office.
When you arrive at the office, you will be asked to complete personal demographic and health information and consent forms. A lab technician will draw a sample of your blood to determine your Rh factor and iron level. Your vital signs will be taken. The clinician (a Physician Assistant or Nurse Practitioner) will review your medical history and perform a physical examination and transvaginal (internal) ultrasound. An admissions staff member will explain the procedure to you and assist you in completing additional paperwork.
Taking the First Pill (Mifepristone)
You will take the first pill, mifepristone, in the clinic. We will give you the misoprostol, antibiotics and a prescription for pain medication to take home. Though most women have no side effects after taking mifepristone, some possible side effects are nausea, headache, bleeding and cramping. Some women even pass the pregnancy with mifepristone alone, though this is rare.
Day 2: Take Misoprostol at Home
We will give you a time frame in which to take the misoprostol. The exact time is your choice, depending on work, school, childcare or other responsibilities. Plan to be at home for at least 12 hours after taking misoprostol. Expect to have bleeding, blood clots and cramping. Some other possible side effects of misoprostol are nausea, diarrhea and an elevated temperature. We will give you pain medication to help you through this time. You are free to go to work or school the day after you take misoprostol. You will also be given an instruction sheet with our 24-hour emergency number. Call with any questions or to discuss problems that occur after your visit.
Your Follow-Up Appointment
You will have your vital signs taken, a transvaginal (internal) ultrasound, and a physical exam and/or blood testing (if necessary). If you would like to start a birth control method, we can provide you with one at this time, if you are medically eligible.
Frequently Asked Questions
What is the abortion pill?
The ‘abortion pill’ is a non-surgical method used to terminate a pregnancy. This method is available for women under 10.0 weeks of pregnancy.
With the ‘abortion pill’ procedure, a set of two medications are taken over the course of two days to induce a miscarriage at home. On the first day you will come into the facility, fill out paperwork, have lab work, an exam and an ultrasound, go over your paperwork with one of our staff members and then take the first medication while you are in our office. The first medication terminates the pregnancy and then 24-48 hours later, at home, you will take the second medication. The second medication softens the cervix and induces uterine contractions, which the pregnancy to pass. It is normal to feel cramping, have moderate to heavy bleeding, and to pass large blood clots during this process. A follow up visit is required 1-2 weeks later in order to confirm that the ‘abortion pill’ was successful and that you are no longer pregnant.
Will it hurt?
After taking the abortion pill, you may experience moderate to severe cramping while passing the pregnancy. In most cases ibuprofen (Motrin/Advil/Midol), naproxen (Aleve) or acetaminophen (Tylenol) will alleviate the cramping. If medically appropriate, we will also give you a prescription for a stronger pain reliever, such as Tylenol with codeine for additional pain relief.
How will I know that the abortion was successful?
The only way to know if the abortion was successful is to return for your follow-up visit 1-2 weeks later. In our experience, it is possible to have heavy bleeding and cramping and pass clots, yet still be pregnant. In very rare cases, the pregnancy can continue to grow and progress after taking the ‘abortion pill’. This is why it is so important to return within a few weeks of your procedure.
What if the pill doesn’t work?
In a small percentage of cases, the medication abortion does not successfully cause a miscarriage. In these cases, the patient will require additional medications and medical treatment or a surgical abortion. Any additional care is covered by your initial payment provided that you return for evaluation and treatment in a timely manner.
Can I exercise after taking the pill?
You should not exercise after taking the pill until you return for you follow-up visit. The clinician will advise you at that time when you can resume physical activity.
Most often you can go back to your regular activities within a week of your procedure. Strenuous exercise can sometimes increase the amount of bleeding and cramping that you experience. If you notice an increase in your bleeding or cramping after exercising you may want to decrease your activity for a few days. Please do not hesitate to contact us if you have any questions or concerns. If at any point you fully soak a maxi-pad in one hour or less you should call us right away. We have a 24-hour call service in case of emergent concerns or questions.
How long will I bleed after taking the pill?
In some cases patients can have period like bleeding for up to 2 to 3 weeks after taking the abortion pill. Bleeding can range from very light spotting to a flow heavier than a normal period. If you ever fully soak one pad in an hour or less, or if you have any questions about what is normal after your abortion, you can always call our office. We have a 24-hour on-call service in case of emergent questions and concerns.
Can I use tampons after taking the abortion pill?
You should not use tampons for two weeks after taking the abortion pill. Sanitary napkins should be used to decrease the possibility of infection and help you to monitor how much bleeding you are having more closely.
How effective is the abortion pill?
The abortion pill is 95-98% effective. This means that 5 to 8 out of every 100 woman who take the abortion pill will need additional medications, medical treatment and/or a surgical procedure to complete the abortion. This is why it is so important for you to return for your follow up visit after taking the medication.
When can I return to school or work?
You will take the Mifeprex in our office on ‘day one’ after having an exam, ultrasound, lab work and signing consents. You can go to work, school or make other plans that day, it is very rare that you would start to bleed or pass the pregnancy after taking the first medicine alone. You should make arrangements to be at home on ‘day two’ for at least 24 hours after taking the Cytotec (the second medication). The bleeding and cramping is moderate to heavy for most women and you should not be at school or work while you are passing the pregnancy. In most cases you can return to your regular obligations and activities the following day.
If I can’t come back to FPA for my follow-up appointment, can I just see my doctor or take a home pregnancy test?
By consenting to take the abortion pill at FPA, you also commit to returning to our office for your follow-up appointment. If you know that you are unable to return to see us, you should not take the abortion pill with us. In order to confirm that the abortion is complete, it is necessary for us to do an ultrasound. The abortion pill procedure is not 100% effective. If the abortion is not complete, only FPA can provide you with the additional medications or services needed to complete it. Home pregnancy tests can remain positive for over a month in some cases.