What’s a Medication Abortion Really Like?
People who choose medication abortion over in-clinic (surgical) abortion do so for a number of reasons: they can do it in the privacy of their own homes, they may not like going to doctors or being in clinic-type environments, they may want to have a friend or partner with them, or clinic open hours may not mesh with their work or school schedules. Medication abortion is notably cheaper, and in some places, it's the only available option.
But people often report being surprised by how intense their abortion was, and people who were surprised are more likely to say they'd never do it again. We wrote this blog post to help you know what's coming, so you can make an informed decision, prepare yourself, and gather all the supplies needed to make your experience go as smoothly as possible.
So what's it really like?
Note: the information provided here is freely available in many reputable places on the internet and beyond. This blog post should not be taken as advice, medical or legal, and should not stand in for the guidance of an experienced care provider. If you prefer to hear directly from the people who are having abortions, you can read a wide variety of experiences on the subreddit r/abortion.
Most medication abortions in the US are done with two drugs: first mifepristone, then, 24-48 hours later, misoprostol. Most people report no side effects from the first pill. Sometimes people have a little bleeding or a little crampiness, but most people don't notice anything at all*. Taking the misoprostol is a much more intense experience. This is the drug that brings the bleeding and cramping that cause a person to pass the pregnancy and complete the abortion.
Bleeding
Depending on how far along the pregnancy is, the bleeding can be like a regular period, like a really heavy period, or much heavier than a period would normally be. Sometimes the bleeding is dangerously heavy, but this is rare. A person can keep track of how much they're bleeding by using heavy-flow maxi pads, and paying attention to how many pads they soak through per hour. The rule of thumb is if a person completely soaks two pads per hour for two hours in a row, that's too much. Anything short of that is normal.
Along with the blood, people often see clots, sometimes big ones. If the pregnancy is far enough along, they might see a gestational sac with the fetus inside. If the person doesn't want to see that, it's fine to bleed directly into the toilet and flush whatever comes out.**
The bleeding will be heaviest the day that the person takes the misoprostol. Then it will lighten up, but the person may bleed off and on up to 6 weeks after the abortion is complete, right up until the next period. This is normal.
Cramping
The pain, too, is variable depending on how far along the pregnancy is. It may be like a heavy, crampy period, or it might be considerably more painful than that. Some people who had an abortion after they'd had children say that the pain reminded them of labor contractions.
Some descriptions of the pain from r/abortion:
"I was scared but I’m glad I did it. It really wasn’t bad at all."
"The miso pills worked instantly... not even 30 minutes after they dissolved I was cramping and in excruciating pain."
"It’s so painful to me right now, all I can do is curl up on the floor/stay on the toilet."
"They were overwhelming cramps however I was able to lay down and sleep through them. By the morning the cramps were gone..."
"It was uncomfortable but was manageable."
Ibuprofen (Advil, Midol) or naproxen (Aleve) can take the edge off. Up to 1000mg of acetaminophen (Tylenol) can be taken, but studies haven't shown acetaminophen to be as effective as ibuprofen or naproxen. Opioids can be used with caution. A heating pad or hot water bottle held on the low belly can help, as well as a hot shower/bath, rocking back and forth, changing position, and putting pressure on the low back. If you happen to have a TENS unit, using that can help. Distractions, like conversation, a movie or TV series, a game, or a really engaging book might help, too.
Other Side Effects
Nausea, vomiting, diarrhea, low fever and chills, dizziness... these are all expected side effects of misoprostol. There are medications a person can take to relieve them somewhat: Dramamine, meclizine, or Zofran for nausea, Kaopectate for diarrhea, and Tylenol for fever. In addition, the misoprostol causes fewer side effects if it's taken vaginally. Abortion is legal in Washington State, but someone who lives in a state where abortion is restricted or banned might not want to take it vaginally, as traces of the pills can be found during a pelvic exam.
We hope that you can use this information to help you decide whether a medication abortion is right for you. If you have questions or would like to talk to someone further, feel free to contact our abortion doulas at karamutualaid@gmail.com.
* Rarely, the bleeding may begin before someone takes the misoprostol. In this case, the misoprostol is still taken, so that it can cause the uterus to contract and expel the pregnancy, and eventually stop the bleeding.
** Medication abortion is only approved in the US for pregnancies up to 10 weeks (counted from the first day of the last menstrual period, or determined by the size of the fetus as seen on an ultrasound), and risk that it won't work (and the likelihood of needing a surgical procedure to complete the abortion) increase with gestational age after 10 weeks. However, the World Health Organization considers medication abortion safe until 12 weeks gestation, and Doctors Without Borders has determined that medication abortion is safe and effective (though slightly less so) in the second trimester. So long as the person self-managing the abortion is 14 weeks or less, everything that comes out can safely be flushed. Someone considering a second trimester (13 weeks or later) medication abortion should consult an expert. They will need to use the pills differently and they'll need legal advice to decide what to do with the fetal remains.