Abortion Pill: What Is a Medical Abortion?

Does it hurt?

The short answer is that it’s different for everyone. No one can tell you exactly how it will feel.

Some people compare the process to menstrual cramps, while others report more discomfort.

Whether it hurts depends on several unique factors, such as:

  • your overall health, including underlying medical conditions
  • how far along the pregnancy is
  • your general pain tolerance
  • the type of abortion you have
  • your emotions and stress level

Keep reading for more on what to expect of a medical or surgical abortion, as well as questions to ask your healthcare provider.

What does it feel like to have a medical abortion?

Your provider will administer two drugs: oral mifepristone (Mifepred) and misoprostol (Cytotec).

Although misoprostol is usually taken orally, some take it vaginally, buccally (between your teeth and cheek), or sublingually (under the tongue).

These drugs block pregnancy hormones and also cause uterine contractions to push the embryo out. It can take four or five hours for tissue to be expelled.

This process causes vaginal bleeding somewhat heavier than a normal period. That means you’ll need a good supply of pads.

You’ll also pass some rather large clots. This will slow down after a few days, but you may continue to bleed or spot for a couple of weeks.

You may also experience:

  • mild to severe cramping
  • headache
  • breast tenderness
  • upset stomach
  • nausea
  • vomiting
  • low-grade fever
  • chills
  • diarrhea
  • dizziness
  • fatigue

These side effects usually clear up in a day or two.

Vaginal, buccal, or sublingual medications may have fewer side effects than oral medications.

What your healthcare provider can do to minimize pain during the process

Talk to your provider about taking an over-the-counter (OTC) medication beforehand, such as ibuprofen. This may help reduce your risk for cramping.

If you tend to get nauseous, you should also ask about anti-nausea medication. Your provider may advise you to take this beforehand, or wait until you begin experiencing symptoms.

They may also prescribe stronger pain killers or other medication to help relieve discomfort.

What you can do after to alleviate pain and related symptoms

Ibuprofen is more effective than acetaminophen at relieving pain following medical abortion. However, you shouldn’t take aspirin, because it can increase bleeding.

You may also find it helpful to:

  • Try and schedule the process on a day you can stay at home.
  • Wear loose clothing for the first couple of days.
  • Use a heating pad or hot water bottle on your abdomen to relieve cramping.
  • Use pillows to prop yourself up in a comfortable position.
  • Try deep breathing exercises.
  • Take a long, warm shower.
  • Get someone to rub your back.

What does it feel like to have a surgical abortion?

Surgical abortion starts out similarly to a pelvic exam. Your healthcare provider will ask you to rest your feet in the table’s stirrups and use a speculum to inspect your vagina and cervix.

After that, they’ll apply numbing medication and dilate your cervix. Then, they’ll insert a small, flexible tube into your uterus. The tube is attached to a gentle suction device, which is used to empty the contents of your uterus.

Your doctor may also gently scrape the inside of your uterus with a small, loop-shaped tool. This is called ‘curettage.’ This will ensure that your uterus is completely empty.

If the pregnancy is more than 15 weeks along, your provider will use a combination of suction, curettage, and extraction with forceps to completely empty the uterus.

You may start to feel uterine cramping and bleeding right away. This may continue for several weeks.

Other potential side effects include:

  • nausea
  • vomiting
  • fever
  • chills
  • dizziness
  • heavy bleeding

What your healthcare provider can do to minimize pain during the process

Most providers will administer local anesthesia before performing a surgical abortion. You may also be instructed to take pain medication prior.

You can request to be sedated. Your provider can give you a mild dose of general anesthesia(“twilight sedation”), or an oral sedative to help block pain and reduce anxiety.

You’ll remain conscious during the procedure, but you won’t remember what happened. You’ll feel “out of it” until the anesthesia wears off, so you’ll need someone to drive you home afterward.

What you can do after to alleviate pain and related symptoms

You can take OTC medications like ibuprofen to help ease your symptoms. Avoid aspirin, as it may increase post-abortion bleeding.

You can also apply a heating pad or hot water bottle to your abdomen to ease cramping. Wearing loose clothing for the first few days can also minimize the pressure on your abdomen.

Does the embryo feel any pain?

To feel pain, humans must be able to transmit signals from peripheral sensory nerves to the brain. We also need certain brain structures to process those signals.

According to the American College of Obstetricians and Gynecologists, rigorous scientific studies have found that the connections necessary to process pain signals don’t develop until at least the 24th week of gestation.

Current laws don’t allow for abortions performed after this point, as the pregnancy is considered viable.

Are there any other physical risks to consider?

Any medical procedure comes with some risk.

For abortion, the risks include:

  • infection
  • prolonged or severe bleeding
  • incomplete medical abortion requiring further intervention
  • unwanted pregnancy if a medical abortion doesn’t work

In 2012, a large-scale study concluded that legal induced abortion is safer and has lower morbidity than that associated with childbirth.

An uncomplicated abortion won’t affect your ability to get pregnant again. In fact, pregnancy can happen right away.

Are emotional side effects possible?

The emotional aspects of having an abortion are different for everyone. A lot depends on your reasons for having one, what stressors may have been involved, and whether you have a solid system of support.

You may feel relieved, grateful, and quickly ready to move on. Or you may feel sadness, guilt, or a sense of loss. You might even have a mixture of all these feelings. There isn’t a right or wrong way to feel.

If you’re experiencing negative emotions and feel that they’re interfering with your daily life, you may find it helpful to consult a healthcare professional. They can help you work through your emotions in a healthy way.

Talk to a healthcare provider

Having an abortion and deciding which type are big decisions, so it’s important to get the information you need up front.

Make sure you discuss the following with your healthcare provider:

  • any underlying medical conditions you have
  • medical versus surgical abortion: how they work, and the pros and cons
  • what you need to do to prepare
  • recovery time
  • potential side effects and what to do about them
  • symptoms that mean you should call your doctor
  • what you need to know about birth control after abortion
  • alternative options for the pregnancy, including adoption

Remember, time is of the essence. Laws vary depending on where you live. Your region may require a waiting period, multiple appointments, or have time limitations.

Start with your OB-GYN. If you have trouble getting answers or an appointment, ask them for a referral. Or:

  • Contact your primary care physician or local hospital for assistance.
  • If you’re in the United States, search for the closest Planned Parenthood health center or call 1-800-230-PLAN.
  • If you’re in the United States, search for a National Abortion Federation member provider or call 1-877-257-0012.

Understanding a medical abortion

The abortion pill is also known as a medical abortion. ­There are two main types of abortions: medical abortions and surgical abortions. A medical abortion may be commonly called “the abortion pill” but it involves taking two types of abortion pills. These pills will terminate a pregnancy, and are not the same as what is commonly known as the “morning-after pill” or Plan B, which is designed to prevent pregnancy.

The first pill that you will take is mifepristone. The second is misoprostol (also known as Cytotec). The use of the two medications together increase the effectiveness of the abortion, and can reduce the duration of side effects.

You can obtain these medications through doctors and clinics that provide abortion services, like Planned Parenthood. You should never buy them online or on the black market. The cost of the medication depends on location and additional tests or follow-ups that may be necessary. According to Planned Parenthood, abortion procedures can cost up to $800. However, this cost fluctuates depending on the area where you live.

Who is eligible for the abortion pill?

Women who are under 10 weeks into their pregnancy are eligible to take the abortion pill. After 10 weeks, women who wish to terminate their pregnancy may opt for a surgical abortion.

Women with pre-existing medical conditions may not be eligible to take the abortion pill. Women who cannot receive the abortion pill include:

  • women who are not willing to have an aspiration (surgical abortion) if the pill is not effective.
  • women with an ectopic pregnancy or mass on their ovaries
  • women on long-term corticosteroids
  • women with certain genetic diseases
  • women who are not able to understand the procedure or how to follow the directions
  • women who will not have access to emergent medical treatment and facilities
  • women who have a molar pregnancy, in which the placenta develops abnormally
  • women who have heart, kidney, or liver problems
  • women with severe adrenal gland problems
  • women who currently have an IUD (though you can take the pill upon its removal)
  • women with bleeding disorders, or those who are taking anticlotting medications

Effectiveness

The abortion pill is very effective. When misoprostol and mifepristone are used together, they have about a 98 percent effectiveness rate. The age of the pregnancy, the medication doses and administration, and whether or not a woman has been pregnant before may impact the effectiveness. The effectiveness rate decreases for each additional week of pregnancy.

While this effectiveness rate is high, it’s possible for a medical abortion to fail to terminate a pregnancy. In these cases, a woman would need to then undergo a surgical abortion.

How does it work?

When you’re taking both medications in a medical abortion, they’ll work together to terminate a pregnancy.

Mifepristone will be the first pill that you take. It works by blocking progesterone and causing the lining of the uterus to break down, terminating the pregnancy. About 24 to 48 hours after you take the first pill, you will take misoprostol, which causes the uterus to contract and expel the embryo and uterine lining.

Side effects and recovery

Women who undergo a medical abortion often experience bleeding and cramping that can last for up to two weeks after the procedure, including passing blood clots. Other common side effects include:

  • nausea and vomiting
  • diarrhea
  • feeling dizzy or heaving a headache
  • short-lasting hot flashes

Most women will abort anywhere from a couple of hours to a day or two after taking the second medication. However, it’s normal to experience light bleeding, spotting, and some cramping for up to four weeks following a medical abortion. Note that you can get pregnant almost immediately following an abortion.

Pros and cons of the abortion pill

When women decide they want to have an abortion, they may get to choose between a medical abortion with the abortion pill, and a surgical abortion.

Pros of medical abortion include:

  • Medical abortions can occur as early as a woman finds out that she is pregnant.
  • There is no anesthesia required.
  • It’s less invasive than a surgical abortion.
  • Some women feel that it’s more “natural,” like a miscarriage.
  • Medical abortions don’t carry the same risks of uterine perforation.
  • Abortion pills often cost less than surgical abortions.

Medical abortions do have some disadvantages, which include:

  • Medical abortions are not 100 percent effective. Failed medical abortions require women to also undergo surgical abortions, and can result in infections.
  • Bleeding and cramping may last longer than with a surgical abortion.
  • Medical abortions may require more than one visit to the doctor’s office.
  • They cannot end a tubal or ectopic pregnancy.

Your doctor will discuss your options with you, and will likely break down some of the pros and cons.

Potential risks and complications

Though medical abortions are considered safe, it is possible to experience complications from the medications.

Potential risks and complications of a medical abortion include:

  • an incomplete or failed abortion, where the fetus is viable or remains in the womb (this can cause serious infections)
  • an undetected ectopic pregnancy, which can be dangerous and is a medical emergency
  • blood clots remaining in the uterus
  • heavy bleeding

Emergency symptoms of serious complications include:

  • severe pain
  • fever
  • excessively heavy bleeding (defined as going through two or more pads within an hour span)
  • strong-smelling vaginal discharge
  • passing clots for two or more hours that are larger than the size of a lemon

What to do after taking the pill

In many cases, you will take the first pill in front of your doctor at your first appointment. You may then return to the office for the second medication between one and three days later. You may experience symptoms like bleeding and cramping for two to four weeks. Your doctor will schedule a follow-up appointment with you to test for pregnancy at the end of this time frame to ensure that the procedure was successful.

After taking the abortion pill, wait at least one week to have sex, even if your doctor has prescribed you antibiotics. This reduces the risk of getting an infection. When you do have sex, use contraception immediately, as you can get pregnant very soon after an abortion.

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