The Abortion Pill: How It Works, Side Effects And More

“Medication abortion, or abortion through pills, is actually two medications,” says Erica Pasciullo Cahill, M.D., a clinical assistant professor of obstetrics and gynecology at Stanford Medicine.

Those two medications include the first one, mifepristone, followed by misoprostol, which is typically four 200 microgram tablets, taken between four and 24 hours after the mifepristone.

Kate White, M.D., an associate professor of obstetrics and gynecology at the Boston University School of Medicine, explains that mifepristone blocks progesterone, one of the hormones that is elevated during pregnancy. “Without progesterone, the lining of the uterus won’t support a pregnancy,” she explains. Meanwhile, the second medication (misoprostol) causes the cervix to open and assists the uterus in expelling the remains of the pregnancy.

It’s not uncommon to experience light bleeding after taking mifepristone, according to Dr. White, who adds that heavy bleeding occurs one to four hours after taking the misoprostol. “[I] tell patients that the bleeding is heavier than even the heaviest day of your period,” she says, adding that it’s not uncommon to pass large blood clots. “The bleeding starts to slow down a few hours after it started, but it’s not unusual to continue to bleed for up to three weeks.”

Confirming that the medication abortion was indeed effective at terminating the pregnancy can be done “based on symptoms, which include several hours of heavy bleeding that then completely resolves and a negative urine pregnancy test several weeks later, typically four weeks,” says Dr. Cahill. It is important to note that a urine pregnancy test will remain positive for several weeks after the medication abortion because it takes a while for the pregnancy hormone level to decrease after the abortion.

Before the COVID-19 pandemic, it was standard for someone to go to a clinic or doctor’s office for an ultrasound a week or two after taking the abortion pill to ensure it worked, explains Dr. White. But now, she says many people simply take an at-home pregnancy test and follow up with their doctor over the phone.

How Effective Is the Abortion Pill?

The abortion pill has been found to be between 95.5% and 98.8% effective when taken through 63 days of pregnancy, according to a study in Contraception^[2]Gatter M, Cleland K, Nucatola D. Efficacy and safety of medical abortion using mifepristone and buccal misoprostol through 63 days. Contraception. 2015;91(4):269-273. . Experts say the abortion pill becomes less effective the further into pregnancy a person is, and do not advise taking the abortion pill after 10 weeks of pregnancy.

Side Effects, Risks and Safety of the Abortion Pill

In addition to heavy bleeding, there are other side effects of the abortion pill to be aware of. Taking misoprostol can also result in a low-grade fever, chills and hot flashes, says Dr. Cahill. “Our typical guidelines suggest seeking care if you’re soaking through greater than two pads per hour for more than two hours, have a fever above 100.4 degrees Fahrenheit  or are experiencing severe pain that cannot be managed with heat pads and over-the-counter pain medication,” she explains.

While these side effects may be unpleasant, taking the abortion pill is considered low-risk and complications are rare. In one study published in Contraception, between .7% and 4% of people who had a medication abortion required transfusion, and no patient in that study required a hysterectomy or died^[3]Raymond E, Grossman D, Mark A, Upadhyay U, Dean G, Creinin M, Coplon L, Perritt J, Atrio J, Taylor D, Gold M. Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic nad beyond. Contraception. 2020;101(6):361-366. . However, deaths and serious complications have occurred over the years, but they are incredibly rare and are typically related to Clostridium infections, which may also happen in miscarriage or term pregnancies.

Experts emphasize that the abortion pill is completely different from the over-the-counter emergency contraception medication Plan B, and they serve entirely different purposes. While the abortion pill is used to end an existing pregnancy, Plan B is a brand of emergency contraception designed to be used within 72 hours of unprotected sex, preventing pregnancy from taking place, explains Dr. Roskin.

If someone is already pregnant, taking Plan B will not work in terms of ending the pregnancy, says Dr. White. “Plan B is progesterone, and taking a lot of progesterone will actually help support the pregnancy,” she says.

Generally, a person is eligible for the abortion pill if they are less than 10 weeks pregnant, not experiencing an ectopic pregnancy (which occurs when the pregnancy is outside the uterus), does not have a blood clotting disorder or other significant medical complications and has access to emergency care in case of complications, says Amy Roskin, M.D., an obstetrician-gynecologist in Weston, Florida.

The abortion pill must be prescribed by a doctor, adds Dr. White. “The pandemic also changed things in terms of access,” she says, explaining that before the pandemic, someone had to go to a clinic or doctor’s office to get a prescription. But in December 2021, the Food and Drug Administration (FDA) announced the abortion pill could be obtained through the mail. This increased access and made the abortion pill available in all 50 U.S. states, although guidelines surrounding when and how the abortion pill can be used varies by state.

For example, 19 states require the clinician prescribing the medication to be physically present when it’s being administered. Some states have recently passed legislation that severely limits abortion access, including the mail-order abortion pill. For these reasons, whether or not someone has easy access to the abortion pill depends greatly on where they live.

How Much Does the Abortion Pill Cost?

The abortion pill’s cost varies depending on where you live, the doctor you see and the type of insurance you have.

In terms of Medicaid coverage, federal law does not allow federal funds to be used for abortion aside from cases of rape, incest or life endangerment, although 16 states do allow for state funds to be used to cover abortion for those enrolled in Medicaid, according to the Kaiser Family Foundation. Whether the Affordabe Care Act is allowed to cover abortions also varies by state.

Meanwhile, some private insurance plans cover abortion while others do not, adds Dr. Roskin. For those whose medical insurance will not cover the cost, the average price of the abortion pill is $500.

Whether you are seeking a surgical abortion or a medication abortion, it’s important to meet with your healthcare provider who will help you determine which option is best for you.