The abortion pill: What to expect

Step 1: Counseling, maybe an ultrasound, and maybe a waiting period

First you’ll fill out some paperwork. You’ll talk with a health care provider, and you may have an ultrasound to find out or confirm how far along you are in your pregnancy. If you are further along in pregnancy, then medication abortion may not be an option for you.

If the state where you’re getting your abortion has a mandatory waiting period, you’ll have to wait some number of hours between the counseling appointment and the appointment when you’ll take the first medication. If there is a waiting period, and you are going to have to travel a long way for your abortion, ask if virtual counseling is an option when you call to make your appointment.

Step 2: Get the medication at a health center

Your health care provider will give you both medications and explain when and how you’ll take them.

The first medication is called mifepristone. Mifepristone blocks the hormone progesterone. Because progesterone is necessary for pregnancy to continue, blocking it starts the process of ending the pregnancy. Mifepristone doesn’t usually cause any symptoms, so you probably won’t feel anything after you take it. Your provider may have you take the mifepristone at the health center, or you may take it at home or somewhere safe.

Your provider will give you the second medication. Usually, you’ll get it when you get the mifepristone, but you may have to go back to the provider to get it. Make sure to follow the instructions the provider gives you because they may differ from one provider to the next.

Step 3: Take the second medication up to 48 hours later

Up to 48 hours after taking mifepristone, you’ll take a dose (which is usually four tablets) of the second medication, called misoprostol.

For this step, you need to be somewhere you can relax and where you’ll have easy access to a bathroom. Misoprostol empties your uterus, expelling the pregnancy. It causes cramping and bleeding.

There are a few different ways to take misoprostol: you can take it orally, by swallowing the pills; you can take it vaginally, by putting the pills inside your vagina; you can take it sublingually, which means that you place the pills under your tongue and let them dissolve; or you can take it buccally, which means putting the pills in your mouth between the inside of your cheek and your gum and letting them dissolve there.

You may take one or more doses of misoprostol depending on how far along you are and how your body responds to the first dose—your provider will let you know. Misoprostol starts working about 30 minutes to a few hours after you take it. When it kicks in, it’s normal to experience bleeding. The bleeding could range from medium to very heavy. You will likely pass some blood clots. You’ll also likely have cramps, which can be severe. You may experience diarrhea or vomiting, and you may also have a mild fever on the day you take the misoprostol.

Your provider may also prescribe anti-nausea medicine for you to take before you take the misoprostol.

You can take over-the-counter pain medication, or your health care provider may prescribe a prescription-strength pain medication. But after a few hours, the symptoms will usually pass. Bleeding will decrease over the next few days. You can go back to work, school, taking care of your kids, or your other normal activities the next day. You can have sex again as soon as you’re ready.

You should get your next period within eight weeks of having a medication abortion. If it’s been eight weeks or longer since your abortion, and you haven’t had a period, contact your abortion provider. You can also contact your abortion provider sooner if you think you may still be pregnant.

It is possible to get pregnant again within two weeks of having the abortion, meaning that you may be able to get pregnant again before you get your next period.

Some health care providers will recommend a follow-up appointment a few weeks after your medication abortion to make sure the pregnancy is over. This appointment could take place via telehealth, a phone call, or in person, depending on the provider.