Medication Abortion

A medication abortion is a safe and effective way to end a pregnancy in its earliest weeks through the use of medications. Planned Parenthood of New York City provides mifepristone (Mifeprex™) and misoprostol for medication abortion up to 56 days (eight weeks) from the first day of the last menstrual period. The information below explains what you should expect when having a medication abortion, as well as the benefits and possible problems. Before having a medication abortion, you will have the opportunity to discuss all of your options and have any questions answered. To reach PPNYC, call (212) 965-7000 or (800) 230-PLAN.

Safety and Effectiveness

For more than a decade, millions of women worldwide have safely used the mifepristone-misoprostol combination for medication abortion. The U.S. Food and Drug Administration approved mifepristone for medication abortion in the U.S. in September 2000. Since then, half a million women have safely used this option to end a pregnancy in its earliest weeks.

The mifepristone-misoprostol combination is approximately 95-97% effective when taken within 56 days (eight weeks) of the last menstrual period. Medication abortion has certain benefits, and satisfaction is high among the women who have chosen this procedure. It allows women who want to end their pregnancies to do so very early. At PPNYC you will be instructed to use the second medication (misoprostol) at home. Heavy bleeding and cramping are expected and a medication abortion can take days to weeks to complete.

The most common side effects reported by women using mifepristone plus misoprostol for early abortion are similar to those of a spontaneous miscarriage: abdominal pain, bleeding, changes in body temperature, dizziness, fatigue, and gastrointestinal distress including nausea and vomiting. As with any medical procedure, complications can occur. Heavy bleeding or incomplete abortion occurs in 1– 5% of procedures and may require taking additional medications or having a vacuum aspiration procedure. A small number of women have developed serious and sometimes fatal infections following medication abortion, but this complication is extremely rare.

While medication abortion is a preferable option to surgical abortion for some women, it may not be the right choice for others. You will have a chance to discuss your concerns with your provider before you make the decision.

First Steps at Your Appointment

Once you check in at a Planned Parenthood center, you will be asked to complete a medical history and other paperwork. A number of tests will be done, including a blood test to determine if you are Rh positive or negative and to make sure that you are not anemic. You will also have an ultrasound examination. During that exam, a probe will be inserted into your vagina so that a picture of the pregnancy can be taken to accurately determine the age and size of the pregnancy. A medication abortion using mifepristone cannot be performed if the pregnancy is further along than 56 days (eight weeks), or located outside the uterine cavity (an ectopic pregnancy).

Is Medication Abortion the Right Option for You?

A counselor or medical provider will spend some time with you to explain the procedure, go over your medical history, obtain your written consent, and answer any questions you may have. The final decision as to whether a medication abortion can be done will depend on your medical history, your physical examination, and the results of your laboratory tests and ultrasound exam. You should not use mifepristone if:

• It has been more than 56 days (eight weeks) since your last menstrual period began.
  
• You have an IUD. It must be taken out before you use mifepristone.
  
• Your provider has told you that you have a pregnancy outside the uterus (an ectopic pregnancy).
  
• You have problems with your adrenal glands (chronic adrenal failure) or severe heart, liver, or kidney problems.
  
• You take a medication to thin your blood.
  
• You have a bleeding problem.
  
• You take certain steroid medications.
  
• You cannot return for the follow-up visit(s).
  
• You cannot easily get emergency medical help should a problem occur.
  
• You are allergic to mifepristone, misoprostol, or medicines that contain misoprostol (Cytotec or Arthrotec).
  
• You are not sure that you want to end your pregnancy and you would be unwilling to have a surgical abortion if the medication abortion fails.

Taking the Medications

If you and your medical provider decide that medication abortion is the right option for you, you will be given two medications. You will take the first, mifepristone, by mouth before you leave the center (Day 1). Mifepristone works by blocking progesterone, a hormone produced by your body and needed to maintain pregnancy. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue. The second medication, misoprostol, is given to you to take home. Between 24 and 48 hours after taking mifepristone (on Day 2 or Day 3), you will take misoprostol tablets according to your clinician's instructions. Misoprostol causes the uterus to contract and expel its contents.

When you have a medication abortion using mifepristone and misoprostol, you will be given a phone number so you can reach your provider at any time should problems occur. It is also very important that you provide us with a phone number where we can contact you or leave a message if necessary.

What You Will Experience

Cramping and bleeding are expected during a medication abortion and usually mean that the treatment is working. About 5% of women (5 out of 100) will start to have cramps and bleeding before they take the misoprostol tablets. But for most women, uterine cramping begins anywhere from one to seven hours after they take the misoprostol tablets. The cramping can range from mild to very intense and can last for several hours as the pregnancy tissue is being expelled. Bleeding usually starts sometime after the cramping and can range from light with a few small clots to very heavy with several large clots. Bleeding or spotting can be expected for an average of 9-16 days and may last for up to 30 days. In a very few cases, bleeding will be so heavy that a surgical procedure will be required to stop it. You may experience other side effects such as diarrhea, nausea, vomiting, headache, dizziness, back pain, and tiredness. These side effects lessen by Day 3 and are usually gone by Day 14.

Ensuring That Your Pregnancy Has Ended 

You must return to Planned Parenthood for a follow-up visit to ensure that the pregnancy has ended. (Even if you experienced cramping and bleeding, these symptoms do not always mean that the pregnancy has ended.) The follow-up visit will be scheduled about two weeks after you take mifepristone, and there is no additional fee for this visit. You will be given another ultrasound examination to confirm that the pregnancy has completely ended and that all the pregnancy tissue has been expelled. If the medications fail and the pregnancy has not ended, there is a chance there may be birth defects. If you are still pregnant, your provider will talk with you about your options, including a surgical abortion that can be performed at the center. You should not begin a medication abortion unless you are sure you want to end your pregnancy and you are willing to have a surgical abortion if the medication abortion fails. If the ultrasound exam shows that the pregnancy has ended but the tissue has not been completely expelled, the misoprostol tablets may be used a second time or the abortion can be completed through a surgical procedure. About 5% of women (5 out of 100) will need a surgical procedure to end the pregnancy, complete the abortion, or stop heavy bleeding.

You can become pregnant again right after your pregnancy ends. Your follow-up visit will give you an opportunity to discuss your birth control plans and when to return for future health care visits.