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There are two different ways to have a medication abortion: 

This page talks about having an abortion using only misoprostol — it's safe, effective, and legal to use in states where abortion is legal. It works 85-95% of the time and can be used up to 11 weeks from the first day of your last period.

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What happens during a medication abortion using only misoprostol?

At Planned Parenthood, before you take misoprostol, you’ll meet with a nurse or doctor — either in person at the health center, or by video or phone — to go over how to take the pills. Your doctor or nurse will give you detailed directions about when and how to take the pills. 

You will take 3-4 doses of misoprostol. Misoprostol causes cramping and bleeding that empties your uterus. The pregnancy tissue will come out through your vagina — it’s like having an early miscarriage or a really heavy period.

How do I take the misoprostol pills?

30 minutes before you take your first dose of misoprostol:

  • Take pain medicine to help with cramps. Ibuprofen (Advil or Motrin) works the best, but you can take a different pain medicine like acetaminophen (Tylenol) if you need to. But don’t take aspirin because it can make you bleed more. 
  • Take medicine for nausea if you have it.

There are a few different ways to take misoprostol. You can put the pills in your vagina (vaginal), under your tongue (sublingual), or in your mouth between your cheeks and gums (buccal). They will slowly dissolve (break down), and your body will absorb the medicine through the skin in your vagina or mouth. Your doctor or nurse will talk you through the best way for you to take the pills given your situation. Here are the steps for each method:

Vaginal 

  • Wash your hands. 
  • Put 4 pills deep into your vagina, as far as they will go. Put in 1 pill at a time. Then lay down for 30 minutes so they don’t fall out.
  • 3 hours later do the same thing with 4 more pills. 
  • 3 hours after that, do the same thing again with 4 more pills. 
  • You’ll use a total of 12 pills.

Pieces of the pills may fall out of your vagina later. If it’s been more than 30 minutes since you put that dose of pills in your vagina, your body probably absorbed enough of the medicine so you don’t need to put them back in.

Sublingual

  • Put 4 pills under your tongue and leave them there for 30 minutes.
  • If there are still pieces of the pills left after 30 minutes, swallow them with some water. 
  • 3 hours later do the same thing with 4 more pills. 
  • 3 hours after that, do the same thing again with 4 more pills. 
  • You’ll use a total of 12 pills.

Buccal 

  • Tuck 2 pills between your cheek and your gum on one side of your mouth. Do the same thing with 2 more pills on the other side of your mouth. Leave them there for 30 minutes.
  • If there are still pieces of the pills left, swallow them with some water. 
  • 3 hours later do the same thing with 4 pills. 
  • 3 hours after that, do the same thing again with 4 more pills.
  • You’ll use a total of 12 pills.

Some people may need to take more misoprostol. If your doctor or nurse told you that you need another dose, take 4 more pills 3 hours later. 

It’s best to keep taking the pills the same way for each dose. But if that’s not really possible because you’re bleeding too much, or feel too nauseous, you can switch to a different way of taking them.

What happens after I take the misoprostol pills?

Misoprostol causes strong cramping and bleeding in your uterus that makes the pregnancy come out through your vagina — similar to a heavy period or early miscarriage. 

You should expect cramping and bleeding to start within an hour after you take the second dose, but sometimes it can take until shortly after the third dose or longer. 

It’s normal to see large blood clots (up to the size of a lemon) or clumps of tissue during the abortion. But the pregnancy itself is very small — at 8 weeks, an embryo is about ¼ to ½ inch long. You may not see it when it comes out, especially if you’re less than 8 weeks pregnant.

The cramping and bleeding can last for several hours. It’s heaviest when the pregnancy comes out, and it will start to slow down after that. Most people finish passing the pregnancy tissue in 4-5 hours, but it may take longer. You may have cramping on and off for 1 or 2 more days.

If you don’t have any bleeding within 24 hours after taking the last dose of misoprostol, call your nurse or doctor.

It’s common to have side effects like nausea, diarrhea, and sometimes vomiting from the misoprostol. Anti-nausea medicine can help with this.

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