Abortion with Pills (Medication Abortion)

We know that abortion is an extremely safe and effective option for people who do not want to remain pregnant. We also know that access to safe and affordable abortion care leads to improved economic, social, and health outcomes.

Despite this, there is a lot of misinformation in the media regarding abortion. Anti-choice politicians conflate emergency contraception pills (such as Plan B and ella) with abortion pills, spread the false idea that an abortion can be “reversed,” and continue to lie about non-existent connections between abortion and infertility.

These lies make it hard for pregnant people to get the information they need when deciding whether or not an abortion is right for them. Abortion with pills, also called medication abortion, is a safe and effective way to end a pregnancy by inducing miscarriage

What is an Abortion with Pills (Medication Abortion)?

Medication abortion has many names and may be referred to as different things by different people. When pregnant people visit the doctor for an abortion using pills, they are most often prescribed two different drugs, to be taken 1-2 days apart. Mifepristone (brand name Mifeprex) is taken first. Misoprostol (brand name Cytotec) is taken second, between 24-48 hours after mifepristone is taken, and causes uterine contractions to expel tissue from the uterus. Mifepristone used in combination with misoprostol is up to 99% effective, and serious complications are rare. The World Health Organization recommends the use of mifepristone and misoprostol for safe abortions.

Some pregnant people may choose to induce an abortion on their own without involving a clinician. The NWHN supports the right of individuals to make this choice. (Learn more about our position.) In these cases, pregnant individuals take either the two types of pills described above, or take only misoprostol, following a different dose and schedule. (Misoprostol alone is up to 90% effective.)

Two trusted websites, AbortionPillInfo.org and PlanC, provide information on how to access and use abortion pills in the US without a clinician.

In conversation, these pills may be referred to as RU486 (the original name of mifepristone when it was developed in France), a medical abortion, or simply an abortion with pills. All of these names can refer to the same thing: an abortion that is brought on by taking pills approved by the FDA for that purpose.

History

Misoprostol was originally used for the treatment of ulcers, but when it was discovered that it caused uterine contractions, it began to be used more frequently for abortion. Mifepristone was approved by the FDA in 2000 and is legally prescribed in more than 60 other countries, including the UK, Sweden, and France. Medication abortion has become increasingly popular, in part because of the privacy and control it offers patients relative to other methods that must be performed in a clinic setting. In 2014, for example, medication abortion accounted for nearly one-third of all nonhospital abortions in the US and has been safely used over 2.5 million times since its approval. On average, medication abortion costs about $500, but can cost up to $800 or more, depending on the county and/or state. It may or may not be covered by health insurance depending on your plan and the state laws where you live.

In March 2016, the FDA released updated, evidence-based guidelines for medication abortion. Medication abortion is now approved for use through 70 days from the first day of the last menstrual period (LMP). The new label also allows for a lower dose of mifepristone (200 mg instead of 600 mg) and eliminates the need for an in-person follow-up visit, which means misoprostol (the second part of the medication abortion regimen) can be taken at home or another convenient location. Despite these changes, medication abortion—and its label—are still restricted because of political opposition. (Learn more about the role of politics in shaping access to mifepristone and what the NWHN is doing to help.)

Process

In order to obtain a prescription for mifepristone in the US, a pregnant person must go to a health care provider—though mifepristone can also be obtained through online pharmacies. The provider will be able to determine how far along the pregnancy is and whether medication abortion is an option for ending the pregnancy. If it is, and the person decides to end the pregnancy, the health care provider will give the patient a pill consisting of 200 mg of mifepristone to be swallowed at the provider’s office. Mifepristone blocks the hormone progesterone which helps line the uterus during pregnancy. Unlike misoprostol, which has a number of approved uses and can be picked up at a pharmacy with a prescription, mifepristone is almost exclusively used to induce abortions and is not available for pick-up at traditional brick-and-mortar pharmacies—it must be taken at the provider’s office.

Then, between 24-48 hours after taking the first pill, the patient will take 800 mcg of misoprostol by dissolving it in the cheek (not by swallowing) at a location of the patient’s choice. (Unlike mifepristone, the FDA does not require misoprostol to be taken in a doctor’s office.) Misoprostol causes contractions that expel the embryo from the uterus. 

After taking both parts of the medication abortion regimen, the patient follows up with a health care provider in two weeks to confirm the pregnancy has ended.

People who have a medication abortion experience more bleeding, cramping, and nausea than people who choose to have an abortion in a clinic. (Often called “surgical abortions,” most abortions performed in clinics to physically remove the contents of the uterus, either through aspiration or through dilation and curettage (D&C), do not involve surgery. There is no incision or cutting and the procedure is performed on an outpatient basis.)

Other common side effects include diarrhea, fever, and/or dizziness after taking the pills. While these are normal side effects, a person who experiences very heavy bleeding, severe pain, or nausea/vomiting that lasts longer than 24 hours should contact a health care provider immediately. When seeking medical care, it is not necessary to tell medical personnel whether you have had an abortion or a miscarriage. Trusted resource Women on Web notes, “there are no tests that can show that a pregnant person has done a medication abortion,” and “any clinic that can deal with complications of miscarriage can also help women with incomplete abortions, because the symptoms are the same.”

Conclusion

Medication abortion is a very common method that has proven safe and effective for ending a pregnancy. Some people prefer medication abortion because they feel it offers an increased feeling of control and privacy or because they prefer taking a pill. Whatever one’s reason for choosing this option, it is important that access to medication abortion remain free of partisan politics. People considering medication abortion should know it is safe and effective, and are encouraged to talk to their provider about how to access medication abortion in their state.

 

Updated May 2018