Abortion with Pills vs. Miscarriage: Demystifying the Experience

In the United States, pregnant people are often culturally discouraged from revealing their pregnancies in the first trimester and may only discuss their miscarriages or abortions with their closest friends or family members, creating a veil of secrecy and shame around a very normal part of human reproduction.

Fake women’s health clinics (sometimes referred to as “crisis pregnancy centers” or “pregnancy resource centers”) have been known to capitalize on this lack of knowledge, significantly exaggerating the likelihood of miscarriage in an effort to dissuade people from seeking desired abortions or lying about the health effects of abortion.

From a medical perspective, there is no physiologically significant difference between a medication abortion (sometimes called an abortion with pills) and a miscarriage. In both cases, the symptoms, risks, warning signs, complications, and treatments are likely to be the same. This fact sheet seeks to demystify and destigmatize what happens when an early pregnancy ends to help pregnant people know what to expect, when they can safely manage the process at home, and when they need to seek help.

What’s the Difference?

A medication abortion is an abortion induced by FDA-approved abortion pills, usually within the first 10 weeks of gestation. Some pregnant people may choose a medication abortion with the help of a licensed medical provider, often following an exam to determine how far along their pregnancies are. Other pregnant people may choose to self-induce a medication abortion with FDA-approved pills that they acquire and take on their own. The NWHN strongly supports the right of individuals to make these choices for themselves.

A miscarriage (sometimes called a “spontaneous abortion” in medical parlance) occurs when an early pregnancy (before 20 weeks of gestation) ends on its own. In people who know they are pregnant, the estimated rate of miscarriage is 15 – 20%. The cause of any single miscarriage is often difficult to determine, though most are caused by chromosomal abnormalities that happen by chance during early embryonic development. Miscarriage is almost never directly related to the actions of the pregnant person.

Miscarriage and medication abortion have different causes and the emotional experiences of the person undergoing each type of pregnancy termination may be very different. There is no one right way to feel, and each person will experience the process differently. The end of an early pregnancy can be very taxing physically, and sometimes mentally. Physical recovery can range from a few days to a few weeks. Emotional recovery can take longer. Whatever the experience, take measures to make the process as comfortable as possible.

Finally, it’s important to note that symptoms will vary person-to-person; some early miscarriages will not present any symptoms, or may seem like an unusually heavy menstrual period. Symptoms depend on a range of factors, such as how far along the pregnancy is. Each body is unique and no experience is exactly the same. If something feels wrong, contact a health professional right away.

What to Expect

Bleeding or spotting

Experiencing bleeding during an early pregnancy is not unusual. Blood is not always an indicator of a miscarriage, and a pregnancy can continue without complications after some spotting. However, if blood is darker or lasts for more than a couple of days, this is a stronger indication of a miscarriage. In contrast, when people try to end a pregnancy using medication, bleeding is expected and a sign that the pills are working. The further along a pregnancy, the heavier the bleeding will be.  

Cramping

Some cramping or slight discomfort is not unusual in early pregnancy. However, during a miscarriage or medication abortion, the body goes through contractions in an effort to expel anything in the uterus. Experiences of pain range in severity, but if you cannot manage the discomfort with standard over-the-counter pain relievers you should see a health care provider. During a medication abortion, if contractions do not begin within a few hours, this may be a sign that the pills were not legitimate.

Blood clots and/or tissue passing from the vagina

Everyone experiencing an early pregnancy termination experiences bleeding. Depending on the amount of flow, and how quickly it is passing through the vagina, there may be some blood clots.  If the pregnancy was longer than eight weeks, it is more likely that visible fetal tissue may pass. It could be mixed in with clotted blood, or visible as small but distinct bit of grayish tissue. Tissue passing is nothing to be concerned about, and the tissue itself can be flushed safely.

Softened cervix

Following longer pregnancies, the cervix may soften to allow an easier passing of fluid and tissue. Physicians recommend avoiding putting anything into the vagina, such as tampons or insertive sex, for up to two weeks after an early pregnancy ends to avoid infection.

Hormone balancing

hCG, the hormone associated with pregnancy, may take between 4 – 6 weeks to return to its normal resting state. Typically, the further along the pregnancy was, the longer it will take for hCG to disappear. Pregnancy side effects, such as morning sickness and breast tenderness, will begin disappearing as hCG drops. A pregnancy test can confirm when hCG has lowered to its normal level.

First menstrual cycle

The first menstrual cycle after the end of early pregnancy will be different from previous periods. It should return within four to eight weeks and may be heavier, as your body is still trying to expel thicker uterine lining. Elevated levels of hCG and other hormones may alter the timing and length of your period.

Later pregnancies

Whether an early pregnancy ends spontaneously or as the result of intervention with pills, it will not impact your ability to become pregnant again. Having one miscarriage does not change the likelihood that a person will be able to get pregnant again. There is also no evidence that an abortion impacts fertility. However, having more than one miscarriage may indicate an underlying cause that will require further testing.

Seeking Further Assistance

Most of the time, a miscarriage and a medication abortion can both occur safely. However, there are some signs that you should seek outside assistance. If you have foul-smelling discharge, a fever, persistent cramping, or if bleeding increases or stays bright red, contact your health care provider. There is a possibility that your body is struggling to remove all parts of the pregnancy and there is still tissue in your uterus.

There are typically two options to remove the tissue and prevent infection: 1- medication to help the body eliminate the contents of the uterus on its own (misoprostol pills, also part of the process used in a medication abortion), or 2- a procedure to physically remove the contents of the uterus, either through aspiration or through dilation and curettage (D&C). Both medication and physical removal are completely safe and the choice between the two is up to the individual.

When seeking medical care for either an incomplete miscarriage or abortion, 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.”