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Abortion - medication

Definition

A medication abortion is the use of medicine to end an undesired pregnancy. The medicine helps remove the fetus and placenta from the woman's womb (uterus). Medication abortion is also called the abortion pill.

A medication abortion is not the same as a miscarriage. Miscarriage is when a pregnancy ends on its own before the 20th week of pregnancy. Miscarriage is sometimes called a spontaneous abortion.

An abortion procedure uses a medical procedure to end a pregnancy.

Description

A medication abortion can be done within 11 weeks of the first day of the woman's last period. A combination of two prescription hormone medicines is most often used to help the body expel the fetus and placenta tissue. Your health care provider may prescribe the medicines for you after doing a physical exam and asking questions about your medical history.

Medicines used are mifepristone and misoprostol. Your provider will prescribe the medicines, and you will take them at home. Some providers may require you to take the mifepristone in their office before you leave.

After you take the medicine, your body will expel the pregnancy tissue. Most women have moderate to heavy bleeding and cramping for several hours. You may have nausea, diarrhea, and sometimes vomiting from taking misoprostol. Your provider may prescribe medicine for pain and nausea to ease your discomfort during this process.

Why the Procedure Is Performed

Reasons a medication abortion might be considered include:

• You have made a personal decision to not carry the pregnancy.

• Your baby has a severe birth defect or genetic problem.

• Your pregnancy may be harmful to your health.

• The pregnancy resulted after a traumatic event such as rape or incest.

The decision to end a pregnancy is very personal. To help weigh your choices, you may want to discuss your feelings with a counselor, provider, or a family member or friend.

Risks

Medication abortion is very safe and has been used in the United States for more than 20 years. Rare risks of medication abortion include:

• The medication abortion does not work and the pregnancy does not end

• Continued vaginal bleeding

• Pregnancy tissue not passing completely from body

• Blood clots in the uterus

• Infection

• Allergic reaction to one of the abortion medicines

Before the Procedure

Before the procedure, you may have the following tests:

• Pelvic exam to confirm the pregnancy and estimate how many weeks pregnant you are.

• A urine or blood HCG test to confirm that you are pregnant.

• A blood test checks your blood type. Based on the test result, you may need a special shot to prevent problems if you get pregnant in the future. The shot is called Rho(D) immune globulin (RhoGAM and other brands).

• An ultrasound test to check how many weeks pregnant you are and the location of the fetus in the uterus.

After the Procedure

It is very important to follow-up with your provider. This is to make sure the process was completed and all the tissue was expelled. The medicine may not work in a very small number of women. If this happens, another dose of the medicine or an abortion procedure may need to be done.

Physical recovery most often occurs within a few days. It will depend on the stage of the pregnancy. Expect some vaginal bleeding and mild cramping for a few days.

To relieve discomfort or pain in your abdomen:

• Apply a heating pad set on low or a hot water bottle filled with warm water on your abdomen to help ease discomfort.

• Take over-the-counter painkillers as instructed.

Follow these activity guidelines after your procedure:

• Rest as needed.

• Do not do any vigorous activity for a few days. Light housework is fine.

• Avoid sexual intercourse for 2 to 3 weeks.

• A normal menstrual period should occur in about 4 to 6 weeks.

You can get pregnant before your next period. Be sure to make arrangements to prevent pregnancy, particularly during the first month after the abortion.

Outlook (Prognosis)

Medication abortions are safe and effective. They rarely have serious complications.

References

American College of Obstetricians and Gynecologists website. ACOG Guide to Language and Abortion. www.acog.org/contact/media-center/abortion-language-guide. Updated September 2023. Accessed April 2, 2024.

Gilner JB, Rhee EHJ, Padro A, Kuller JA. Reproductive genetics. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 2.

Lesnewski R, Prine L. Pregnancy termination: medication abortion. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 114.

Mullins EWS, Regan L. Women's health. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clark's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier Limited; 2021:chap 39.

Rivlin K, Davis AR. Contraception and abortion. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Review Date: 11/10/2022

Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 04/05/2024.