Can the Abortion Pill Fail?
Whether you’re weighing your options before taking the abortion pill or you have already taken it and are wondering whether it worked, you deserve honest, clear information about possible outcomes—including abortion pill failure.
The short answer is that yes, the abortion pill can fail. While it is effective in most cases, it does not always work. Understanding how it works, how often it fails, what signs to watch for, and what to do next can help you make informed decisions about your health, your situation, and your future.
How Does the Abortion Pill Work?
The term “abortion pill” typically refers to a two-drug regimen used to end a pregnancy. The first medication in the regimen is mifepristone, followed by misoprostol.
Mifepristone (taken first) works by blocking progesterone, the primary hormone needed for a pregnancy to continue. Without progesterone, the uterine lining breaks down, and the pregnancy can no longer be sustained.
Misoprostol (taken 24–48 hours after mifepristone) causes the uterus to contract and expel the pregnancy. Cramping and bleeding typically begin within a few hours of taking misoprostol.
This regimen is FDA-approved through 10 weeks of pregnancy (70 days from the first day of the last menstrual period). In some cases, only misoprostol is used, typically when mifepristone is unavailable. However, the combination of the two is most effective.
How Often Does the Abortion Pill Fail?
Just like with any medication or medical procedure, there are no guarantees that the abortion pill will work 100% of the time. Success rates vary depending on several factors, including how far along the pregnancy is at the time of use.
Research indicates that the mifepristone-misoprostol combination is about 95–98% effective when used within the first 7–8 weeks of pregnancy. Effectiveness decreases between 8–10 weeks, dropping to roughly 93–95%. When used after 10 weeks, which is outside FDA-approved guidelines, the failure rate increases further.
In other words, for every 100 people who take the abortion pill, about two to seven will experience a failed or incomplete abortion.
What Does “Abortion Pill Failure” Mean?
Abortion pill failure can mean one of two things: an ongoing pregnancy or an incomplete abortion.
An ongoing pregnancy means the medications did not end the pregnancy at all. The embryo or fetus is still developing. This occurs in approximately 1–2% of cases.
An incomplete abortion means the pregnancy has ended, but not all of the pregnancy tissue has been expelled from the uterus. This is more common than a fully ongoing pregnancy, and it can lead to significant complications if not treated.
Whether you think the abortion worked or failed, you should follow up with a trusted provider to ensure it worked or to receive the care you need if it didn’t. A failed abortion is not something that will resolve on its own.
Signs the Abortion Pill May Not Have Worked
After taking the abortion pill, it’s normal to experience significant cramping and bleeding, as these are signs that the medications worked. But confusingly, they can also be signs that the abortion wasn’t successful.
Signs that the abortion pill may have failed include:
- Little or no bleeding after taking misoprostol
- Pregnancy symptoms (nausea, breast tenderness, fatigue) that continue or worsen rather than fade
- A positive pregnancy test taken 4 or more weeks after taking the medication
- A follow-up ultrasound showing fetal cardiac activity or retained tissue
- Persistent or worsening pelvic pain
It’s important to note that a positive pregnancy test shortly after taking the abortion pill is not necessarily a sign of failure. Pregnancy hormones (hCG) can remain elevated for several weeks, even after a successful abortion. A negative urine pregnancy test and a return of your menstrual cycle are the most accurate ways to know the abortion was complete.
When to Seek Emergency Care
Regardless of whether the abortion pill worked, certain symptoms require immediate medical attention. Go to an emergency room or call 911 if you experience:
- Soaking through more than two thick maxi pads per hour for two or more consecutive hours
- Fever above 101°F (38.3°C) that lasts longer than 24 hours
- Severe abdominal pain not relieved by ibuprofen
- Foul-smelling vaginal discharge
- Feeling faint, dizzy, or lightheaded
These can be signs of infection, hemorrhage, or an ectopic pregnancy, all of which are serious medical emergencies.
What If You’ve Changed Your Mind After Taking the Abortion Pill?
Some women take the first pill (mifepristone) and then feel uncertain or change their minds before taking the second medication (misoprostol). If this happens to you, there is a protocol called Abortion Pill Reversal (APR) that some providers offer.
APR involves taking progesterone to try to counteract the effects of mifepristone. It must be initiated as quickly as possible, ideally within 24 hours of taking mifepristone, and no later than 72 hours. The earlier it is started, the more likely it is to work.
The research on APR is limited and remains a subject of medical debate. Some studies suggest progesterone supplementation may allow the pregnancy to continue; others raise questions about its efficacy and safety. If you are considering this option, Call 1-877-558-0333 to speak with someone about your eligibility to start this process.
Abortion Pill Failure or Not, You Don’t Have to Figure Things Out Alone
Whether you’re still weighing your options, worried the pill didn’t work, or looking for support after a successful or incomplete abortion, you don’t have to navigate this alone.
Women’s Clinic of Atlanta (WCA) provides compassionate, confidential care for women and AFAB individuals at every stage of an unplanned pregnancy journey, regardless of where you are in your decision-making process. Our team offers pregnancy confirmation ultrasounds, which can tell you how far along you are and whether a pregnancy is progressing, each a critical piece of information before or after taking the abortion pill.
Chat With Women’s Clinic of Atlanta Today to Schedule Your Abortion Screening or Post Abortion Assessment
If you are interested in taking the abortion pill or are concerned that the abortion pill may not have worked, schedule a screening or assessment with Women’s Clinic of Atlanta. Our compassionate team offers these services in either of our non-judgmental, supportive, and comfortable clinics. It’s our goal to help you understand your health, your options, and your next steps on your terms.
Schedule an abortion screening or post abortion assessment by sending us a chat today.
Women’s Clinic of Atlanta is a nonprofit clinic serving teen girls and women in the Atlanta area. We provide pregnancy testing, abortion screenings, post-abortion screenings, birth control, STI testing, and a range of sexual and reproductive health services with compassion, confidentiality, and zero judgment.
Women’s Clinic of Atlanta is HIPAA compliant and AAAHC accredited.
Frequently Asked Questions About the Abortion Pill
How do I know if the abortion pill worked?
The most reliable way to confirm the abortion was complete is a follow-up ultrasound, typically done 1–2 weeks after taking the medication (performed with your abortion provider). Continued or worsening pregnancy symptoms, little or no bleeding, or a positive pregnancy test four or more weeks after the procedure may indicate the pill did not fully work. A negative urine pregnancy test and the return of your menstrual cycle is the most accurate way to know the abortion was complete.
Can you still be pregnant after taking the abortion pill?
Yes. In approximately 1–2% of cases, the abortion pill does not end the pregnancy at all, resulting in an ongoing pregnancy. An incomplete abortion, where the pregnancy ends but not all tissue is expelled, is more common and also requires medical follow-up.
What happens if the abortion pill doesn’t work?
If the abortion pill fails, either partially or completely, medical follow-up is necessary. Options typically include a surgical procedure to remove the pregnancy tissue or, in some cases, a second round of medication. Your provider will help determine the most appropriate option for your situation.
How long after taking the abortion pill should I bleed?
Most people begin bleeding within 1–4 hours of taking misoprostol, the second medication. Bleeding and spotting can continue for up to 2–6 weeks. If you experience little or no bleeding after taking misoprostol, this may indicate the medication is not working, and you should contact your abortion provider.
Is it normal to still have pregnancy symptoms after the abortion pill?
Some pregnancy symptoms, like nausea or breast tenderness, may linger for a week or two as hormone levels adjust. However, symptoms that persist beyond two weeks or that worsen rather than improve could indicate an ongoing pregnancy or incomplete abortion and should be evaluated by a provider.
Can the abortion pill harm a continuing pregnancy if it fails?
Research suggests that if the abortion pill fails and the pregnancy continues, there may be an increased risk of certain birth defects, particularly from misoprostol. This is one of the reasons medical follow-up after a suspected failure is so important.
What is Abortion Pill Reversal, and does it work?
Abortion Pill Reversal (APR) is a protocol involving high-dose progesterone intended to counteract the effects of mifepristone, the first pill in the abortion pill regimen. It must be started within 24–72 hours of taking mifepristone. Research on its effectiveness is limited and debated among medical professionals. If you are considering APR, contact 1-877-558-0333 immediately, as time is critical.
Where can I get a follow-up ultrasound after taking the abortion pill?
Women’s Clinic of Atlanta offers confidential pregnancy confirmation ultrasounds and follow-up care post abortion assessments 4-6 weeks after the abortion; however, we do not perform ultrasounds to confirm the abortion is complete. If you are concerned that the abortion pill did not work, you should contact your abortion provider immediately. If you are looking for support as you navigate your next steps, our team is here to help, without judgment.
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