Medical Abortion: Understanding Mifepristone and Misoprostol
A medical abortion (sometimes called the abortion pill or medication abortion) uses two medications—mifepristone and misoprostol—to end an early pregnancy without surgery. Mifepristone is FDA-approved for use with misoprostol through 10 weeks of pregnancy (70 days from the last menstrual period). Mifepristone blocks the hormone progesterone, which the pregnancy needs to continue, while misoprostol causes the uterus to contract and empty. For most women, the abortion occurs over a two-day period, though bleeding and spotting can continue for one to two weeks. It’s vital to know what these medications do to the body to recognize any warning signs or issues. Additionally, it’s critical to understand how your state’s abortion laws affect your access to a medical abortion. In Georgia, abortion is restricted after a fetal heartbeat is detected (roughly around the 6-week mark following conception), with narrow exceptions. If you’re facing an unplanned pregnancy, confirming how far along you are with an ultrasound is one of the most important first steps, since gestational age determines which options are available to you.
Key Takeaways
- Medical abortion uses mifepristone and misoprostol, taken in sequence to end a pregnancy without a surgical procedure.
- The FDA has approved this regimen for use through 10 weeks of pregnancy (70 days since the first day of the last menstrual period).
- Mifepristone stops the pregnancy from progressing, while misoprostol causes the uterus to contract and expel the pregnancy tissue from the body.
- Common side effects include cramping, bleeding, nausea, chills, and fatigue, symptoms that are expected and not necessarily signs of a problem.
- Heavy bleeding that soaks through more than two pads an hour for two hours, fever over 100.4°F lasting more than 24 hours, or severe pain not relieved by medication are reasons to call 911 or go to the ER.
- Medical abortion differs from surgical (procedural) abortion in timing, setting, and how the process feels.
- Abortion laws differ significantly by state; Georgia currently restricts most abortions after approximately six weeks of pregnancy.
- Women’s Clinic of Atlanta offers abortion screenings that include pregnancy testing and limited ultrasound screening, as well as post-abortion assessments, which can include a follow-up pregnancy test and ultrasound to confirm the pregnancy has ended.
What Is a Medical Abortion?
A medical abortion (also called medication abortion or “the abortion pill”) is a way to end an early pregnancy using medication instead of a surgical procedure. It involves two different drugs taken in sequence: mifepristone and misoprostol. This approach has been used safely in the United States since 2000 and is now one of the most common ways people end an early pregnancy, particularly since it can typically be done at home rather than in a clinical setting.
It’s a different process from a surgical (or procedural) abortion, which physically removes pregnancy tissue from the uterus using instruments or suction. Medical abortion works with the body’s own processes, prompting it to pass the pregnancy tissue out of the body entirely.
If you’re considering a medical abortion after a positive pregnancy test, it’s crucial to know these three basics: how far along you are, what each medication does, and what to expect from the process.
How Does Medical Abortion Work?
The two-drug regimen for a medical abortion works in stages, with each medication playing a distinct role.
Mifepristone
Mifepristone is taken first to block progesterone, a hormone the body needs to maintain a pregnancy. Without enough progesterone, the lining of the uterus breaks down and the pregnancy can no longer continue. On its own, mifepristone does not typically cause immediate symptoms. In fact, most people don’t feel anything different right after taking it.
Misoprostol
Misoprostol is taken next, usually 24 to 48 hours after the mifepristone. This medication causes the uterus to contract, which helps expel the pregnancy tissue. This is the medication that causes most of the physical symptoms, such as cramping, bleeding, and passing tissue. Many women report that symptoms feel similar to an intense period or an early miscarriage.
How Far Along Can You Be for a Medical Abortion?
The FDA has approved the mifepristone-misoprostol regimen for use through 10 weeks of pregnancy, calculated as 70 days or fewer since the first day of your last menstrual period. However, in some states—like Georgia—any form of abortion is banned once there is a fetal heartbeat detected, which usually occurs by the 6th week of pregnancy. Whether you’re in a state with laws similar to Georgia or not, confirming gestational age is critical as it directly affects which options are available to you and how they’re expected to work.
A home pregnancy test is not enough. These tests can only confirm that you’re pregnant, not how far along you are. An ultrasound is needed to establish gestational age accurately and is why a pregnancy screening that includes a limited ultrasound is the first recommended step before pursuing any of your options, whether you’re considering abortion, adoption, or motherhood.
What to Expect: A General Timeline of the Abortion Pill
Every person’s experience is different, but here’s a general sense of what the process of a medical abortion can look like:
Day 1: You take the first pill, mifepristone. Most people feel little to nothing right away, though some notice light spotting.
24–48 hours later: You take the second medication, misoprostol. Cramping and bleeding typically begin within a few hours, which many describe as a heavier, more intense version of a period. Nausea, diarrhea, chills, and a low-grade fever are common side effects of misoprostol and usually resolve within 24 hours.
The following days: Bleeding and clotting continue. It’s often heaviest in the first 24 hours after misoprostol, but it should gradually taper. Light bleeding or spotting can persist for one to two weeks.
Follow-up: A follow-up assessment—often including a pregnancy test or ultrasound—helps confirm that the pregnancy has fully ended and the uterus is empty. This is vital, because in a small percentage of cases, the medication doesn’t fully complete the process, which may require an additional dose or a procedural follow-up.
Medical Abortion Side Effects
Because misoprostol causes the uterus to contract, the resulting symptoms can feel intense, but most are expected and temporary. Common side effects include:
- Cramping, sometimes severe
- Heavy bleeding with clots
- Nausea or vomiting
- Diarrhea
- Chills or low-grade fever
- Fatigue
- Headache
Over-the-counter pain relievers like ibuprofen are commonly recommended to help manage cramping, and a heating pad can offer additional comfort.
When to Seek Emergency Care
While discomfort is expected, certain symptoms are not normal and need immediate medical attention.
Call 911 or go to the emergency room if you experience:
- Soaking through more than two maxi pads per hour for two or more hours in a row
- A fever of 100.4°F (38°C) or higher that lasts longer than 24 hours
- Severe pain that isn’t relieved by prescribed pain medication
- Foul-smelling vaginal discharge
- Signs of an allergic reaction, such as difficulty breathing or swelling
These symptoms can indicate complications like infection, retained tissue, or excessive blood loss, all of which are treatable with immediate action.
Life After a Medical Abortion
Once the process is complete, it’s important to ensure that the medication regimen worked and that your body is recovering as expected. A post-abortion assessment, roughly three to six weeks after taking the medication, can include a follow-up pregnancy test, a limited ultrasound to confirm the pregnancy has ended, a check-in on your emotional well-being, and a conversation about birth control moving forward, if desired.
Women’s Clinic of Atlanta offers post-abortion assessments to help bring clarity and comfort. Here, you’ll receive a compassionate space to check your body and talk through how you’re feeling, physically and emotionally. If you’ve had a medical abortion and want confirmation that it was successful, schedule your assessment with Women’s Clinic of Atlanta today.
Understand Your State’s Abortion Laws Before Taking the Abortion Pill
As mentioned, it’s important to understand that abortion access and legal gestational limits differ significantly depending on where you live. While some states allow abortion later in pregnancy, some restrict it earlier, and access to medication abortion by mail or telehealth also varies by state law.
In Georgia, current state law restricts most abortions once fetal cardiac activity can be detected on ultrasound, which typically occurs around six weeks of pregnancy. There are limited exceptions, including medical emergencies and certain cases of rape or incest. Because the window for a legal abortion is so short—often closing before people know they are pregnant—confirming pregnancy and gestational age as soon as possible is especially important for Georgia residents weighing their options.
Abortion law is an evolving and often contested area, and requirements can change. If you’re trying to understand what’s legally available to you, be sure to confirm current, location-specific information rather than relying on general assumptions about your state’s laws.
Frequently Asked Questions About Medical Abortions, Mifepristone, and Misoprostol
How long does a medical abortion take?
The process of taking both abortion medications typically spans one to two days, though bleeding can continue for one to two weeks afterward. Complete resolution and return to a normal cycle can take four to six weeks.
Is a medical abortion painful?
Most people experience cramping during a medical abortion, which can range from mild to intense, especially after taking misoprostol. Pain is generally manageable with over-the-counter medication, though everyone’s experience differs.
Can a medical abortion fail?
In some cases, yes, the abortion pill can fail, causing the pregnancy not to fully terminate or the tissue not to fully pass. This requires an additional dose of medication or a follow-up procedure. This is why a follow-up appointment to confirm completion is recommended.
How do I know a medical abortion worked?
A follow-up pregnancy test and ultrasound are the most reliable ways to confirm the pregnancy has ended after a medical abortion. A pregnancy test alone can sometimes still show positive for several weeks afterward, so an ultrasound gives more definitive information.
What’s the difference between the abortion pill and Plan B?
A medical abortion and emergency contraception like Plan B are not the same thing. Plan B prevents a pregnancy from occurring after unprotected sex. It doesn’t work if you’re already pregnant. Mifepristone and misoprostol end an existing pregnancy.
Why do I need an ultrasound before a medical abortion?
An ultrasound is critical to confirm gestational age, ensure you are still in the legal window for an abortion in your state, and rule out an ectopic pregnancy, which medical abortion cannot safely treat.
Does Women’s Clinic of Atlanta provide medical abortions?
No, Women’s Clinic of Atlanta does not provide medical or surgical abortions. WCA offers pregnancy testing and limited ultrasound screening that can help confirm gestational age before a medical abortion, as well as post-abortion assessments afterward.
What if I think something is wrong after taking the medication?
If you experience heavy bleeding (soaking more than two pads an hour for two hours), a fever over 100.4°F lasting more than 24 hours, or severe unrelieved pain after taking the abortion pills, call 911 or go to the emergency room right away.
Get Your Abortion Screening or Post-Abortion Assessment With Women’s Clinic of Atlanta
If you’re in the Atlanta area or anywhere across Georgia, and you’re considering a medical abortion, let Women’s Clinic of Atlanta provide the abortion screening you need to ensure you’re pregnant and determine your gestational age. Or, if you have taken the abortion pills recently and want to confirm that the process worked, let us provide a compassionate, confidential post-abortion assessment.
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 assessments, 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.
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