Mifepristone is the first medication in a two-pill regimen used to end an early pregnancy, and bleeding is an expected and necessary part of the process. The presence of bleeding is the clearest physical sign that the medication is working as intended. Understanding the mechanism of action, the expected characteristics of the flow, and when to seek medical guidance can help in navigating this experience. This process, medically termed a medication abortion, is designed to mimic a natural miscarriage.
How Mifepristone Initiates the Process
The process begins with the oral tablet, mifepristone, which acts on the body’s hormonal system. Mifepristone functions as an anti-progestin, blocking the effects of the hormone progesterone. Progesterone is naturally produced by the body and is essential for maintaining the uterine lining and supporting a pregnancy.
By blocking progesterone’s receptors, mifepristone causes the uterine lining to break down and detach. This detachment leads directly to the eventual bleeding. While this first pill initiates the changes, most people do not experience heavy bleeding or cramping immediately after taking mifepristone.
The second medication, misoprostol, is typically taken 24 to 48 hours later to complete the process. Misoprostol causes the uterus to contract and soften the cervix, helping the body expel the tissue. The most significant bleeding and cramping usually begin shortly after taking misoprostol, signifying the uterus is actively emptying.
What to Expect Regarding Bleeding and Flow
Bleeding usually starts within one to four hours after taking misoprostol, though it can take longer for some. The flow is significantly heavier than a regular menstrual period and includes passing blood clots and tissue. This heavy flow indicates that the medication is working effectively.
The heaviest bleeding typically lasts for four to six hours, centered around the time the pregnancy tissue is expelled. During this peak time, it is common to soak through multiple maxi pads in a short period. Clots can range in size, often described as being as large as a lemon or a golf ball, which is normal during this phase.
After the heaviest flow subsides, the bleeding will lessen but will not stop immediately. Light bleeding or spotting is expected to continue for an average of 9 to 16 days, or until the next menstrual period. The flow may stop and start again, but it should progressively become lighter over time.
Managing Physical Discomfort and Cramping
Intense cramping is an unavoidable part of the medication abortion experience, caused by the uterus contracting forcefully to expel the tissue. The pain level is often similar to very strong menstrual cramps or the contractions experienced during labor. This cramping is a sign of uterine activity and is most intense just before and while the tissue is passing.
Pain management should be planned for in advance, often involving over-the-counter pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are recommended and can be taken before the misoprostol dose. Follow the dosage instructions carefully and avoid taking aspirin, as it can increase bleeding.
Applying heat is an effective non-pharmacological method to help manage the discomfort. A heating pad or hot water bottle placed on the abdomen can help soothe the uterine muscles during contractions. The most severe cramping usually subsides once the main expulsion of tissue is complete, though mild cramping may continue for a day or two.
Identifying Warning Signs and Complications
While heavy bleeding and cramping are expected, specific signs indicate a complication requiring prompt medical attention. Excessive bleeding is the most immediate concern, defined as soaking through two or more large sanitary pads per hour for two consecutive hours. If this level of bleeding occurs, a healthcare provider should be contacted immediately.
Signs of infection are also a warning sign, even though they are rare. These include a persistent fever of 100.4°F (38°C) or higher that lasts for more than four hours, or a fever that occurs more than 24 hours after taking misoprostol. Other symptoms to watch for are severe, unrelenting pelvic pain not relieved by pain medication, or foul-smelling vaginal discharge.
A lack of bleeding 24 to 48 hours after taking misoprostol is another reason to contact a provider, as it may suggest the process has not started. Any general feeling of illness, such as weakness, nausea, vomiting, or diarrhea, that lasts for more than 24 hours after taking misoprostol should also be reported.