Medication abortion, often referred to as the “abortion pill,” is a common and effective method for ending an early pregnancy. It involves taking two different medications, mifepristone and misoprostol, to induce a miscarriage. Understanding what to expect and how to confirm its success is important. This article outlines the typical course of a medication abortion, signs of success or complications, and the importance of follow-up care.
What to Expect During the Process
The medication abortion process typically involves taking two different medications: mifepristone first, followed by misoprostol. Mifepristone works by blocking the hormone progesterone, which is necessary for the pregnancy to continue. Misoprostol is then taken 24 to 48 hours later, causing the uterus to contract and expel the pregnancy tissue.
After taking misoprostol, cramping and bleeding usually begin within 1 to 4 hours. This bleeding is often heavier than a typical menstrual period and may include large blood clots or tissue. The most intense cramping and heaviest bleeding generally occur for several hours as the uterus works to empty. Some individuals may also experience side effects such as nausea, vomiting, diarrhea, headaches, or a low-grade fever or chills for about a day.
Signs the Abortion Was Successful
A successful medication abortion is generally indicated by a significant reduction or complete cessation of pregnancy symptoms. Symptoms such as nausea, breast tenderness, and fatigue should begin to diminish within a few days to a week after taking the medications. The bleeding pattern also provides important clues.
Initially, heavy bleeding and strong cramping are expected as the uterus expels the pregnancy. After this initial phase, the bleeding should gradually become lighter, similar to a regular period, and may continue for several days to a few weeks, sometimes stopping and starting. Passing blood clots, which can be as large as a lemon, is also a normal part of the process. The overall decrease in the intensity of cramping and bleeding after the initial heavy phase suggests the abortion has worked.
Signs the Abortion Was Incomplete or Failed
An incomplete abortion occurs when the pregnancy has ended but some tissue remains in the uterus. A failed abortion means the pregnancy continues to grow. Signs that the abortion may not have been successful include persistent or worsening pregnancy symptoms, such as continued nausea or breast tenderness, several days after taking the medication. Very light bleeding or no bleeding at all within 24 hours of taking misoprostol can also indicate a failed or incomplete process.
Extremely heavy bleeding is another warning sign. This is defined as soaking through more than two maxi pads in one hour for two consecutive hours. Persistent severe abdominal pain that does not improve with pain medication, a foul-smelling vaginal discharge, or a fever lasting more than 24 hours after taking misoprostol could signal an infection or other complication.
Confirming the Outcome and Follow-Up Care
Medical follow-up is important to confirm the abortion’s success and ensure overall health. Healthcare providers often recommend a follow-up appointment within two to five weeks after the medication abortion. During this visit, various methods can be used to confirm the outcome.
An ultrasound may be performed to check if the uterus is empty and the pregnancy has been expelled. Blood tests, specifically checking levels of human chorionic gonadotropin (hCG), the pregnancy hormone, can also confirm success, as these levels should drop significantly after a successful abortion. While home pregnancy tests can be used, it is important to wait at least two to four weeks, as hCG levels can linger in the body and cause a false positive result if tested too soon. If the abortion is found to be incomplete, additional medication or a minor procedure may be necessary to remove any remaining tissue.
When to Seek Medical Attention
It is important to contact a healthcare provider immediately if certain symptoms arise after a medication abortion. Severe, unmanageable pain that does not respond to pain medication warrants urgent attention. Signs of potential infection, such as a fever above 100.4°F (38°C) lasting more than 24 hours, or vaginal discharge that has an unpleasant odor or unusual color, require immediate medical evaluation.
Extremely heavy bleeding or passing clots larger than a lemon indicates a need for urgent care. Other concerning symptoms include feeling dizzy, weak, or light-headed, which could indicate excessive blood loss. Any persistent pregnancy symptoms or concerns about the process should also prompt a call to a healthcare professional.