The term “abortion pill” refers to a medical abortion, a non-surgical procedure that uses a combination of two medications—mifepristone and misoprostol—to end an early pregnancy. The process involves taking mifepristone first, which blocks the hormone progesterone necessary to sustain the pregnancy. The second medication, misoprostol, causes the uterus to contract and expel the pregnancy tissue. Because this process intentionally causes the uterus to contract, pain and significant cramping are expected.
The Physical Experience of Medical Abortion
The pain experienced during a medical abortion is caused by the uterine muscles contracting strongly to push out the contents of the uterus, similar to a heavy, intense miscarriage. Many people describe the sensation as being like severe menstrual cramps, though the intensity can sometimes be compared to the early stages of labor.
The severity of the discomfort is highly variable from person to person, but it often increases just before the passage of blood clots and tissue. Along with the pain, very heavy bleeding is expected, often containing large blood clots that can be up to the size of a lemon.
Other physical side effects commonly accompany the cramping and bleeding. These are often related to the action of the misoprostol medication:
- Nausea, vomiting, and diarrhea.
- Chills or a mild fever.
- Dizziness.
- A general feeling of weakness for a day or so.
Managing Discomfort During the Process
Pain relief should be taken proactively. Healthcare providers recommend taking pain medication about 30 minutes before taking misoprostol to allow the medication time to work before strong contractions begin. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are the most common and effective over-the-counter pain relievers for this type of pain.
Standard advice is to take 400 to 600 milligrams of ibuprofen and repeat the dose every six hours as needed. Acetaminophen can also be used with ibuprofen, but aspirin is generally not recommended as it may increase bleeding. For pain that is particularly severe, a healthcare provider may prescribe stronger medication.
In addition to medication, non-pharmacological methods can offer comfort and relief:
- Applying heat to the abdomen using a heating pad or hot water bottle.
- Taking a warm bath to manage intense cramping.
- Staying hydrated.
- Resting in a comfortable position.
The Expected Timeline of Cramping and Bleeding
The most significant physical effects begin after the misoprostol is taken. Cramping and bleeding usually start within one to four hours after using the misoprostol. The pain then generally increases in intensity, corresponding with the uterine contractions.
The most intense period of cramping and heavy bleeding often peaks approximately two to five hours after taking the misoprostol. Once the pregnancy tissue has been passed, the strong cramping pain usually subsides almost immediately. The most severe cramping and bleeding typically last for a few hours.
After the heaviest part of the abortion is complete, the bleeding and cramping lessen, transitioning into a pattern similar to a heavy menstrual period. It is common to experience cramping on and off for a few more days. Light bleeding or spotting can continue for several weeks afterward as the body returns to its pre-pregnancy state.
Warning Signs Requiring Immediate Medical Attention
While heavy bleeding and intense pain are expected during a medical abortion, certain symptoms indicate a need for immediate medical evaluation. One serious warning sign is excessively heavy bleeding that soaks two or more maxi pads in an hour for two consecutive hours or more. Bleeding that is unmanageable or continues to be extremely heavy should prompt a call to a healthcare provider.
Another concerning sign is a high or prolonged fever, specifically a temperature that lasts longer than four hours after misoprostol was taken. This could indicate a potential infection. Pain that is so severe it cannot be managed by the prescribed pain medication, rest, or heat may also signal a complication.
Seek medical care if you experience:
- Persistent vomiting for more than four to six hours.
- Vaginal discharge that increases in amount or develops a foul odor.
- A rapidly increasing heart rate.
- Sudden abdominal swelling.
These symptoms are not typical side effects and require prompt attention to rule out a serious complication.