The medication abortion, often referred to as the “abortion pill,” is a non-surgical process that uses a combination of two medications, mifepristone and misoprostol, to end an early pregnancy. Mifepristone works by blocking the hormone progesterone, which is necessary for the pregnancy to continue. The second drug, misoprostol, causes the uterus to contract and expel the pregnancy tissue, which is the part of the process that causes physical sensations.
The Physical Experience and Expected Discomfort
The process of a medication abortion involves uterine contractions that cause cramping and heavy bleeding, and the intensity of the discomfort varies significantly from person to person. Many people report that the pain is comparable to severe menstrual cramps or an early miscarriage. For others, the pain can be more intense, and studies have shown that a significant percentage of people report experiencing moderate to severe cramping.
The most intense part of the experience begins after taking the second medication, misoprostol, which triggers the uterine activity. Pain usually peaks about two to four hours after misoprostol administration and often lasts for an hour or so, coinciding with the passage of the pregnancy tissue and large blood clots. Passing these clots can bring near-immediate relief as the uterus successfully empties its contents.
Bleeding during a medication abortion will be significantly heavier than a normal menstrual period, often involving large blood clots. It is common to pass clots that are up to the size of a lemon, and this heavy bleeding typically subsides after the pregnancy tissue has been expelled.
Strategies for Managing Pain and Cramping
Healthcare providers routinely offer advice and medications for this purpose. The most effective over-the-counter (OTC) option is generally considered to be a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen. Taking a dose of ibuprofen, such as 800 milligrams, is often recommended shortly before or at the time of taking misoprostol, which can help mitigate the peak discomfort.
It is important to avoid aspirin, as it can interfere with blood clotting and potentially increase bleeding. Acetaminophen is an alternative if NSAIDs are contraindicated, though it may not be as effective for uterine cramping.
Utilizing non-pharmacological methods alongside medication can also provide significant relief, such as applying heat to the abdomen with a heating pad or hot water bottle. Resting and ensuring adequate hydration throughout the process helps the body cope with the physical demands. Having a supportive person nearby can also be beneficial, providing comfort and assistance when the symptoms are at their strongest. Remember that the most severe pain is typically short-lived, resolving once the bulk of the tissue has been passed.
Other Common Side Effects
The misoprostol medication can trigger other systemic side effects as it is absorbed by the body. Many people experience gastrointestinal symptoms, including nausea, vomiting, and diarrhea. These effects are temporary and usually resolve within 24 hours of taking the misoprostol.
It is also common to experience chills or a temporary low-grade fever after taking the medication. A fever should not exceed 100.4°F (38°C) and should resolve within a few hours. These temporary reactions are a normal response to the medication and not usually a cause for concern unless they persist or worsen.
Some individuals may also notice a headache or experience temporary dizziness and fatigue during the process. These systemic symptoms contribute to the overall feeling of discomfort but are typically mild and disappear quickly once the misoprostol has been processed by the body. Taking anti-nausea medication beforehand, if provided by a healthcare professional, can help manage the stomach-related side effects.
Recognizing When to Seek Emergency Care
While medication abortion is a safe procedure, it is crucial to recognize specific signs that may indicate a complication requiring immediate medical attention. The most serious concern is prolonged, heavy bleeding, which is defined as soaking through two or more standard-sized maxi pads in one hour for two consecutive hours. Passing blood clots larger than a lemon is also a sign that warrants contacting a healthcare provider.
Unrelenting, severe pain that does not improve after taking prescribed pain medication is another indicator of a potential issue. This severe discomfort may signal a rare complication like an incomplete abortion or an infection. Any fever that is high—over 100.4°F (38°C)—and lasts longer than 24 hours after taking the misoprostol should be reported immediately.
Signs of infection also include foul-smelling vaginal discharge, which is distinct from the normal odor of blood. If symptoms of shock appear, such as extreme lightheadedness, a rapid heart rate, or feeling faint, emergency medical services should be contacted without delay.