Medication abortion involves two different medications to end a pregnancy. This non-surgical option is primarily used in the early stages. It is a widely used method, accounting for over half of all abortions in the United States in 2020. Understanding the steps involved can help individuals prepare for this experience.
The Purpose of Mifepristone and Misoprostol
The medication abortion process relies on a combination of two distinct drugs: mifepristone and misoprostol. Mifepristone, often taken first, blocks the hormone progesterone, which is necessary for a pregnancy to continue. Without progesterone, the uterine lining thins, and the pregnancy cannot progress. This prepares the uterus for the second medication.
Misoprostol is then taken to complete the process. This medication causes the uterus to contract and the cervix to soften. These contractions help expel the pregnancy tissue, similar to a miscarriage. The combined action of these two medications ensures the effectiveness of the medical abortion.
The Recommended Misoprostol Timing
The timing of misoprostol administration after mifepristone is important for the procedure’s effectiveness. Misoprostol is recommended 24 to 48 hours after mifepristone. This window allows mifepristone sufficient time to block progesterone and begin uterine changes. Taking misoprostol too soon or too late might affect the success rate.
Some protocols allow misoprostol to be taken up to 72 hours later, or even immediately in certain situations, depending on clinical guidance and gestational age. Healthcare providers offer precise instructions on when and how to take the second medication, which may include oral, buccal, or vaginal administration. Adhering to these instructions is important for the best outcome. Studies have shown that administering misoprostol within this general timeframe maintains high effectiveness rates for early medical abortion.
What to Expect After Taking Misoprostol
After taking misoprostol, individuals can expect a range of physical symptoms as the abortion process unfolds. Cramping and bleeding are the most common effects, often starting within one to four hours. The cramping can be intense, similar to or stronger than menstrual cramps, and indicates the uterus contracting to expel the pregnancy.
Bleeding will be heavier than a normal period, often accompanied by blood clots and tissue. Clots up to the size of a lemon are common. While the heaviest bleeding and cramping occur for a few hours, some bleeding and spotting can continue for several weeks. Other common side effects include nausea, vomiting, diarrhea, dizziness, headache, and a mild fever or chills on the day misoprostol is taken. These symptoms subside within 24 hours.
Important Safety Considerations
While medication abortion is safe, it is important to recognize signs that warrant medical attention. Individuals should contact their healthcare provider immediately if they experience excessive bleeding, defined as soaking through two large sanitary pads in an hour for two consecutive hours. Passing blood clots larger than a lemon also indicates a need for prompt evaluation.
Signs of infection, such as a fever of 100.4°F (38°C) or higher that lasts more than 24 hours after taking misoprostol, foul-smelling vaginal discharge, or severe abdominal pain not relieved by medication, require urgent medical care. Persistent pregnancy symptoms or no bleeding 24 hours after taking misoprostol also warrant medical consultation. A follow-up appointment, within one to three weeks, is recommended to confirm the abortion is complete.