How Does the Abortion Pill Work & 10 Other Common Questions Answered

The abortion pill is one of those things that’s often misunderstood, even though it’s used more frequently than you probably think. “The number of [people] taking the abortion pill versus opting for surgical abortion has definitely increased over the years because of better availability and proven safety,” Alyssa Dweck, M.D., a gynecologist in Westchester, New York, and assistant clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, tells SELF.

Indeed, the rate of people who had an early medication abortion (also known as using the abortion pill) increased by 25 percent from 2014 to 2017 and accounted for 39 percent of all abortions, according to research from the Guttmacher Institute, a leading sexual and reproductive health research and policy organization. To clarify, this doesn’t mean that more people were getting abortions—in fact, the overall abortion rate dropped 8 percent during this same time period—it likely means that more people opted for early medication abortions than surgical abortions.

Despite this, when most people discuss abortion, they’re often talking about surgical abortion, as in, going into a doctor’s office, hospital, or clinic to terminate a pregnancy. But anyone who needs to end a pregnancy should know that, if they’re 10 or fewer weeks along, they have another option: the abortion pill, aka medication abortion.

“Some women prefer medication abortion because it can be more private, since the abortion occurs at home,” Caitlin Weber, M.D., a family physician specializing in family medicine, tells SELF. Others don’t want a surgical procedure, while still others feel like it’s more natural because it induces the same process as a miscarriage, Leah Torres, M.D., an ob/gyn practicing in Salt Lake City, Utah, tells SELF.

Any medical procedure can be scary, but abortion is often shrouded in extra mystery or false information that makes it even more intimidating. Here’s everything you should know about the abortion pill to keep you safe and informed.

1. Okay, so what is the abortion pill?

When we talk about the “abortion pill” we’re referring to medication that stops the progress of a pregnancy, then helps your body expel that pregnancy. But a medication abortion actually involves two separate medicines. The first is mifepristone, also known as the pill RU-486, which starts the process of safely terminating a pregnancy. “Mifepristone blocks the receptors for progesterone, which is the principal hormone in pregnancy,” Dr. Torres says. “Since progesterone can’t do its job to continue the pregnancy, essentially, the pregnancy stops growing.”

According to the standard of practice, you may need to take mifepristone in the presence of a medical professional, depending on where you live. In some states, this is required by law. To find out the rules in your state, check out this list from the Guttmacher Institute.

After the first pill, 24 to 48 hours later, you’ll take the second medicine, called misoprostol, which helps your uterus expel the pregnancy. Depending on when you take it, you may already have started to experience bleeding and cramping as your body realizes the pregnancy is no longer progressing.

“Like in a miscarriage that happens without the aid of medication, the body will start to cramp and push out a pregnancy that has stopped growing,” Dr. Torres says. “To ensure it’s done safely, we add misoprostol so the risks of heavy bleeding and infection are reduced.”

2. Wait, is that the same thing as the morning-after pill?

Nope, if you’re wondering if the morning after pill is abortion, they’re two very different things. While the abortion pill stops the progression of a pregnancy, the morning-after pill and other types of emergency contraception prevent ovulation from occurring, Dr. Torres explains. If you’ve already ovulated, emergency contraception can’t do anything to stop you from getting pregnant. (The only exception is the copper IUD, which works by creating an inflammatory reaction that’s toxic to sperm and may also prevent implantation from occurring, which is why it’s the most effective form of emergency contraception.)

3. How long does a medication abortion take?

From start to finish, the abortion should take around two days to be complete. Starting from the time you take the second pill, it usually takes up to six hours for the abortion to be completed, Dr. Torres says. So the whole process should be about a few days, during which time you may expel big blood clots or tissue as the pregnancy aborts.

It’s good to rest while all this is happening, if possible. “Most [people] prefer to stay at home for the first few hours after taking the second set of medicine, so we’ll often talk with them about their schedules to figure out a good time,” Dr. Weber says. And after the abortion, you may still experience bleeding for up to four weeks.

4. Where can you get abortion pills?

It depends on a few factors. If you want to obtain a medication abortion, ideally your first step would be to call an ob/gyn that you have an established relationship with and who you know will support you regardless of your reproductive choices, Jennifer Conti, M.D., M.S., an ob/gyn and clinical assistant professor of obstetrics and gynecology at Stanford University School of Medicine, tells SELF. Depending on your relationship with your primary care physician, you may also call them for guidance. That said, “your regular doctor is not the one who would administer the abortion pill,” says Dr. Dweck. “You’ll need to see a gynecologist or someone dedicated to women’s health.”

If you don’t have a relationship with an ob/gyn or a primary care physician, you can also call a clinic like Planned Parenthood, and ask if they have the medicine or can access it, Dr. Torres says. Even if they don’t, they should ideally be able to refer you to somewhere that can better help you. Unfortunately, we live in an ever-changing reproductive health landscape and depending on where you are, the medication is not always easily accessible in clinics, Dr. Torres says. But more on that later.

At your appointment, the practitioner will confirm your pregnancy and probably perform an ultrasound to see how far along you are. They’ll ask about your medical history and which medications you’re currently taking, Dr. Weber says, before giving you the pills you have to take and explaining when and how to take them—and what to expect.

5. Can I just buy the abortion pill online?

The thing about the internet is if you want something, you can probably find it. But the FDA says it’s not a good idea to buy the abortion pill online—and Dr. Torres agrees.

“Obtaining the abortion pill without the guidance of a medical practitioner is dangerous, just as I would say obtaining depression medication without the guidance of a medical practitioner is dangerous,” Dr. Torres says. “You could do yourself a lot of harm by not having a proper evaluation.” A medical professional is the only one who can determine whether the abortion pill is right for you.

That said, some providers are supportive of telemedicine services that help people access medication abortions in this tricky reproductive health landscape.

In recent years there has been a rise of organizations like Aid Access that help provide abortions with the aid of telemedicine. Unlike acquiring and abortion pill on your own, telemedicine services involve an evaluation with a remote doctor and professional oversight for a medical abortion at home. You have a direct line of communication with a medical professional throughout the process so you can ask questions and get support.

The conversation about these telemedicine services isn’t exactly straight forward. On the one hand, the FDA says it’s risky and wants them to stop, but on the other, there’s a growing consensus that the FDA’s regulations on abortion pills aren’t medically necessary. Some providers have started considering them as viable options for those who don’t have access to clinics.

“The sort of unifying message is that we are currently living in a reproductive health landscape that is changing week by week,” says Dr. Conti. “I think, whereas before a lot of providers and ob/gyns would say, ‘We absolutely don’t support that,’ you’re seeing a shift of people moving over to supporting [telemedicine services] as an option.” And it’s just that: an option. Dr. Conti still emphasizes that the ideal scenario is seeing a provider IRL. “I would prefer to help walk people through these situations in their lives. But the reality is, a lot of people don’t have access to providers like me who could walk them through it.” You can read more about the complicated reality of buying abortion pills online here.

6. How much does the abortion pill cost?

It varies. The abortion pill can cost anywhere from $ 300 to $ 800, depending on where you are and where you’re getting them (think: a clinic versus a private office), according to the American Pregnancy Association. Different clinics may have funds to help you out, Dr. Torres explains. And sometimes insurance does cover it, notes Dr. Dweck.

There are also cheaper or donation-based options available through telemedicine services that provide medication abortions.

7. Is the abortion pill dangerous?

No. “A lot of my patients ask me about safety, and the abortion pill is very safe,” Dr. Weber says. So is abortion in general. Fewer than one woman dies in every 100,000 legal abortions performed by a professional (including medication abortion), according to the Center for Disease Control and Prevention’s abortion surveillance data. For context, 16.9 women died per 100,000 live births in 2016, according to the CDC’s most recent pregnancy mortality data. Per those numbers, giving birth is about 27 times more fatal than abortion.

The incredibly small risk of dying from an abortion rises the longer someone is pregnant, and since medication abortions are only advisable up to 10 weeks along, that makes them even safer. In fact, serious complications requiring hospitalization occur in less than 0.4 percent of patients who get medication abortions, according to Guttmacher Institute.

8. What are the abortion pill side effects?

Beyond the bleeding and cramping, you may also experience nausea. “We provide medications to help control cramping, like ibuprofen, Motrin, or Advil,” Dr. Weber says. Your doctor or nurse practitioner may also offer a treatment like phenergan or zofran to deal with nausea.

She also recommends having a heating pad at home (you can buy one at a pharmacy), pads to deal with the bleeding, and confiding in a friend, family member, or partner whom you trust and can stay with you. Lastly, Dr. Torres says Netflix or some other form of entertainment can be supremely helpful.

9. How effective is the abortion pill? What happens if it’s not?

Usually, a medication abortion works completely. If not, you may need follow-up care ASAP. There are a few signs that you should reach out to a medical practitioner during your abortion, according to the Mayo Clinic. You need their input if you’re soaking through more than two maxi pads an hour for two or more hours in a row, passing clots for two hours or more, your abdominal pain is still severe after taking OTC painkillers, you have a chills and a fever of 100.4 degrees F or higher the day after the abortion, your nausea, vomiting, or diarrhea lasts over 24 hours, you’re dealing with strange smelling discharge, or you think you’re still pregnant.

When originally dispensing the medication, your medical practitioner should provide a phone number where you can reach someone 24/7 if you have questions or concerns about the abortion, Dr. Weber says.

10. How do you know if the abortion pill worked?

You’ll have a follow-up with your doctor to make sure everything went as planned. It used to be that you had to go into the office so your doctor could make sure the abortion was complete, but in an effort to make medication abortions more accessible, the FDA broadened the way you can follow up in 2016, Dr. Conti says. Now, you can follow up over the phone and take a pregnancy test at home. The idea is if you can check in with your provider over the phone, rather than in person, you will have to make fewer trips to the clinic—something that helps a lot if you have to worry about work, childcare, or general life. Some doctors still prefer in-person follow-ups, so make sure to chat with them ahead of time if you have a preference.

In case you’re wondering how a follow-up looks over the phone, according to the Mayo Clinic, your doctor will likely ask if you still feel pregnant, details about your bleeding, and whether you actually saw the expulsion of the gestational sac or embryo.

If your doctor suspects your abortion isn’t complete, you may need an ultrasound and, depending on the results, an additional procedure called a dilation and curettage, which removes tissue from the uterus.

11. Anything else I should know?

Even if you aren’t currently pregnant, it can be smart to figure out what you’d do in case of any accidents. “It’s always best to know what your options and resources are before you have an emergency,” Dr. Torres says. “I would highly recommend people at least contact Planned Parenthood or a health care professional to ask questions and have a plan in place, because birth control can fail. You want to know as quickly as possible which options and resources are available to you.”

Additional reporting by Abigail Libers.


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