Medication Abortion

A medication abortion involves taking pills to cause a miscarriage. This process takes 1-3 days to complete, depending on the timing of the medication. 

Step 1: A medication abortion begins by swallowing a tablet called Mifepristone. Mifepristone stops the growth of a pregnancy and starts to detach it from the wall of the uterus. Mifepristone blocks the hormone that allows a pregnancy to grow. Side effects include bleeding, cramping, and nausea - though they are typically mild and do not last long. 

Step 2: After taking Mifepristone in the clinic, patients will be given misoprostol tablets to take at a later time. Misoprostol causes the cervix (narrow passageway between the vagina and uterus) to open and the uterus to push out pregnancy tissue. When to take these tablets depends on how a patient prefers to take them. Options for how to take misoprostol are detailed below. Please follow the Medication Abortion Instructions given at the time of your appointment. 

1. Buccal Method: 24-48 hours after leaving the clinic, place all 4 misoprostol tablets in the mouth between the gums and cheeks, with 2 pills on each side. These pills should sit in the cheeks for 30 minutes and be left to dissolve. After 30 minutes anything that remains should be swallowed.
2. Vaginal Method: 6-48 hours after leaving the clinic, place all 4 misoprostol tablets in the vagina and let them dissolve.
   • Vaginal Insertion Diagram

Some patients will be instructed to take additional misoprostol tablets 4 hours later.

After taking misoprostol, symptoms usually start within 1-4 hours. Most people will pass the pregnancy within 24 hours. 

Hope Clinic provides patients with instructions for managing the symptoms they will experience, along with our 24-hour on-call emergency number so patients can get in touch with a provider or nurse from our facility at any time. It is important that all patients review the WARNING SIGNS listed on our instruction sheet for when to call during/following a medication abortion.

Step 3: We will arrange for a self-assessment, remote or in-person follow-up after an abortion. This is important because of the possibility of complications such as failed or incomplete abortion. The most common types of follow-up are listed below. 

1. Self-monitoring symptoms followed by taking a urine pregnancy test 4-5 weeks after taking Mifepristone, involving a provider as directed.
2. Vaginal ultrasound 1-2 weeks after taking Mifepristone
3.  

Symptoms of miscarriage (listed below) usually start within 1-4 hours of taking misoprostol. In most cases, the pregnancy will be passed within 24 hours of taking misoprostol. During this time, we encourage patients to use pads, get rest, drink plenty of fluids, monitor their bleeding every couple of hours, and have access to a telephone.

Symptoms:

• Vaginal bleeding (moderate to heavy, small and large clots)
• Pain/cramping (mild to severe)
• Feeling feverish, having chills
• Nausea (feeling sick), vomiting, diarrhea

In order to manage pain, patients are advised to use prescribed/over-the-counter medications as directed along with heating pads, hot baths/showers, back rubs, etc. Preparing a comfortable environment ahead of time is important. Comfy blankets, watching favorite movies/TV shows or reading favorite books, and creating a relaxing atmosphere will help improve the experience. 

It is normal to have a positive pregnancy test for at least 4 weeks after taking Mifepristone. 

Risks associated with medication abortion are similar to the risks associated with an in-clinic abortion procedure. For most people, a medication abortion is just as safe as an abortion procedure.

These risks include:

• Incomplete abortion
• Failed abortion (continuing pregnancy)
• Hemorrhage (too much bleeding)
• Infection

Risk of hemorrhage or infection occur in fewer than 1 out of every 100 people having a medication abortion, with risks for serious infection occurring even less frequently. Serious infection or hemorrhage can have negative health impacts if left untreated. For this reason, Hope Clinic provides all patients with access to a 24-hour emergency line for concerns, as well as detailed guidelines for reasons to call us or seek immediate medical attention. This line is available on our instruction sheet.

Risks of incomplete or failed abortion vary depending on length of pregnancy and timing of misoprostol, but are generally considered to occur in 2-9 out of every 100 people (2-9%) having a medication abortion. In some cases, an incomplete passage of pregnancy tissue requires an in-clinic abortion procedure, also known as a vacuum aspiration procedure.

Please read our Medication Abortion Consent for more information on the risks/benefits of and alternatives to medication abortion. 

Medication Abortion is a safe way to end an early pregnancy.  However, there are certain health issues, medications, and circumstances that may make increase chance of problems or make it unsafe for a specific individual. It is important to talk to your provider about your medical history so they can help you decide if medication abortion is right for you. 

Let your healthcare provider know if you have any of the following:

• inherited porphyria
• a blood or bleeding disorder (including blood clotting problems such as, sickle cell anemia, hemophilia, or a thalassemia).
• any condition that requires me to take “blood thinners” such as Coumadin (warfarin), or heparin
• adrenal failure
• an IUD in place
• allergy to mifepristone or misoprostol/cytotec
• long term use of corticosteroids (such as prednisone)
• known or suspected tubal (ectopic) pregnancy

• liver or kidney disease
• heart disease (such as angina, arrhythmia, valvular disease)
• respiratory disease (besides mild or moderate asthma)
• inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• seizure disorder or epilepsy
• high blood pressure not controlled with medication

If you feel you may change your mind after taking mifepristone, do not take it. There is no evidence that a medication abortion can be successfully “reversed” once started. We encourage you to take the time you need to decide whether abortion is right for you.

It is possible for the medication abortion to fail. The recommended treatment for a failed medication abortion involves terminating the pregnancy through additional medications, or an in-clinic abortion procedure. Treatment options may depend on the length of the pregnancy, your provider’s medical opinion, and your personal preferences.

English:

• Medication Guide
• Patient Agreement Form

Español - Spanish:

• Guía de medicamento
• Formulario de acuerdo del paciente

Kreyòl ayisyen - Hatian Creole:

• Gid Medikaman
• Fòm akò pasyan an

Français - French:

• Guide du médicament
• Formulaire d'approbation de la patiente

Português - Portuguese:

• Guia de medicação
• Formulário de acordo do paciente

Tiếng Việt- Vietnamese:

• Hướng dẫn dùng thuốc
• Mẫu thỏa thuận bệnh nhân

中国人 - Chinese (simplified):

• 用药指南
• 患者协议书

中國人- Chinese (traditional):

• 用藥指南
• 患者協議書

عربي - Arabic:

• دليل الدواء
• نموذج اتفاقية المريض

русский - Russian:

• руководство по лекарствам
• форма соглашения с пациентом