A medication abortion is the use of pills to end a pregnancy. Most commonly, a medication abortion involves taking two medicines, called mifepristone and misoprostol.
The patient takes one mifepristone pill followed by 4 or 8 misoprostol pills within the next 48 hours. The pills essentially induce a miscarriage.
The Food and Drug Administration (FDA) approved mifepristone in 2000. As of 2018, more than 3.7 million people in the United States had had medication abortions.
Medication abortion is highly effective.
For pregnancies that are less than 10 weeks (70 days) along, the mifepristone + misoprostol pill regimen produces complete abortion in about 95% of patients.
About 5% of patients may need to have a minor suction procedure or additional medication because of a continuing pregnancy, incomplete abortion, or persistent bleeding.
The treatment is more effective the earlier in pregnancy it is used.
To estimate how far along the pregnancy is, use the Gestational Age Estimator.
Medication abortion is very safe.
Potentially serious risks are rare. They include heavy bleeding, pelvic infection, and delay in detection of ectopic pregnancy (pregnancy in the tube, ovary, or abdomen).
It is very unusual for patients to need admission to a hospital for treatment or to have a blood transfusion after a medication abortion.
Almost everyone having medication abortion will have vaginal bleeding and abdominal cramping; that is the medications working as expected.
Many people also have other symptoms, such as nausea, vomiting, diarrhea, fatigue, headache, mild dizziness, back pain, chills, and mild fever. These side effects usually last a short time (hours or a few days) and can be treated with over-the-counter medications.
The MA-ASAP study will provide medicine for pain and nausea in addition to the abortion pills.
Most guidelines say that medication abortion may be used by people who are no more than 10 weeks pregnant. Also, the person must NOT have any of the following conditions, all of which are rare:
- Signs that the pregnancy might be ectopic, which means that it is growing outside the uterus.
- Failure of the adrenal glands
- Allergies to mifepristone or misoprostol
- Bleeding disorders, such as hemophilia
- Inherited porphyria, a genetic disease of the skin and nervous system
- Use of certain medications, including steroids or anticoagulants (blood thinners)
- Use of an IUD during the pregnancy. An IUD is a contraceptive device that is placed in a person’s uterus. Examples of IUDs include Paragard, Mirena, Skyla, Liletta, and Kyleena.
To estimate how far along your pregnancy is now, use the Gestational Age Estimator.
Until recently, most abortion providers did require that every patient requesting medication abortion must have an ultrasound before treatment to confirm the duration of the pregnancy and to make sure it is growing in the uterus.
But in the past few years, research has shown that many patients don’t need an ultrasound; the pregnancy can usually be evaluated just by asking patients about their menstrual periods, past history, and current symptoms.
Accordingly, all major professional organizations in the United States that issue recommendations about abortion have now updated their guidelines to eliminate the requirement for routine ultrasound before medication abortion. The MA-ASAP study follows those guidelines.
But not having an ultrasound can have some risks:
- If the pregnancy is much more than 11 weeks along, the chance of abortion failure increases, which could result in heavy bleeding and the need for a procedure to complete the abortion.
- If the pregnancy is more than 11 weeks along and the medicines do work, the patient could abort a larger fetus at home, or even a premature baby.
- If the pregnancy is an ectopic pregnancy – i.e., it is growing outside the uterus, usually in the tube – the treatment will not work to end the pregnancy, and the detection of the condition may be delayed. Ectopic pregnancy is quite rare but it can be dangerous, even resulting in death if not treated. It is usually treated with a surgical procedure or with medicines.
If you have regular menstrual periods about once a month, simply counting the number of days since the first day of your last menstrual period usually gives an accurate estimate of how far along the pregnancy is.
To use this method to estimate the length of the pregnancy, use the Gestational Age Estimator.
If you do not have regular, normal menstrual periods or do not remember the date your last period started, this method will not work well. Also, it may be inaccurate if you have been using hormonal birth control or if you had a previous pregnancy just before this one. In such cases, you should consult a clinician and probably get an ultrasound before medication abortion. Therefore, you would not be eligible for the MA-ASAP study.
You could have a procedure abortion, in which the abortion provider uses suction (aspiration) or other methods to remove the pregnancy from the uterus. Procedure abortions must be done in a clinic. Like medication abortions, they are very safe and effective.
Or, you could decide not to have an abortion at all, and instead continue the pregnancy. Once you give birth, you could either raise the child yourself or place the child for adoption.