Here’s how abortion pills work – and why we need them

While safe access to abortion continues to be debated in the United States, there is much misunderstanding around how abortion works. The use of medical abortions (medication abortions), or the “abortion pill”, is an effective way to end a pregnancy up to 11 weeks gestation.

Medical abortions account for more than half of all abortions, especially now with declining access to abortions across the country.

What are medical abortions?

“Medical abortion in the United States involves two pills, mifepristone and misoprostol,” says Dr. Emily Godfrey, associate professor of family medicine and obstetrics and gynecology at the University of Washington School of Medicine. . “They can be used safely up to the first 11 weeks of pregnancy.”

Here’s what to expect with a medical abortion:

  • The first pill a person seeking an abortion would take is mifepristone, which blocks pregnancy hormones and is a single pill that is swallowed.
  • The second pill, misoprostol, is taken 24 hours after mifepristone. It is placed under the tongue or between the gumline and the cheek – not swallowed like mifepristone. Typically, four of these pills are needed to be effective. Within two to four hours, cramping and bleeding to empty the uterus can be expected. Bleeding and cramping may hurt like a bad period, but there will be more blood than with a normal period.
  • If a person seeking an abortion cannot obtain mifepristone due to legal restrictions in their area, a regimen containing only misoprostol can be used.

This method of abortion has an extremely high success rate, with its effectiveness depending on gestational age. For example, these abortions are 98% effective at seven weeks, but closer to 95% at nine weeks. After the nine-week mark, the dose of misoprostol is repeated for up to 11 weeks, so the success rate remains around 98% in terminating the pregnancy.

It is important to remember that these medical abortions can also be used for miscarriages. In all uses, bleeding can be expected to last nine to 16 days.

What makes medical abortions different from emergency contraception?

Pills prescribed for abortions work differently than plan B or other emergency contraceptive pills.

Plan B uses the synthetic hormone levonorgestrel, which has been used in birth control for over 35 years. After unprotected sex, emergency contraceptives like Plan B work to stop the release of an egg from an ovary – also known as ovulation. It can also prevent sperm from joining with an egg — or fertilizing. Plan B is only effective up to 72 hours after unprotected sex, and the earlier it is taken, the better.

There are other emergency contraceptive pills on the market that work similarly to Plan B, such as Ella. This pill contains a non-hormonal medicine called ulipristal acetate and can be taken up to five days after unprotected sex.

The biggest difference between emergency contraceptives and the abortion pill is that emergency contraceptives are not effective on eggs that have already successfully joined with sperm. In other words, if unprotected sex has resulted in pregnancy, emergency contraceptives cannot terminate the pregnancy.

Are medical abortions safe?

Godfrey says complications from medical abortions are rare.

“There is less than a 1% chance that a patient using this regimen will need hospitalization, blood transfusion, antibiotics or surgery. This is something I really want to emphasize to patients,” says Godfrey.

At the onset of bleeding, if two maxi pads are filled end to end and side to side for two hours in a row, this is a sign of an emergency. Contact your doctor or an emergency room if this happens – but it rarely does.

Due to the low risk associated with medical abortions, they do not need to be administered by a doctor or healthcare professional in a clinic after being prescribed. Instructions are easy to follow and, due to their accessibility, account for more than 39% of all abortions. When and where you take the drug depends on the laws of your state, but your doctor will give you this information.

“The two drugs [mifepristone and misoprostol] are safer than many other drugs I prescribe, including penicillin, Tylenol, or insulin,” says Godfrey.

What happens after a medical abortion?

Someone who has a medical abortion is not alone through the process. The prescribing physician or healthcare professional will advise them on what to expect during and after treatment and once the bleeding has stopped.

Although routine in-person follow-up is not required for most medical abortions, this option is available for those who choose to attend the clinic to assess the success of the medical abortion. A transvaginal ultrasound will generally be used for these appointments.

For most people, telemedicine or self-reports are enough to determine the success of medical abortions. There may be a check-up with a doctor or healthcare professional about a week after the diet, and a home urine pregnancy test may be taken after four weeks to confirm a successful abortion.

Abortions are a necessary part of health care, like any other routine preventive procedure. And with something as safe, successful, and accessible as abortion pills, understanding how drugs work can help us understand why they’re needed.

Barbara Clements contributed to this article. A version of this story originally appeared on the UW Medicine Newsroom.

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