Abortion self-care is the process of taking pills to end a pregnancy without direct supervision of a health-care provider. This is also commonly referred to as self-managed abortion. An ‘abortion with pills’ is also referred to as a medication abortion. A medication abortion can be done as a ‘self-managed abortion’ or with the support of a health-care provider, depending on a woman’s preference.

References:

– WHO consolidated guideline on self-care interventions for health: Sexual and reproductive health and rights. Geneva: World Health Organization; 2019 https://apps.who.int/iris/bitstream/handle/10665/325480/9789241550550-eng.pdf?ua=1

It is wise to be prepared before a medication abortion—which includes setting aside sufficient time and being in a secure and comfortable place. Consider being with somebody you trust, especially after you have taken the misoprostol pills, or let someone know they should check up on you in several hours (with or without disclosing the reason). Make sure you have the correct amount of the right abortion pills, a supply of thick sanitary napkins (tampons are not suitable), and some ibuprofen or other locally available non-steroidal anti-inflammatory drug (aspirin is not suitable).

You should NOT have a medication abortion if you have any of the following conditions:

• Previous allergic reaction to mifepristone or misoprostol
• Confirmed or suspected ectopic pregnancy
• Porphyria (only a concern if you are taking mifepristone + misoprostol regimen). Porphyrias are rare inherited disorders that affect mainly the skin or nervous system.
• Chronic adrenal failure (only a concern if you are taking mifepristone + misoprostol regimen)

If you have major health issues or concerns, you should consult with a health-care provider before taking abortion pills. Check the medication pack insert for other medical reasons not to take medication abortion drugs.

Reference:

– Ipas. (2019). Clinical updates in reproductive health. Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

While the medication abortion experience will be different for everyone, it can be painful for some. The process can be more painful in the later stages of early pregnancy. To reduce pain from cramping, you can take ibuprofen or other locally available non-steroidal anti-inflammatory drugs approximately one hour before your first dose of misoprostol or at the time cramping begins. Placing a hot water bottle over the stomach area may help too.

References:

– Clinical practice handbook for safe abortion. World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

– Ipas. (2019). Clinical updates in reproductive health. Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

– Medical management of abortion. World Health Organization; 2018 https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

We recommend that you purchase abortion pills from a trusted source, such as a respected pharmacist or drug seller. You may also be able to buy them from a reputable online source like Women Help Women (https://consult.womenhelp.org/). Purchase misoprostol in double-aluminum blister packs and keep the misoprostol in its original packaging until you are ready to use it. Mifepristone and misoprostol are sometimes sold together in a combination pack.

Reference:

– Ipas. (2019). Clinical updates in reproductive health (Misoprostol product quality). Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

Yes. Medication abortion is suitable for individuals of all ages who want to end a pregnancy—as long as you are doing so by choice and you have no specific medical condition that makes you ineligible (see above: “I have an existing medical condition. Does that mean I cannot use medication abortion?”).

References:

– Ipas. (2019). Clinical updates in reproductive health (Adolescents: safety and effectiveness). Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

– Safe abortion: Technical and policy guidance for health systems – 2nd ed. World Health Organization; 2012 https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf?sequence=1

Yes. Dating the pregnancy before using abortion pills will help you establish your best course of care. The course of treatment is not the same for different stages of pregnancy. If you are less than 12 weeks pregnant, you can use the medication abortion regimens described on this website.

Reference:

– Clinical practice handbook for safe abortion. World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

When the right drugs are used properly, medication abortion is a simple, safe and effective way to end a pregnancy. Medication abortion is most successful when a drug called mifepristone is used in combination with a drug called misoprostol. When mifepristone is not available, a misoprostol-only regimen is also a safe, yet possibly less effective, way to end a pregnancy.

References:

– Medical management of abortion. World Health Organization; 2018 https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

– Clinical practice handbook for safe abortion (2.4 Medical abortion/Clinical considerations). World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

You must have the IUD removed by a health-care provider before you start taking the medication abortion drugs.

Reference:

– Ipas. (2019). Clinical updates in reproductive health (Medical abortion contraindications and precautions). Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

Mifepristone and misoprostol are two drugs used to end a pregnancy. They are both available as pills. The drugs can be taken in combination (most effective) or misoprostol alone may be used. Mifepristone blocks the hormone needed for the pregnancy to progress. Misoprostol causes the uterus to contract, which helps to expel the pregnancy.

Reference:

– Medical management of abortion (1.1 Background). World Health Organization; 2018 https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

If you have access to both mifepristone and misoprostol, you should make sure you have at least 1 mifepristone pill of 200 mg and 4 misoprostol pills of 200 mcg each. If you have access to misoprostol only, you should make sure you have at least 12 misoprostol pills of 200 mcg each.

When taking only misoprostol (and not also mifepristone) to end a pregnancy estimated to be up to 12 weeks, you should follow the three steps below. Even if bleeding starts after Steps 1 or 2, you must complete all 3 steps for best possible results.

• Step 1: Place 4 misoprostol pills (200 mcg x 4 pills) either under your tongue or between your cheeks and gum. Wait 30 minutes for them to dissolve and swallow whatever is left with water. Wait 3 hours.
• Step 2: Place 4 more pills (200 mcg x 4 pills) either under your tongue or between your cheeks and gum. Wait 30 minutes for them to dissolve and swallow whatever is left with water. Wait 3 hours.
• Step 3: Place 4 more pills (200 mcg x 4 pills) either under your tongue or between your cheeks and gum. Wait 30 minutes for them to dissolve and swallow whatever is left with water.

Inserting misoprostol pills into the vagina works well too but the pills may be detectable even several hours later. Putting misoprostol in your vagina is not recommended if you live in a country where abortion is legally restricted.

If you are more than 10 weeks pregnant, it may be safer for you to seek treatment under the supervision of a health-care provider properly trained in abortion care. If your period was more than 12 weeks ago, medication abortion might not work for you.

References:

– Medical management of abortion (3.4.1 Indication for induced abortion). World Health Organization; 2018. https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

– Ipas. (2013). Woman-centered, comprehensive abortion care: Reference manual (second ed.) (Administration of misoprostol only). K. L. Turner & A. Huber (Eds.). Chapel Hill, NC: Ipas. www.ipas.org/resources/woman-centeredcomprehensive-abortion-care-reference-manual-second-edition

When taking mifepristone together with misoprostol to end a pregnancy estimated to be up to 12 weeks, you should follow these three steps:

• Step 1: Swallow 1 mifepristone pill (200 mg) with water.
• Step 2: Wait 1 – 2 days before taking the misoprostol pills.
• Step 3: Place 4 misoprostol pills (200 mcg each) either under the tongue or between your cheeks and gum and allow the pills to dissolve. Wait 30 minutes and swallow whatever is left with water.

Inserting misoprostol pills into the vagina works well too but the pills may be detectable even several hours later. Putting misoprostol in your vagina is not recommended if you live in a country where abortion is legally restricted.

If you are more than 10 weeks pregnant, it may be safer for you to seek treatment under the supervision of a health-care provider properly trained in abortion care. If your period was more than 12 weeks ago, medication abortion might not work for you.

Reference:

– Medical management of abortion (3.4.1 Indication for induced abortion). World Health Organization; 2018. https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

Sometimes bleeding occurs after you take the mifepristone pill. Misoprostol pills should cause bleeding and cramping, and you may see blood clots. Generally, bleeding and cramping start within a few hours after taking misoprostol, but they may start sooner. For some, especially in the later stages of an early pregnancy, bleeding can be heavier, and cramping can be stronger than for a typical menstrual period. Try to keep a note of how many sanitary cloths/napkins are getting soaked through and how often. If you experience little or no bleeding, this is a sign that the medications may not have worked, and you should consider getting medical help. You may continue to have some bleeding and/or spotting until your next menstrual period.

References:

– Medical management of abortion. World Health Organization; 2018 https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

– Clinical practice handbook for safe abortion. World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

When side effects occur, most go away in a few hours. Most side effects occur after taking misoprostol pills. Side effects include:

• Nausea/vomiting. If you vomit within 30 minutes of taking mifepristone or misoprostol, you may need to take the medicine again.
• Light fever and chills. You can use a cool compress or take paracetamol to relieve the symptoms.
• Diarrhea. Try to drink fluids to avoid dehydration.

Reference:

– Clinical practice handbook for safe abortion. World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

Avoid eating or drinking while you wait for the misoprostol pills to dissolve under your tongue or in your cheeks. Otherwise, you should try to drink fluids and eat something throughout the abortion process. You should avoid alcohol.

In general, the medication abortion process can take up to a few days to be complete. For people using a mifepristone and misoprostol regimen, approximately 90% of women will expel the products of conception within 4-6 hours of taking the misoprostol.

For people using a misoprostol-only regimen, most women will expel the products of conception within 24-48 hours of taking the first dose of misoprostol.

Reference:

– Ipas. (2013). Woman-centered, comprehensive abortion care: Reference manual (second ed.) K. L. Turner & A. Huber (Eds.). Chapel Hill, NC: Ipas. www.ipas.org/resources/woman-centeredcomprehensive-abortion-care-reference-manual-second-edition

Bleeding alone does not mean the abortion pills have successfully ended the pregnancy. You must also pass the pregnancy tissue (sometimes called “products of conception”). Some women will only see blood and clots. Some women with pregnancies greater than 10 weeks may see the embryo, which may be wrapped in a blood clot or tissue, although they may not see it unless they really look for it.

Reference:

– Medical management of abortion. World Health Organization; 2018 https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

You must seek immediate care from a health-care provider properly trained in abortion and postabortion care if you experience:

• Excessive, continuous bleeding—especially if you are soaking through 2 or more sanitary pads or their equivalent each hour for 2 or more hours
• Severe pain in the belly that does not go away with pain relief medication
• Unusual and bad-smelling discharge from the vagina
• A high temperature or high fever that last longer than a day Even if abortion is legally restricted where you are, the provision of care for postabortion complications is always legal. You do not have to disclose that you have taken abortion pills if you do not wish—you can say that you have had a failed pregnancy (miscarriage).

Reference:

– Safe abortion: Technical and policy guidance for health systems – 2nd ed. (4.2.2.8 Access to treatment for abortion complications). World Health Organization; 2012. https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf?sequence=1

Hormonal methods of contraception can be started right away with medication abortion—as early as the day of taking the first abortion pill (mifepristone or misoprostol). Hormonal methods include implants, injections, oral pills, patches and rings. You should only consider an intrauterine device or tubal ligation once you are certain you are no longer pregnant.

References:

– Medical management of abortion (3.5 Post-abortion contraception). Geneva: World Health Organization; 2018. https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

– Ipas. (2019). Clinical updates in reproductive health (Postabortion contraception: when and what type). Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

You can have sex as soon as you feel ready.

Reference:

– Clinical practice handbook for safe abortion (2.5 Medical abortion/ 12 weeks (or 84 days) of pregnancy/Follow-up care). World Health Organization, 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

A woman/girl can have sex as soon as she is ready after a medication abortion. She can become pregnant again as soon as 8 days after an abortion. If she does not want this to happen, she should consider using a method of contraception. It is safe for a woman/girl to start using almost all contraception the same day she takes the mifepristone pills (or misoprostol).

Reference:

– Medical management of abortion (3.5 Post-abortion contraception/3.5.4 Additional considerations). Geneva: World Health Organization; 2018. https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

Yes. An uncomplicated abortion will not affect future planned pregnancies.

Reference:

– Clinical practice handbook for safe abortion (1.1. Information, counselling and decision-making). World Health Organization; 2014 https://apps.who.int/iris/bitstream/handle/10665/97415/9789241548717_eng.pdf?sequence=1

You can flush expelled tissue down the toilet or dispose of it with sewage or the way you would dispose of sanitary pads or the equivalent during a menstrual period.

There are several web-based sources for accurate medication abortion information. If you do not find the answer to your medication abortion question on this website, try the FAQ page on one of these websites:

• safe2choose.org
• womenhelp.org
• apps-sa.hesperian.org/app

Other options are:

• Ending the pregnancy at a clinic, either with pills or a surgical abortion. Surgical abortion is typically an outpatient procedure that is often completed with vacuum aspiration (gentle suction that removes the pregnancy).
• Continuing the pregnancy and becoming a parent or putting the infant up for adoption.
• Counseling may help you reach a decision that is right for you.