If you’re faced with having to undergo a medical abortion in your first trimester, you may want to prepare yourself for some of the possible side effects of the abortion pill. While you will no doubt be impacted emotionally and mentally, the focus here is on the physical side effects.
Medical abortion involves using 2 types of abortion pills, mifepristone and misoprostol, to terminate a pregnancy within the first 9 weeks, and sometimes 10 weeks,1 but not beyond that.
Under a doctor’s guidance, you can swallow a mifepristone tablet. Within the next 24 to 48 hours, as your doctor recommends, you can either take the misoprostol orally or have it inserted into your vagina at a clinic. You must return to the clinic after 7 days for a follow-up checkup.
Medical abortion does not require any sort of surgical procedure and can be taken in the privacy of your own home, but always under medical supervision. Ideally, you should do it in a legally authorized clinic or hospital. Do not self-medicate or buy pills online. For girls under 18, state laws often require parental consent.2
Here’s a look at the side effects of abortion pills.
Bleeding is not so much a side effect of the abortion pills but a sign that the pills are working.
Mifepristone, the first pill, blocks the hormone progesterone and detaches the fetus from the uterus. This may cause some bleeding in some women within 8 hours.
Misoprostol, the second pill, is a prostaglandin that brings on contractions in the uterus to enable it to empty. This causes heavy bleeding, more than with a regular period. You may also expel tissue and blood clots. The bleeding starts within 4 hours and this process typically takes between 3 and 5 hours, though it may last longer.3
Wear a sanitary pad to absorb the bleeding and to keep track of any spotting. Even if you think the flow has petered out, keep one handy, just in case.
The average duration of bleeding is 17 days,4 but some women may experience a bit of bleeding and spotting as much as 4 weeks after an abortion.
Caution: Very heavy bleeding or hemorrhaging affects about 2 in 1,000 women.5 If you are soaking through 2 pads in 2 hours or passing very large blood clots the size of a lemon or bigger, you are bleeding very heavily. It’s also a cause for concern if you pass blood clots for more than 2 hours.6 Please get emergency medical help.
Pain in the abdomen and the pelvic region typically begins within 3 hours of taking the misoprostol, once your uterus starts contracting. But it’s possible to experience cramps and pain after mifepristone.
It is quite like your period pain, and the pain is more if you usually have painful periods.7 If you are in your 8th or 9th week of pregnancy, it is likely to hurt more than if you are in your 7th week.8 You may even experience back pain.
Pain relief medication, like acetaminophen or ibuprofen, is safe to take. However, health authorities advise against using aspirin to manage the pain as it can increase bleeding.9
Caution: If abdominal or back pain is so extreme that you are unable to stand up, seek immediate help from a doctor.10
3. Nausea And Vomiting
More than half the women who take abortion pills say they experienced nausea. It can start after the first pill itself; misoprostol may make it worse. Though, usually, most women get nausea after taking misoprostol. This may last for 2 days.11
Vomiting too can start after mifepristone. If you vomit within an hour or so of taking the pill, it could render the dose ineffective. Inform your doctor immediately so a replacement pill can be administered as quickly as possible.12 Usually vomiting should ease off within a day.
The medication may also cause diarrhea, which involves passing 3 or more bowel movements that are watery or loose in a single day.13 Cramps, bleeding, and diarrhea is a bad condition but not life threatening. Should you get diarrhea, stay hydrated.14
Caution: Contact a doctor if diarrhea persists beyond 24 hours.15
5. Fever And Chills
Some women may also experience fever and/or chills after taking misoprostol, but getting it after mifepristone is not uncommon.16 It lasts for around a day. The chances of getting a fever are more if the misoprostol is given under the tongue rather than in the vagina.17
Caution: Contact your clinic or doctor if your fever goes above 100.4°F.18 A high fever indicates an infection.
Headaches are another common side effect of taking abortion pills. Some women may also feel dizzy.19 Dizziness, headaches, and weakness are caused by hormonal fluctuations brought about by the misoprostol. The headaches and the weakness will likely last for 2 days and the dizziness should subside in 1 day.20
The best thing to do is allow yourself some downtime to rest. While you may not have undergone a surgery, the process can take its toll on your system.
[Also Read: Foods That Help To Get Rid Of Headaches]
7. Incomplete Abortion
Sometimes, the medication may not work exactly as planned. This may result in incomplete expulsion of the pregnancy. In such cases, surgical intervention may be required. This happens in approximately 2 to 10% of all patients. Watch out for prolonged pain, pain felt when you press down on the abdominal region, cramps, or continued bleeding in the weeks following the abortion.21
8. Continued Pregnancy
Very rarely, in less than 2% cases, the abortion pills may not be effective in terminating the pregnancy.22 If you continue to experience symptoms of pregnancy, it could be a case of failed or missed abortion. This means that the fetus is still alive. The pills become less effective as you near the 9th week. Also, taking misoprostol orally rather than vaginally can increase the risk.23 24
While abortion pills have low risk of infection because medical abortion is not an invasive procedure, some amount of infection may occur when administering the misoprostol vaginally. A persistent high fever above 100.4 F, pain, and severe bleeding are signs of an infection.
10. Other Risks
Beware of where and how you undergo a medical abortion. Avoid purchasing pills online. Trying to sidestep the legal route of going through a certified doctor by using an online drug retailer poses a host of risks. Besides being illegal, the drugs themselves may not be authentic and may not work as advertised. If they’re improperly manufactured, they might even put you at risk of major health issues involving an incomplete or botched abortion attempt. You could also end up with severe bleeding and cramps due to inaccuracy in dosage. If the pills are contaminated with harmful chemicals, you could even expose yourself to potentially fatal conditions.
|↑1||American College of Obstetricians and Gynecologists, and American College of Obstetricians and Gynecologists. “Medical management of first-trimester abortion.” Practice bulletin 143 (2014): 676-692.|
|↑2||Parental Consent and Notification Laws. Planned Parenthood.|
|↑3, ↑6, ↑9, ↑16||Ending pregnancy with medications. U.S. National Library of Medicine.|
|↑4||Creinin, Mitchell D., Jill L. Schwartz, Helen C. Pymar, and Wendy Fink. “Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial.” BJOG: An International Journal of Obstetrics & Gynaecology 108, no. 5 (2001): 469-473.|
|↑5, ↑12, ↑19||Medical abortion:The Abortion pill up to 10 weeks. British Pregnancy Advisory Service.|
|↑7||Rørbye, Christina, Mogens Nørgaard, and Lisbeth Nilas. “Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study.” Human Reproduction 20, no. 3 (2005): 834-838.|
|↑8||Spitz, Irving M., C. Wayne Bardin, Lauri Benton, and Ann Robbins. “Early pregnancy termination with mifepristone and misoprostol in the United States.” New England Journal of Medicine 338, no. 18 (1998): 1241-1247.|
|↑10, ↑13, ↑18||Possible Physical Side Effects After Abortion. American Pregnancy Association.|
|↑11||Shannon, Caitlin S., Beverly Winikoff, Richard Hausknecht, Eric Schaff, Paul D. Blumenthal, Deborah Oyer, Heather Sankey, Jessica Wolff, and Rachel Goldberg. “Multicenter trial of a simplified mifepristone medical abortion regimen.” Obstetrics & Gynecology 105, no. 2 (2005): 345-351.|
|↑14||Diarrhea During Pregnancy. American Pregnancy Association.|
|↑15||Ending pregnancy with medications. U.S. National Library of Medicine.|
|↑17||Tang, Oi Shan, Carina CW Chan, Ernest HY Ng, Sharon WH Lee, and Pak Chung Ho. “A prospective, randomized, placebo‐controlled trial on the use of mifepristone with sublingual or vaginal misoprostol for medical abortions of less than 9 weeks gestation.” Human Reproduction 18, no. 11 (2003): 2315-2318.|
|↑20||Shannon, Caitlin S., Beverly Winikoff, Richard Hausknecht, Eric Schaff, Paul D. Blumenthal, Deborah Oyer, Heather Sankey, Jessica Wolff, and Rachel Goldberg. “Multicenter trial of a simplified mifepristone medical abortion regimen.” Obstetrics & Gynecology 105, no. 2 (2005): 345-351.|
|↑21||Kruse, Beth, Suzanne Poppema, Mitchell D. Creinin, and Maureen Paul. “Management of side effects and complications in medical abortion.” American journal of obstetrics and gynecology 183, no. 2 (2000): S65-S75.|
|↑22||The Safety of Abortion. National Abortion Federation.|
|↑23||Spitz, Irving M., C. Wayne Bardin, Lauri Benton, and Ann Robbins. “Early pregnancy termination with mifepristone and misoprostol in the United States.” New England Journal of Medicine 338, no. 18 (1998): 1241-1247.|
|↑24||El-Refaey, Hazem, Dhamnasekar Rajasekar, Mona Abdalla, Lynda Calder, and Allan Templeton. “Induction of abortion with mifepristone (RU 486) and oral or vaginal misoprostol.” New England Journal of Medicine 332, no. 15 (1995): 983-987.|