How the abortion pill regimen works

Dr. Emily Godfrey, an associate professor of family medicine and obstetrics and gynecology at the University of Washington School of Medicine, says two-step medication abortions are about 98% effective and carry a risk of hospitalization of less than 1%.

“Medication abortion in the United States involves two pills, mifepristone and misoprostol, and can be safely used up to the first 11 weeks of pregnancy,” said Godfrey. “(The medications) are safer than many other medications that I prescribe, including penicillin, or Tylenol, or insulin.”

How the regimen works.

“The first pill that blocks pregnancy hormones is a single pill that patients can swallow. The second round (taken 24 hours after the first pill) is actually four separate pills,” said Godfrey. “They either go under the tongue or in the buccal mucosa (where inner cheeks meet the gums toward the back of the mouth).”

What happens after the medication is taken?

“When you're placing those four tablets inside your buccal mucosa (inner cheek lining), that's when to expect, within 2 to 4 hours, quite a bit of cramping and bleeding,” Godfrey said. “The bleeding is going to be heavier than a period, for sure. The cramping is going to be, I say, like a really bad period.”

She says the first-step mifepristone blocks progesterone, or “the pregnancy hormone” in the uterus, which keeps the pregnancy from growing. The four-tablet misoprostol dose then induces the body to pass the pregnancy, according to Godfrey.

Are there signs that suggest more medical help is needed?

Godfrey says there's a less than 1% risk of hospitalization, blood transfusion, antibiotics, or surgical procedure as a result of using the regimen – but there are signs to watch for after completing the regimen.

“If there are (menstruation) pads being filled: two an hour, for two consecutive hours. And I like to explain it as front to back, side to side, being filled – that we consider an emergency,” she said. If that severity of bleeding occurs, patients should first try contacting their healthcare provider for guidance, then go to an emergency room for treatment.

Patients also should seek care if they feel ill, have abdominal pain, vomiting, diarrhea or fever greater than 100.4 degrees Fahrenheit 24 hours after using misoprostol.

She also encourages anyone experiencing light bleeding (not spotting) more than two weeks after the abortion to seek medical attention.  Alternatively, if patients have no bleeding at all 24 hours after taking the misoprostol pills, they may consider reaching out to their healthcare provider.

Godfrey says medication abortions beyond the first 11 weeks' gestation should be performed at a clinic or hospital instead of patients using the medication at home.

Godfrey also discusses medication abortions in broadcast-ready soundbites available for download.

UW Medicine