How to ensure a safe abortion with pills

Lesson 1: Am I Pregnant? 

Pregnancy - both planned and unplanned -  is a very common experience. Worldwide, more than 40% of pregnancies around the world are unplanned. If you didn't want to get pregnant, but think that you might be, you're not alone. In this video, we’ll talk about how to confirm a pregnancy.

First, it’s important to know that pregnancy happens after sex when semen is ejaculated from the penis into the vagina. Contraception helps to prevent pregnancy during sex, but there is a small chance you can still get pregnant.

The earliest and most reliable sign of pregnancy is a missed menstrual period. If you’ve had sex and notice that your monthly bleeding is late, you might be pregnant. Other common signs of pregnancy include nausea, headache, feeling tired, and enlarged, tender breasts. If you have any of these symptoms, in addition to a missed menstrual period, there is a good chance that you’re pregnant.

If you think you might be pregnant, you can confirm this by taking a urine pregnancy test. Pregnancy tests are commonly sold at pharmacies and convenience stores, or you can go to a health care facility to get one. It is not a requirement to take a pregnancy test before having an abortion with pills.

If you have signs and symptoms of pregnancy, or if a pregnancy test is positive, but you don’t want to be pregnant, you may decide to end the pregnancy. Abortions can be provided either with pills or via a surgical procedure. Follow along with this video series as we provide factual, evidence-based information and answer frequently asked questions about an abortion with pills before 13 weeks.

In our next video, we answer the question, “How far along is my pregnancy?”

Lesson 2: How many weeks is my pregnancy?

If you are pregnant but don’t want to be, you may decide to have an abortion. 1 in every 3 women will have an abortion in their lifetime. 

The length of your pregnancy will help determine how to safely and effectively undergo an abortion with pills. Estimating the length of a pregnancy is simple, though often misunderstood. If you have a calendar on hand, you can use it for reference.

First, think back to the last time you got your menstrual period. What day did the bleeding start? If you’re using a calendar, circle that date. Then count the number of weeks and days from that day until today’s date. This is how many weeks and days your pregnancy is.

Let’s use an example. Meet Sofia. Sofia’s last menstrual period began on September 13th, and today’s date is October 28th. How far along is her pregnancy?

To find out, Sofia marks September 13th on her calendar and begins to count the number of weeks until October 28th. She counts from September 13th to September 20th as one week, from September 20th to September 27th as two weeks, from September 27th to October 4th as three weeks, and so on. She continues like this until she reaches October 25th, which she marks as 6 weeks. Since there are no more full weeks between October 25th and 28th, Sofia counts by days. October 26th counts as one day, October 27th counts as two days, and October 28th counts as three days. This means that Sofia is 6 weeks and three days pregnant.

If you are not sure when your last menstrual period was, you can also go to a health care facility to get an ultrasound to estimate how many weeks pregnant you are. But an ultrasound is not mandatory before having an abortion with pills.

Keep in mind that it is not always necessary to know the exact number of weeks or days pregnant that you are. As long as you are less than 13 weeks pregnant, you can safely and effectively have an abortion with pills as described in this video course. 

In our next video, we answer the question, “How does an abortion with pills work?”

Lesson 3: How does an abortion with pills work?

An abortion with pills, also known as a medical or medication abortion, is a safe and common method of abortion. Millions of women all over the world safely and successfully use pills to end pregnancies every year. Many people prefer an abortion with pills because it can be done privately within the comfort of their home, is non-invasive, can feel more natural, and is similar to a spontaneous miscarriage.

There are two types of medications used for abortion: mifepristone and misoprostol. An abortion with pills works better if both of these medications are taken together. However, if mifepristone is not available, misoprostol alone will also work to end a pregnancy and is still safe. We will review both options in this video series.

Mifepristone and misoprostol cause the opening of the uterus to relax and the walls of the uterus to contract. This results in bleeding and cramping, which pushes the pregnancy out of the body, just like a miscarriage. Most women experience bleeding and cramping that’s similar to a heavy menstrual period and lasts several hours.

Some women go to see a medical provider, like a doctor or midwife, to get information about an abortion with pills and obtain the necessary medications. Then they go home to take the pills and manage the process themselves. Some women may decide to get information and pills in other ways. So long as the proper instructions are followed and quality medications are used, an abortion with pills will work to end a pregnancy almost every time.

Severe complications are extremely rare. An abortion with pills is so safe that most women successfully manage the process at home without any problems.

Almost everyone can have an abortion with pills – including young women, older women, women with and without children, women who have had an abortion before, women who are pregnant with twins, women who have had Caesarean deliveries, and women who are breastfeeding. Regardless of your age or weight, the dose stays the same and the pills will work equally well.

There are very few contraindications and they are very rare. If you know you have an ectopic pregnancy, which is a rare condition where the pregnancy is outside the uterus, abortion pills will not work to end the pregnancy, so you need to see a health care worker. If you have been told you have a medical condition called porphyria or problems with your adrenal glands, which are both very rare conditions, you should not do an abortion with pills. If you have an IUD in place, it should be removed before using abortion pills.

Many countries have laws surrounding the availability of abortion and the use of abortion pills. To learn more about the abortion laws in your setting, see HowToUseAbortionPill.Org. 

In our 2 next videos, we will explain how to take both mifepristone and misoprostol or misoprostol alone to have an abortion before 13 weeks. Abortions 13 weeks and beyond require a different approach.

Lesson 4: How do I take mifepristone and misoprostol to have an abortion before 13 weeks?

The information about an abortion with pills in this video is intended for pregnancies less than 13 weeks. Pregnancies that are 13 weeks or more need a different approach.

For an abortion with mifepristone and misoprostol, you will need to take one 200mg pill of mifepristone and four to eight 200mcg pills of misoprostol. You’ll also want to have a painkiller on hand, like ibuprofen, to help reduce pain.  Acetaminophen and paracetamol do not work for pain during an abortion so they are not recommended.

Here’s how mifepristone and misoprostol are taken together to end a pregnancy before 13 weeks:

Step 1: Swallow one 200mg pill of mifepristone with water.

Step 2: Wait 24-48 hours.

Step 3: Place 4 misoprostol pills (200 mcg each) under your tongue and hold them there for 30 minutes as they dissolve. You should not speak or eat for these 30 minutes, so it is good to be someplace quiet where you will not be disturbed. After 30 minutes, drink some water and swallow everything that is left of the pills. This is also a good time to take a painkiller like ibuprofen, as the cramping will start soon.

You should begin bleeding and cramping within 3 hours of using the 4 misoprostol pills.

Step 4: 24 hours after taking the 4 misoprostol pills, if you didn’t start to bleed, or if you are unsure that the abortion worked, place 4 more pills of misoprostol under your tongue. Hold them there for 30 minutes as they dissolve. After 30 minutes, drink some water and swallow everything that is left of the pills.

If mifepristone is available in your setting, then you can skip the next video and go directly to “What will I experience during an abortion with pills?”

Lesson 5: How do I take only misoprostol to have an abortion before 13 weeks?

The information about an abortion with pills featured in this video is intended for pregnancies less than 13 weeks. Pregnancies beyond 13 weeks require a different approach. 

If mifepristone is not available in your setting, then you can use misoprostol alone to end a pregnancy.

For an abortion before 13 weeks with only misoprostol, you will need to take twelve 200mcg pills of misoprostol. You’ll also want to have a painkiller on hand, like ibuprofen, to help reduce pain. Acetaminophen and paracetamol do not work for pain during an abortion so they are not recommended.

Here’s how misoprostol alone is used to end a pregnancy:

Step 1: Place 4 misoprostol pills (200 mcg each) under your tongue and hold them there for 30 minutes as they dissolve. You should not speak or eat for these 30 minutes, so it is good to be someplace quiet where you will not be disturbed. After 30 minutes, drink some water and swallow everything that is left of the pills. This is also a good time to take a painkiller like ibuprofen, as the cramping will start soon.

Step 2: Wait 3 hours.

Step 3: Place another 4 misoprostol pills (200mcg) under your tongue and hold them there for 30 minutes until they dissolve.

Step 4: Wait another 3 hours.

Step 5: Place another 4 misoprostol pills (200mcg) under your tongue and hold them there for 30 minutes until they dissolve. You should begin bleeding and cramping while taking the pills. Make sure to take all 12 pills even if you start to bleed before you’ve taken all of them.

In our next video, we answer the question, “What will I experience during an abortion with pills?”

Lesson 6: What will I experience during an abortion with pills?

Before having an abortion with pills, it’s important to know what to expect. Being well-informed will help to reduce stress and anxiety, and can lead to a safer experience. In this video, we’ll talk about what you may experience during an abortion with pills.

After taking mifepristone, you probably won’t feel anything, so you can go about your normal activities. Some women have light bleeding after taking mifepristone, and that’s okay too.

Misoprostol is the medication that will start the main bleeding and cramping involved in the abortion process. The day you take the misoprostol is the day you will need more privacy, to rest, and to plan to be at home.

You can expect the bleeding and cramping to start within 1-3 hours of taking misoprostol. Both bleeding and cramping are signs that the abortion pills are working to push out the pregnancy.

The bleeding is usually similar to or heavier than a menstrual period, and can include blood clots, which is normal. Some women may have a little more or a little less bleeding, and that’s normal too. The heaviest bleeding and pain typically occurs 4-6 hours after taking misoprostol when the pregnancy is being pushed out.

Remember that you can take painkillers like ibuprofen right after taking misoprostol to help reduce pain. Putting a hot water bottle or heating pad on your lower belly can also help with pain.

Aside from cramping and bleeding, you may also experience nausea, dizziness, chills, diarrhoea, headache, or a temporary rise in temperature after taking misoprostol. All of these are normal side effects of misoprostol and will mostly likely go away on their own. You can reduce these side effects by resting, drinking plenty of water, and eating light foods.

Most women do not see or notice anything when the pregnancy comes out. Some women may see the gestational sac, which is white and sometimes looks like a small piece of sponge. If the pregnancy is around 9 weeks or later, women may also see a small embryo. Women can choose to not look at the menstrual pads, wrap them up, and throw them away as they would during their monthly bleeding.

Within 24 hours, the bleeding and cramping should begin to decrease, and most women start to feel better.

In order to be prepared for the abortion, it can be useful to have some things on hand. This includes large maxi pads (not tampons), painkillers, a hot water bottle or heating pad, access to a toilet, light snacks, a friend or support person, and a comfortable bed or mattress. It may also be helpful to think about what time of day you will be able to have some privacy and be free from other responsibilities like work, school, or child care.

In our next video, we answer the question, “What are signs of complication during an abortion with pills?

Lesson 7: What are signs of complication during an abortion with pills?

In our earlier video, we discussed what to expect during an abortion with pills. But it’s also important that you understand what’s not normal during the abortion process. Both the risk of complication and the need for emergency care are very rare. Only 2 or 3 women for every 100 women who have an abortion with pills will experience a complication, and only 1 in 2000 will need emergency medical care. However, to make the process as safe as possible, it’s important to recognize the signs of a complication and also to have a plan in place for how to access emergency care if needed.

You should go to a doctor or hospital immediately if you have any of the following signs:

1) Bleeding that is so heavy that it soaks up 2 regular menstrual pads every hour for 2 hours in a row.

2) Severe abdominal pain that does not go away with pain medication or continues for 2-3 days after taking the pills.

3) A fever or other side effects that last more than 24 hours.

4) Abnormal vaginal discharge that is yellow, green, or smells bad.

If you have very little bleeding or no bleeding at all 3 days after taking the pills, or if you continue to have moderate to heavy bleeding or cramping that doesn’t decrease 7 days after taking the pills, this may be a sign that the pills didn’t fully work. This is not an emergency, but you should seek medical care or talk to a support person within a day or so. You can also get information and support from trusted online resources like www.safe2choose.org, www.womenhelp.org or www.womenonweb.org.

If you do seek medical care, you do not need to say that you used medicines if you do not want to. You can say you are having a miscarriage and you should receive the appropriate care. The symptoms and treatment of a complication of spontaneous miscarriage and abortion with pills are exactly the same. When misoprostol is taken under the tongue or via the mouth, it cannot be detected in the blood or any other body parts. Sometimes women are advised to put misoprostol tablets in their vagina, which takes longer to dissolve, so pieces of the pills may be visible during an examination by a health care worker.

In our next video, we answer common questions after having an abortion with pills.

Lesson 8: What happens after I have an abortion with pills?

After you’ve used the abortion pills, you may still have a number of questions. In this video, we discuss some of the most common questions we hear from women who have recently completed the abortion process.

Question 1: How do I know if the pills worked?

If you had bleeding and cramping like a heavy menstrual period after taking the pills, and you no longer feel pregnant, then the abortion pills have most likely worked. Most women are able to know if the abortion was successful because their pregnancy symptoms, such as nausea and breast tenderness, start to go away.

If you want more reassurance that you are no longer pregnant, you can also take a urine pregnancy test 3-4 weeks after taking the pills. Taking a pregnancy test earlier than 3 weeks is not advised, as the test can stay positive during this time even after a successful abortion.

Question 2: Do I need to see a doctor after having an abortion with pills?

Routine follow-up is not necessary. So long as you no longer feel pregnant, you feel in good health, and your bleeding isn’t heavy, everything is most likely fine.

Of course, you can talk to a health care provider or a support person at any time if you have any questions or concerns. You can also reach out to trusted online resources such as Safe2choose.org, womenhelp.org, and womenonweb.org for support and information.

Question 3: When will I stop bleeding?

Most bleeding stops within a couple days. Some women continue to have light bleeding or spotting off and on for 1 month. This is normal, and you do not need to worry or do anything to make the bleeding stop. The bleeding should get lighter over time until it gradually disappears on its own.

Question 4: Can I get pregnant again after having an abortion with pills?

Yes, you can get pregnant again very soon after having an abortion with pills. For some women, fertility returns as quickly as 8 days after the abortion. If you’d like to know more about your contraceptive options, talk to your healthcare provider.

Question 5: When will my regular period return?

Most women will have their next menstrual period 4-6 weeks after the abortion, but for some women, it can take longer. 

Question 6: How soon after an abortion can I have sex?

So long as there are no signs of complication, you can have sex after an abortion whenever you’d like. Just listen to your body and decide what feels right for you.

If you have additional questions, or if you’d like to learn more about abortion with pills, visit www.howtouseabortionpill.org or safeabortioncare.msf.org. 

Remember: abortion is common; abortion is safe; abortion is health care- and we’re here to support you.