How Medication Abortion Works: Complete Medical Guide
Medication abortion uses two medications—mifepristone and misoprostol—to safely end an early pregnancy at home. This guide explains the medical process, what to expect, and how it works.
Quick Summary
- What it is: Two medications taken 24-48 hours apart
- How early: Effective through 13 weeks of pregnancy (WHO guidelines)
- Success rate: 95-98% effective
- Where: Complete the process at home with medical support
- Safety: FDA-approved since 2000, extensive safety record
- Access: Available through telemedicine in many areas
Understanding the Two Medications
Medication abortion uses two different medications that work together. Understanding what each one does can help you know what to expect.
Mifepristone: The First Medication
What it does: Mifepristone blocks progesterone, a hormone your body needs to continue a pregnancy. Without progesterone, the pregnancy cannot continue to grow.
How you take it:
- One pill
- Swallow with water
- Can be taken at any time of day
What happens after:
- Most people feel no immediate symptoms
- Some may experience light bleeding or nausea
- You can continue with normal daily activities
When you take it: This is the first medication in the process.
Misoprostol: The Second Medication
What it does: Misoprostol causes your uterus to contract and empty, similar to what happens during a miscarriage. This is when you'll experience cramping and bleeding.
How you take it:
- Four pills total
- Place between your cheek and gum (buccal) OR under your tongue (sublingual)
- Let dissolve for 30 minutes, then swallow what remains
What happens after:
- Cramping usually starts within 30 minutes to 4 hours
- Bleeding begins, often heavier than a period
- You'll pass blood clots (this is normal and expected)
- Heaviest symptoms last 3-5 hours
When you take it: 24-48 hours after taking mifepristone.
Step-by-Step: What to Expect
Here's a detailed timeline of the medication abortion process:
Before You Start: Preparation
What you'll need:
- Ibuprofen (Advil, Motrin) for pain - avoid aspirin
- Heating pad or hot water bottle
- Maxi pads (not tampons)
- Comfortable, private space
- Someone available for support (if possible)
- Light foods and drinks
- Entertainment (movies, books, phone)
Choose your timing: Plan to take misoprostol when you can be at home for 6-8 hours. Many people choose evening or weekend timing.
Day 1: Taking Mifepristone
The process:
- Swallow one mifepristone pill with water
- Continue normal activities
- Eat normally if you feel like it
What most people feel:
- Usually no symptoms yet
- Some people experience light cramping or nausea
- Light bleeding is possible but not common
What's happening inside: The pregnancy has stopped growing, though you won't feel much yet.
Day 2-3: Taking Misoprostol (24-48 hours later)
Before you take it:
- Take 800mg ibuprofen 30 minutes before
- Set up your comfortable space
- Have supplies ready
- Put heating pad within reach
The process:
- Place 4 pills between cheek and gum OR under tongue
- Wait 30 minutes (don't talk or eat during this time)
- After 30 minutes, swallow what's left with water
Within 30 minutes to 24 hours:
- Cramping begins (like strong period cramps)
- Bleeding starts
- You may feel nauseous, have chills, or diarrhea
- Bleeding becomes heavier than a period
Note: For most people, cramping and bleeding start within 30 minutes to 4 hours, but it can take up to 24 hours.
Hours 2-5 (usually the most intense):
- Strong cramping (take more ibuprofen if needed)
- Heavy bleeding with clots
- Clots can be large (golf ball size is normal)
- You may see tissue that looks different from regular blood
This is the most difficult part, but it's temporary. Most people say the intense part lasts 3-5 hours.
What's happening inside: Your uterus is contracting and emptying, completing the abortion.
Hours 6-12: Beginning to Ease
- Cramping starts to decrease
- Bleeding may still be heavy but less than peak
- You can start to rest and recover
- Eat light foods if you feel up to it
Days 3-7: Initial Recovery
- Bleeding continues but gradually decreases
- Cramping becomes much lighter
- Energy returns to normal
- You can return to work/school when ready
What's normal:
- Bleeding like a period or lighter
- Occasional cramping
- Passing small clots
Weeks 1-4: Ongoing Recovery
- Light bleeding or spotting may continue for 2-4 weeks
- This is completely normal
- Your next period typically starts in 4-8 weeks
- You can ovulate (get pregnant) within 2 weeks
Week 5: Confirming Completion
How to confirm it worked:
- Take a pregnancy test 5 weeks after taking mifepristone
- Negative test = successful abortion
- If still positive, contact your provider for follow-up
Or: Some providers offer ultrasound confirmation if you prefer.
Managing Symptoms at Home
Pain Management
Most effective:
- Ibuprofen: 600-800mg every 6-8 hours (NOT aspirin)
- Heating pad: Apply to abdomen or lower back
- Rest: Lie down with pillows supporting your back
Also helpful:
- Warm bath or shower
- Gentle massage of abdomen
- Distraction (movies, podcasts, music)
Nausea
- Eat light, bland foods
- Ginger tea or crackers
- Small, frequent sips of water
- Anti-nausea medication if prescribed
Bleeding
Normal bleeding:
- Heavier than a period
- Large clots (up to golf ball size)
- Soaking 1-2 pads per hour during peak (3-5 hours)
- Dark red or brown blood
- Small pieces of tissue
Use maxi pads, not tampons (tampons make it harder to accurately estimate bleeding).
Chills and Fever
- Low-grade fever (under 100.4°F) is normal from misoprostol
- Chills are common and temporary
- Bundle up with blankets
- Drink warm liquids
These symptoms from misoprostol usually pass within a few hours. However, if fever starts 1-2 days after taking misoprostol, contact a healthcare provider as this could indicate infection.
How Safe Is Medication Abortion?
Medication abortion is very safe. Here are the facts:
Safety Statistics
- Serious complications: Less than 0.4% (fewer than 4 in 1,000)
- Death: Extremely rare - about 0.00064% (similar to miscarriage)
- Future fertility: Not affected at all
- FDA approval: Approved since 2000, over 20 years of safety data
Medical Organization Support
Medication abortion is recommended by:
- American College of Obstetricians and Gynecologists (ACOG)
- World Health Organization (WHO)
- National Abortion Federation (NAF)
- Society of Family Planning
How It Compares to Other Medical Procedures
Medication abortion is:
- Safer than wisdom teeth removal
- Safer than childbirth (14 times safer)
- Similar safety to miscarriage
- Much safer than continuing pregnancy
When to Seek Medical Care
While serious complications are rare, contact a healthcare provider if you experience:
Call right away if:
- Soaking through 2 or more pads per hour for 2 hours straight
- Fever that starts 1-2 days after taking misoprostol (could indicate infection)
- Severe pain not relieved by ibuprofen and heating pad
- Signs of infection: fever, chills, severe pain after the first 24 hours
Follow up if:
- No bleeding within 24 hours of taking misoprostol
- Still feel pregnant after 1 week
- Positive pregnancy test after 5 weeks
Emergency room visits are rare (less than 1%), but if needed:
- Medication abortion and miscarriage are medically identical
- Treatment is the same
- Your medical records are private
How Effective Is It?
Medication abortion is highly effective:
- Through 8 weeks: 98% effective
- 9-10 weeks: 96-97% effective
- 11-13 weeks: 94-95% effective (WHO guidelines support use through 13 weeks)
If it doesn't work completely:
- About 2-5% of people need additional medication or a procedure
- This is safe and straightforward
- Your provider will guide you through next steps
Medication Abortion vs. Other Options
Compared to Surgical Abortion
Medication abortion:
- ✓ Complete at home
- ✓ More private
- ✓ Feels more natural (like miscarriage)
- ✓ Available earlier in pregnancy
- ✓ Can be accessed through telemedicine
- ✗ Takes longer (days vs. hours)
- ✗ You experience the full process
Surgical abortion:
- ✓ Completed in one visit
- ✓ Faster process (minutes)
- ✓ Less time experiencing symptoms
- ✗ Requires clinic visit
- ✗ More invasive
- ✗ May not be available in your area
Both are equally safe and effective. The choice is personal preference.
Is This the Same as Plan B?
No. They are completely different:
Plan B (emergency contraception):
- Prevents pregnancy from starting
- Take before/right after unprotected sex
- Will not end an existing pregnancy
Medication abortion:
- Ends an existing pregnancy
- Take after confirming pregnancy
- Requires prescription from healthcare provider
Is This the Same as Miscarriage?
Medically, yes. Medication abortion works the same way as a natural miscarriage:
- Same medications (misoprostol is used to complete miscarriages)
- Same process (uterus contracting and emptying)
- Same symptoms (cramping and bleeding)
- Looks identical in medical testing
This means:
- No medical test can tell the difference
- Treatment in emergency rooms is the same
- Medical privacy laws protect you
How Southern Woven Supports You
We provide medication abortion through secure telemedicine to people throughout the United States.
Our Process
1. Online Consultation (15-20 minutes)
- Complete secure medical questionnaire
- Review your health history
- Licensed provider reviews your information
- Available in English and Spanish
2. Medical Review (Same day or next day)
- Provider approves your prescription
- Confirms you're eligible for medication abortion (through 13 weeks)
- Answers any questions you have
3. Medication Delivery (2-5 business days)
- Discreet packaging (no labels indicating contents)
- Shipped from state where provider is licensed
- Tracking provided
- Includes all medications and instructions
4. Support Throughout
- After completing your intake, you receive 24/7 access to our medical team
- Available by phone and text for patients
- Answer questions before, during, and after
- Help with any concerns or complications
- Follow-up to confirm completion
About Access and Legal Questions
People throughout the United States, including those in states with abortion restrictions, are accessing medication abortion through telemedicine. This is an established pathway that many use safely.
If you have legal questions about accessing abortion care in your specific situation, we recommend contacting:
If/When/How Repro Legal Helpline: 844-868-2812
- Free, confidential legal information
- Lawyers who specialize in reproductive rights
- Can answer questions specific to your state and circumstances
Frequently Asked Questions
Can I do this completely alone?
Medically, yes - the process is safe to complete alone. However, we recommend having someone available by phone if possible, just for emotional support and comfort.
How much does it cost?
Our services are $150, and we operate on an honor system where you pay what you can afford. We never turn anyone away for inability to pay.
Will this affect my ability to get pregnant later?
No. Medication abortion does not affect future fertility. You can get pregnant again within weeks of the abortion.
How private is this?
Completely confidential:
- Packages are discreet with no identifying labels
- Medical records protected by HIPAA
- We never share your information
- You can use a P.O. box or alternate address
What if I'm under 18?
We provide care for people 16 and up. For questions about age-related legal considerations in your state, contact If/When/How Repro Legal Helpline: 844-868-2812
Can I still get an abortion if I'm [X] weeks pregnant?
Medication abortion works through 13 weeks from your last period (WHO guidelines). If you're unsure how far along you are, we can help you determine this during your consultation.
What if I have an IUD?
If you're pregnant with an IUD in place, it's important to know that ectopic pregnancy is more likely. We do not recommend removing your IUD before medication abortion. During the abortion process, the IUD will likely come out naturally. If it doesn't come out, it should be replaced since it wasn't providing full protection. Contact our medical team to discuss your specific situation.
Can I take this if I'm breastfeeding?
Yes, medication abortion is safe while breastfeeding. The medications pass into breast milk in tiny amounts that are not harmful to your baby.
Will I be able to tell when the abortion is complete?
Most people cannot pinpoint an exact moment. The process happens over several hours. You'll know it's complete when bleeding decreases and cramping subsides. Final confirmation comes from a pregnancy test 5 weeks later.
What if I change my mind after taking the first pill?
Some anti-abortion organizations promote "abortion pill reversal," but this is not supported by medical evidence. If you have concerns, contact our medical team to discuss your options.
Can I go to work/school the next day?
Most people take 1-2 days off. You'll want to be home for at least 8 hours after taking misoprostol. After that, you can usually return to normal activities when you feel ready.
Will people be able to tell I had an abortion?
No. There are no visible signs. Medication abortion is completely private.
What do I do with the medication packaging?
You can dispose of it in regular trash. If privacy is a concern, you can:
- Throw it away outside your home
- Remove labels before disposing
- Ask us about return options
What about legal questions or concerns?
Laws around abortion vary by state and situation. For specific legal questions, contact: If/When/How Repro Legal Helpline: 844-868-2812
They provide free, confidential legal information and can answer questions about your specific circumstances.
Next Steps: Getting Started
If you're considering medication abortion, Southern Woven is here to support you through every step.
Ready to start your consultation?
Our process is simple, private, and designed to support you:
- Complete our secure online consultation (15 minutes)
- Receive medical review and approval (same or next day)
- Get medication delivered discreetly (2-5 days)
- Access 24/7 support throughout your abortion
[Start Your Confidential Consultation] (Button/Link)
Have questions first? Contact our support team:
- Email: hello@southernwoven.com
- Available 7 days a week
Legal questions? If/When/How Repro Legal Helpline: 844-868-2812
Medical Disclaimer
This information is for educational purposes and does not constitute legal or medical advice. Every person's medical and legal situation is unique. Medication abortion should be obtained through consultation with a licensed healthcare provider who can evaluate your individual circumstances and provide personalized medical guidance. For legal questions, contact If/When/How Repro Legal Helpline at 844-868-2812.
Sources & Medical Review
This guide is based on current medical evidence and guidelines from:
- American College of Obstetricians and Gynecologists (ACOG)
- World Health Organization (WHO) - including updated guidance supporting use through 13 weeks
- U.S. Food and Drug Administration (FDA)
- National Abortion Federation (NAF)
- Society of Family Planning
- Gynuity Health Projects
Last updated: December 26, 2025
Medically reviewed by: Southern Woven Medical Team
Next review scheduled: March 2026
Last updated: December 26, 2025