What to Expect During Medication Abortion
Understanding normal symptoms and side effects can help you feel prepared and confident during your medication abortion.
Cramping and Pain
What's Normal
- •Cramping is expected and can be strong, especially in the first few hours after taking misoprostol
- •Pain typically feels like strong menstrual cramps
- •Cramping usually improves significantly within a few days
- •Some mild cramping may continue for 1-2 weeks
Pain Relief Options
Medication
- • Ibuprofen (Advil, Motrin) - 400-600mg every 6-8 hours
- • Acetaminophen (Tylenol) - 500-1000mg every 6 hours
- • Avoid aspirin (can increase bleeding)
Comfort Measures
- • Heating pad or hot water bottle on belly
- • Warm shower or bath
- • Back massage
- • Rest in a comfortable position
Bleeding
What's Normal
- •Bleeding usually starts 1-4 hours after taking misoprostol
- •Heaviest bleeding typically occurs in the first 1-2 days
- •Bleeding is often heavier than a normal period, with blood clots
- •Light bleeding or spotting can continue for 9-16 days (sometimes up to 30 days)
- •Passing blood clots (especially in the first 24 hours) is normal
What to Expect
The amount of bleeding varies from person to person. Some experience bleeding similar to a heavy period, while others have more significant bleeding. Both are normal. The gestational age can affect the amount of bleeding - earlier pregnancies typically have lighter bleeding.
Common Side Effects
These side effects usually begin within a few hours of taking misoprostol and typically resolve within 24 hours:
Digestive Symptoms
- • Nausea
- • Vomiting
- • Diarrhea
General Symptoms
- • Fever and chills (mild, lasting less than 24 hours)
- • Headache
- • Dizziness
- • Weakness or tiredness
Managing Side Effects
- •For nausea: Anti-nausea medication, ginger tea, crackers, small frequent meals
- •For diarrhea: Stay hydrated, eat bland foods (BRAT diet: bananas, rice, applesauce, toast)
- •For fever/chills: Rest, stay warm, monitor temperature
- •For tiredness: Rest as much as possible for 1-2 days
When to Seek Medical Attention
Contact a healthcare provider immediately if you experience any of these symptoms:
- Heavy bleeding: Soaking through more than two maxi pads per hour for two consecutive hours. Misoprostol is also the treatment for heavy bleeding: take 4 misoprostol (800 mcg) under your tongue right away, and get seen if it has not slowed after that dose.
- Very large clots: Clots the size of your fist or larger, together with dizziness, fainting, or feeling very unwell. Smaller clots are expected. A clot the size of a quarter, or even a golf ball, is normal.
- Severe pain: Pain not relieved by medication, rest, or heating pads
- Persistent fever: Fever of 100.4°F (38°C) or higher that starts more than 24 hours after taking misoprostol, or lasts more than 24 hours
- Severe digestive symptoms: Vomiting or diarrhea lasting more than 24 hours
- Uterine infection: Fever and chills together with severe pelvic tenderness, meaning your lower belly hurts to press on rather than just cramping. Foul-smelling discharge along with fever and chills belongs here too.
Not an emergency: no bleeding at all within 24 hours of taking misoprostol usually means the medication has not worked yet, and often means another dose. It is worth following up on, but an emergency room is not where it gets resolved. Contact whoever provided your care.
This is educational content only and is not medical or legal advice. Medication abortion regimens may vary, and the right plan for you depends on your specific situation. For care decisions, talk to your provider. For legal questions, contact If/When/How at 844-868-2812.