Here's some news about abortion that you may have missed: the US abortion rate reached an all-time low in 2017. At 13.5 abortions per 1,000 women ages 15 to 44, it’s the lowest level since the Supreme Court legalized abortion in its pivotal 1973 Roe v. Wade decision.
Also in 2017, the number of early medication abortions rose to an all-time high: close to 340,000, up 25% since 2014. This 2-pill procedure has been accessible and FDA-approved in the US since 2000 and now accounts for 39% of all US abortions.
Prior to medical abortion, women seeking a first-trimester abortion had one option: an in-clinic aspiration abortion, or surgical abortion. This kind of abortion involves visiting a clinic, having bloodwork and perhaps an ultrasound done, getting a shot of numbing agent in the cervix, and then undergoing a 5-minute procedure that uses plastic tubes connected to a vacuum device to suction out the uterus.
Because medication abortion is newer, it's not as well-known as an in-clinic abortion. But as the statistics show, an increasing number of women are opting for it. Here's everything you need to know about medication abortion.
What is a medication abortion?
Sometimes called medical abortion or pill abortion (or the slang term "abortion pill,") it's been legally available since 2000, when the FDA approved a two-pill protocol to end an early pregnancy. Medication abortion is a safe procedure, with a 0.05% risk of major complications. In a 2015 study of more than 13,000 women who had a medication abortion over a five-year period, the two-pill regimen was 97.7% effective, and rates of infection requiring hospitalization or transfusion were under 1%.
Gillian Dean, MD, a New York ob-gyn and senior director of medical services at Planned Parenthood Federation of America (PPFA), tells Health that medication abortion involves taking two different medications to end a pregnancy: mifepristone and misoprostol. It can be accessed up to 70 days, or 10 weeks, after the first day of a patient’s last menstrual period, though some health centers offer it up until 77 days from a woman's last period.
What happens when you take mifepristone, the first pill
Ashia George, RN, at the Scotsdale Women’s Center in Detroit, tells Health that patients wishing to have a medical abortion must have their hemoglobin levels checked to ensure that they are not anemic. Candidates will also have an ultrasound.
To begin the abortion, a patient will first take mifepristone. This medication is used to block progesterone, the hormone necessary to continue pregnancy. Dr. Dean explains that without progesterone, the lining of the uterus breaks down, and a pregnancy cannot continue.
Leah Coplon, RN, a certified nurse midwife and nurse practitioner at Maine Family Planning, tells Health that for most women who have a medication abortion, that first pill will be taken in the clinic, under the supervision of the provider. However, some clinics may simply dispense it to the patient, who can take it at home.
Coplon emphasizes that mifepristone is a safe medication that rarely causes side effects.“You can take it and go about your day—go back to work, or to school, whatever you need to do," says Coplon. "Once in a very great while, a patient may experience some bleeding or cramping, but usually they don’t feel anything."
Dr. Dean agrees. “Most people do not have any symptoms or feel different after taking the mifepristone,” she says.
How the second pill, misoprostol, works
Mifepristone by itself will not complete the medication abortion procedure. For the procedure to be complete, the second medication in the protocol must be taken.
Depending on the gestational period, a patient will take the second medication, misoprostol, between 6 to 48 hours after taking the dose of mifepristone. Misoprostol works by causing the uterus to contract, thus expelling its contents.
Misoprostol can either be inserted vaginally and dissolved there, or it can be dissolved inside of a patient’s cheek or under a patient’s tongue, says Coplon. “There are different ways to get it into the body, but it needs to be absorbed,” she explains.
After the misoprostol is taken, a patient can then typically expect to pass their pregnancy within approximately six hours. “Plan on taking it easy during the day that you take the misoprostol,” advises Dr. Dean. While waiting for the contents of the uterus to be expelled, a woman can expect to experience heavy bleeding and cramping, “heavier than a period,” says Coplon.
Many patients will experience nausea, too, adds George; the side effects are similar to that of a miscarriage. Most clinics, she says, will send patients home with medication to help manage these side effects, such as Motrin for cramping and anti-nausea medication.
Often a patient will see clots pass and might also see some gray or white tissue pass as well. She notes that a woman who is further along in her pregnancy, perhaps at 9 or 10 weeks gestation, might see something recognizable as a pregnancy pass, though at any earlier gestational age they will not.
Is a medication abortion always effective?
George explains that if a patient does not expel the contents of the uterus within 48 hours after taking misoprostol, a second dose will be administered. If a patient is only having light bleeding, not a lot of cramps, and not passing any tissue or blood, that’s an indication that the medication may not be working, and a second dose may be necessary, she says.
As rare as it is for a medication abortion to not work the first time, it is even less common for the procedure to not be completed after a second dose of misoprostol. In these cases, George says, an in-clinic aspiration abortion will be necessary.
After the contents of the uterus pass, some people will “go about their day totally fine. Some people have a medical abortion and feel fine by the next morning, but some have a period of bleeding or cramping for about another day,” says Coplon.
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