Medication abortion, how it works in medical care

Medication abortion, also called medical abortion or the abortion pill, uses medicines instead of a procedure to end a pregnancy. In most countries where it is legal, it is the most common method in the first weeks of pregnancy. The World Health Organization describes it as safe and effective when it is provided in line with its guideline, and national medical societies such as ACOG in the United States, RCOG in the United Kingdom, CNGOF and HAS in France and DGGG in Germany publish their own clinical guidance on it.

The usual regimen combines two medicines. The first, mifepristone, blocks the hormone progesterone that the pregnancy needs to continue. The second, misoprostol, causes the uterus to contract and empty. Where mifepristone is not available, some guidelines describe a regimen with misoprostol alone. The exact medicines, timing and route are decided by the clinician for each person, which is why this page gives no doses.

• Two medicines in most regimens, mifepristone followed by misoprostol
• No surgery and no anesthesia
• The pregnancy passes with bleeding and cramping, like a heavy period or a miscarriage
• Can take place at home or in a clinic, depending on local law and the clinic's practice

The WHO Abortion care guideline (2022) recommends medication abortion as one option up to 12 weeks of pregnancy, counted from the first day of the last menstrual period, with care that can often be managed partly at home. After 12 weeks the guideline still describes medication abortion as an option, usually with the medicines given in a health facility and with closer supervision.

National rules can be narrower than the WHO guideline. Many countries allow medication abortion at home only up to a certain week, and the overall legal limit for abortion on request differs widely between countries. Before planning care, check the abortion gestational limits that apply where you are and in the places you could reach.

• Up to 12 weeks, WHO describes a regimen that can be partly managed at home under medical care
• After 12 weeks, the medicines are usually given in a facility
• Local law and clinic protocols decide what is offered in practice

A legal provider first confirms the pregnancy and estimates how many weeks it has been, from the date of the last period and sometimes with an ultrasound. They ask about your health, current medicines and allergies, explain the options and answer questions. In some countries the law adds a waiting period, counseling or a second appointment, and the law card for each country lists those requirements with the source.

The first medicine

The first medicine is usually taken at the clinic or during a telehealth visit where that is legal. Many people feel nothing in particular after it, while some have light bleeding or nausea.

The second medicine

The second medicine follows after an interval set by the clinician, often a day or two later. Cramping and bleeding usually start within a few hours of the second medicine. The clinic tells you where to be, what pain relief to have ready and who to call.

The following days

Bleeding is usually heaviest for a few hours while the pregnancy passes, then becomes lighter and can continue on and off for one to two weeks or until the next period. The next period typically comes four to six weeks later.

It helps to know in advance what an expected course looks like, so that normal symptoms are not alarming and real warning signs stand out.

• Cramping that is stronger than a usual period for some hours, easing with the pain relief recommended by the clinic
• Bleeding heavier than a period, with clots, for a few hours while the pregnancy passes
• Spotting or light bleeding on and off for up to a couple of weeks
• Short lived nausea, vomiting, diarrhea, chills or a mild raised temperature on the day of the second medicine
• Tiredness and mixed emotions in the days afterwards

Having someone with you, a heating pad, sanitary pads rather than tampons and easy access to a bathroom make the day more comfortable. Your clinic gives you written information for your own situation.

Serious complications are uncommon, and the clinic that provides care should give you a number to call at any hour. Contact that number, or your local emergency number such as 112 in the European Union or 911 in the United States and Canada, if any of the following happens.

• Very heavy bleeding, for example soaking two or more large pads an hour for two hours in a row
• Fever that lasts longer than a day after the second medicine, or starts days later
• Severe pain in the abdomen that pain relief does not ease
• Feeling very unwell, weak or faint, especially more than a day after the medicines
• Discharge with a strong unpleasant smell
• No bleeding at all after the medicines, or continuing signs of pregnancy a week or more later

The WHO guideline does not require a routine follow-up visit after an uncomplicated medication abortion early in pregnancy. Many clinics instead offer a phone call, a symptom checklist or a home pregnancy test a few weeks later to confirm that the abortion is complete. Some countries and clinics still schedule a visit or an ultrasound. Follow the plan your clinic gives you, and read more in our abortion aftercare guide.

Fertility can return within a couple of weeks, so contraception is usually discussed at the first appointment and can often start right away. See our contraception guide for the options.

Both methods are described as safe by WHO. Medication abortion avoids a procedure and can partly take place at home, but it takes longer and you are awake for the bleeding and cramping. A procedural abortion is shorter, happens in a clinic and is usually finished in one visit. The choice depends on the stage of pregnancy, your health, your preferences and what is legal and available near you, and you make it together with a doctor.

• World Health Organization, Abortion care guideline (2022)
• American College of Obstetricians and Gynecologists (ACOG), clinical guidance on medication abortion
• Royal College of Obstetricians and Gynaecologists (RCOG), guidance on abortion care
• International Federation of Gynecology and Obstetrics (FIGO), recommendations on medication abortion

This page is general information and not medical advice. Medical decisions are made together with a doctor. Read our sources and editorial policy.