14 Things You Should Know About The Abortion Pills, Like The Fact That They're 98% Effective

From what it is, to how it works in your body, let's break this down.

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As you probably already know, sex education is pretty terrible across the United States. And when it comes to abortion access or information around abortion, it's even worse. But everyone deserves accurate, accessible information so they can make informed decisions when it comes to their own body and their own life. And in light of the fact that the leaked draft Supreme Court opinion overturning Roe v. Wade suggests that the 1973 landmark decision that recognized the constitutional right to abortion could be overruled within the next two months, there's no time like the present.

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This classic scene from Mean Girls is unfortunately a little too on the nose for a large portion of America's sex education system. And this is unacceptable!

And when it comes to the abortion pills in particular, a lot of people have questions. So we spoke to Melissa Grant, chief operating officer of Carafem — a network of reproductive health clinics that offer compassionate, convenient abortion, birth control, and testing services — to answer some of the most common questions about the abortion pills.

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The image above shows a combination pack of mifepristone (L) and misoprostol tablets, two medicines used together, also called the abortion pill(s).

1. First, what exactly is the abortion pill?

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The abortion pill is a combination of what is usually two kinds of medication (mifepristone and misoprostol) that are taken in sequence. In the US, these are most often used before 11 weeks of pregnancy.

2. And how do these pills work in your body?

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The first pill, mifepristone, blocks a hormone necessary for a pregnancy to continue. The second medication is a set of four misoprostol pills. Misoprostol works by stimulating the uterus to cramp and bleed so the pregnancy will leave the body. 

3. When should someone take the second abortion pill? Can someone take misoprostol at night?

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It’s recommended to use misoprostol within the first 72 hours after taking mifepristone. This pill is not simply swallowed like other pills; Carafem provides instructions for using these pills in the ways they work best, either by holding them in your mouth between your cheek and gums for 30 minutes or by inserting them into your vagina like you would a tampon. 

And for what it's worth, Grant says you can absolutely take misoprostol at night — many of Grant's clients choose to do this when they discuss their options with their care coordinator during a visit. Evenings are a time many people have the most privacy. 

4. How much do the abortion pills cost the average person?

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The abortion pills cost between $150–450, depending on the type of medication chosen and where you choose to have your visit if you use a place like Carafem (online vs in person). The abortion pills are widely available online starting around $150, with broadly accessible financial aid. In fact, you can now order pills to have on hand before you’re even pregnant. Please be aware that acquiring and using pills may carry legal risk, especially for marginalized people.  You can learn more about access and cost across the US here. 

5. Where can someone find access to the abortion pills in the US?

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In the US, you must go to a specialized provider who prescribed and dispenses abortion pills (they cannot be found in a regular pharmacy at this time). However, due to COVID-19, the FDA has temporarily lifted unnecessary restrictions, which allows abortion pills to be mailed in states that allow it. Learn more about how to access abortion pills through the mail here!

6. How much time does someone have to decide whether or not to take the abortion pills?

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According to Grant, you have up to 11 weeks into your pregnancy, as measured from the start of your last period.

7. Are the abortion pills considered safe?

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Yes, the abortion pills are considered safe. The abortion pills have been used by hundreds of thousands of people in the US since the year 2000 and millions of people worldwide for over 20 years. Research shows that serious complications are rare and occur in fewer than .04% of people.

8. What might the abortion pills feel like in your body after ingesting?

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Most people start to see cramping and bleeding within about an hour after taking misoprostol (the second medication), though it can start in as little as 30 minutes or take up to a day. It’s normal to feel chills, nausea, or even have diarrhea along with bleeding and cramping while your body is pushing the pregnancy from your uterus. It’s kind of like having a really heavy, crampy period along with mild flu-like symptoms. 

This particular provider, Carafem, provides you with medications to help with both pain and nausea, but it’s good to plan to use the abortion pill in a private place and to have some things prepared ahead of time to help make you more comfortable.  

The heaviest bleeding and cramping ends once the pregnancy has passed, usually within 3–4 hours. It is important to plan for possible vaginal bleeding to continue off and on after any type of abortion. Some see light bleeding that lasts until their next period starts, which is usually within about 4–6 weeks.

9. What kind of efficacy are we talking when it comes to the abortion pills?

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The pills are considered to be 98% effective. 

10. Do abortion pills work for all body types and ethnicities?

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The short answer: yes! The abortion pills work for all body types, weights, and ethnicities. There are very few people who cannot safely use this medication to end a pregnancy. 

People who may not be able to safely use the abortion pills include the following: 

1. Someone with a pregnancy beyond 77 days

2. Someone with a previous allergic reaction to mifepristone or misoprostol

3. Someone with a known or suspected ectopic pregnancy

4. Someone with inherited porphyria

5. Someone living with chronic adrenal failure

6. Someone with a history of bleeding disorders or long-term corticosteroid use

7. Someone with an IUD in place (IUDs just need to be removed before proceeding!)

11. Will the abortion pills impact someone's menstrual cycle moving forward?

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After taking the abortion pills, you may experience light bleeding off and on for several days or longer. Your next period will likely start in about 4–6 weeks. After that, most people will go back to their regular menstrual cycle. 

12. Can you safely use the abortion pills more than once?

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Yes! You can safely use the abortion pill as many times as you need to. Carafem provides respectful quality supportive care as many times as it's needed, with no judgment. 

13. And let's quickly break down the different abortion routes — what should someone consider when looking at options?

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According to Melissa Grant, individuals are actually the best suited to choose a method of abortion, as it’s often a highly personal decision. There is no one specific rule for what makes one option better than another. Both the surgical route and the pill route are considered safe and effective.

The process of medication abortion requires the use of medication over a couple days and passing the pregnancy involves cramping that generally lasts several hours. This process simply takes a while and can’t be rushed to move faster. So those choosing the abortion pill option must be aware of what this involves. Pain medications are often available during medication abortion to make this process more manageable, but it does involve more time than an in-office abortion and will involve cramping, bleeding, and potentially flu-like symptoms, like chills or diarrhea. 

Some people feel that using medications to end a pregnancy is more natural to them, as cramping and bleeding are not an uncommon experience for people who have periods. The abortion pill can also be used in the earliest weeks of pregnancy, and it requires no surgery or anesthesia.

Many people also prefer to have an abortion at home, in more familiar surroundings using pills rather than traveling to a medical office and experiencing a more invasive abortion procedure with instruments in a provider's office. An in-office abortion procedure involves the gradual opening of the cervix with sterile instruments and mild suction to empty the uterus, similar to releasing a period all at once. The procedure takes about 2–7 minutes. Stronger medications for pain relief can be provided for this option, and one of the things many people may prefer about this is that they can leave the medical office no longer pregnant. It does involve placing trust in a medical provider that can leave some people feeling more vulnerable. People who have experienced sexual violence, for example, may have a harder time with the process of having a speculum exam than taking a medication at home to end a pregnancy. 

Another real issue is that 89% of US counties have no abortion provider. So an in-office procedure often means travel for many, and that may prove very difficult or even impossible for some people.

Ultimately, most patients feel best when they are able to ask questions and choose which option seems best for them personally! 

14. And finally, what are possible side effects people should consider prior to taking the abortion pills?

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Despite some of the misinformation out there, there is no current evidence to support the idea that taking the abortion pill will have any long-term effects on your body. Most people feel physically fine shortly after an abortion and can resume regular activities within as little as 24 hours. 

Many people have bleeding or spotting off and on for up to a few weeks after their abortion. Some people choose to start a method of birth control immediately after medication abortion, and this can help to make bleeding more predictable. Without a birth control method, people will often be able to get pregnant again in as little as the first two weeks after an abortion. Carafem's staff can help to provide information about a variety of methods and provide birth control to many people immediately or shortly after their visit.

It is important to note that taking the abortion pills will not increase your risk for breast cancer or affect your fertility. Abortion via the abortion pills is considered very safe and doesn’t cause problems with future pregnancies and doesn’t negatively impact your physical or mental health. These are common myths that are not backed by medical evidence.

For more info about this and more, check out this blog about what to expect when taking the abortion pills.