9 Abortion Pill (Mifepristone and Misoprostol) Side Effects and How to Manage Them

When we talk about the “abortion pill,” we’re usually referring to two medications — mifepristone (Mifeprex) and misoprostol (Cytotec). They are taken together to end a pregnancy. This combination is also called a medical (or medication) abortion. While less effective, some people take misoprostol alone for this purpose.

You’ll take the pills over the course of 2 to 3 days, starting with mifepristone. This is followed by misoprostol taken 24 to 48 hours later. It usually takes about 2 to 24 hours to pass a pregnancy after you’ve taken both medications.

A medical abortion is a safe and effective way to terminate a pregnancy. Even so, it can cause some unpleasant side effects — especially after you take misoprostol. Side effects usually start within 2 to 24 hours of taking it. Cramping and bleeding are expected, but more serious side effects are possible, too.

Below, we’ll review nine abortion pill side effects, how to manage them, and when to get help.

1. Cramping

You should expect to experience cramping, especially after taking misoprostol. This is because misoprostol causes strong uterine contractions to help your body pass the pregnancy.

Your healthcare provider may recommend an over-the-counter or prescription pain reliever to help you feel more comfortable. But you should avoid taking aspirin, since it can cause more bleeding.

2. Vaginal bleeding

You should also expect vaginal bleeding as the pregnancy leaves your body. This is sometimes heavier than your normal period. You may also see clots and tissue. Your healthcare provider may recommend using sanitary pads for a few days to keep track of your bleeding.

Together with cramping, these side effects usually mean that the medications are working. But, there are some exceptions that we’ll cover later. Although uncommon, some people may need to have surgery to stop the bleeding if it’s too heavy.

Over the next week or two, you may notice some bleeding or spotting — this is also normal. Sometimes it can even last up to a month. Because of this, you may need to wear sanitary pads during this time.

3. Nausea

You may feel nauseated — or generally unwell — after taking misoprostol. This side effect is temporary and doesn’t last for very long.

But if you’ve been feeling this way more than 24 hours after taking misoprostol, get medical attention. Nausea, as well as weakness, diarrhea, and/or vomiting that goes on for this long can be a sign of a serious infection.

4. Fever or chills

It’s also possible to develop a fever and/or chills during a medical abortion. Similar to nausea, this should be temporary.

But if your fever is at least 100.4°F and lasts for 4 hours or more, contact your healthcare provider. This can be a sign of a serious infection, especially if you have a fever more than 24 hours after taking misoprostol.

5. Incomplete abortion

Medical abortions are very effective at terminating a pregnancy. But sometimes they don’t work — even if you experienced the expected side effects.

It’s important to follow up with your healthcare provider 1 to 2 weeks after the medical abortion. That’s because there’s a small chance that you may still be pregnant. In this case, a surgical procedure may be required to complete the process.

6. Heavy bleeding that requires surgery

Although bleeding is normal, there are certain situations that may require medical attention. This includes if you’re bleeding through two full-size sanitary pads every hour for at least 2 hours, or if you’re concerned about how much you’re bleeding. If this happens, contact your healthcare provider right away.

In some cases, you may need to have a surgical procedure to remove anything remaining in your uterus. This is usually rare, affecting 1 out of every 100 people going through a medical abortion. Surgical procedure options may include:

• Surgical aspiration: A type of surgical abortion that uses gentle suction to remove a pregnancy

• Dilation and curettage (D&C): A surgical procedure that uses a scraping or suction tool to remove tissue from the uterus

7. Blood clots in your uterus

As mentioned above, you may see some blood clots as you bleed. This is normal, unless they’re large (e.g., larger than a lemon) or you’ve been passing them for 2 hours or more. In this case, contact your healthcare provider right away.

8. Serious infection

Having abdominal pain or feeling sick (with or without fever) more than 24 hours after taking misoprostol can be a sign of something more serious, like an infection. In this case, contact your healthcare provider immediately. You should also call them right away if you’re experiencing a fever of 100.4°F or higher for more than 4 hours.

Although rare, there have been some reports of sepsis — a life-threatening response to an infection in your body. This is thought to be due to a certain toxin-producing bacteria found in the vaginas of about 10% of women.

You may not always develop a fever from a serious infection or sepsis after a medical abortion. So, it’s best to pay attention to how you feel throughout the process and afterwards.

9. Severe or persistent abdominal pain

As mentioned above, abdominal pain can be a sign of an infection. But it’s important to know that this can also be a sign of an ectopic pregnancy — a pregnancy outside of the uterus.

Ectopic pregnancies can’t be treated with a medical abortion. In fact, mifepristone shouldn’t be given to someone with a confirmed or suspected ectopic pregnancy for this reason.

You also shouldn’t have an intrauterine device (IUD) in place during a medical abortion. It needs to be removed before you take the medications. What’s more, getting pregnant with an IUD in place can increase the likelihood of an ectopic pregnancy.

Your healthcare provider may perform tests in advance of a medical abortion. But sometimes ectopic pregnancies are missed on an ultrasound. However, ectopic pregnancies in people obtaining medical abortions are rare, with 97 reported cases between 2000 and 2018.

Ectopic pregnancies can also cause a fallopian tube (a tube connecting the ovaries to the uterus) to rupture. This can lead to severe or life-threatening internal bleeding. And the symptoms you might experience, like abdominal pain, can overlap with medical abortion side effects.

When should I contact my healthcare provider about abortion pill side effects?

As mentioned above, you should follow up with your healthcare provider 1 to 2 weeks after the medical abortion. But don’t hesitate to contact them sooner if you have any concerns.

We’ve covered a few situations that warrant medical attention, including heavy bleeding, persistent fever, and severe abdominal pain. However, it’s important to let them know if any side effects aren’t going away, are getting worse, or are concerning to you.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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