Everything You Need to Know Before You Take the Abortion Pill

It's incredibly safe, but you should still know what to expect.

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Abortion pills are currently the method used for more than half of abortions in the U.S. They're proven to be a safe way to end early pregnancies, and the U.S. Food and Drug Administration (FDA) ruled that people can permanently access them by mail, as of December 2021.

However, the Supreme Court's decision to overturn Roe v. Wade, the 1973 ruling that protected the right to an abortion in the U.S. under the Constitution, has complicated matters. Now, states are able to decide the legality of abortion, and it's unclear how exactly this will impact access to abortion pills via mail or otherwise in states that aim to ban all abortion methods. (FYI, as of January 2023, most abortions are banned in at least 13 states, and the fight for access to abortions continues in many more, according to The New York Times.)

Regardless of what the future holds, it's important to understand how the medication works if you need it and can access it. Ahead, find out how the abortion pill works to terminate a pregnancy, the side effects you can expect, the cost, how to get it, and more.

How the Abortion Pill Works

First of all, the abortion pill is technically two pills that you take over a couple of days: mifepristone and misoprostol. Mifepristone (RU-486), also known as "the abortion pill," is the pill the FDA approved to be delivered by mail. The second pill, misoprostol, has always been easily available (and thus didn't need FDA approval to be mailed). That's because it's historically been widely used in gynecology for multiple reasons, including inducing labor and cervical ripening (aka softening and dilating), which is sometimes necessary for certain gynecological procedures.

The first pill, mifepristone, blocks progesterone (a pregnancy hormone) by breaking down the lining of the uterus and in doing so stops the pregnancy from evolving. No progesterone means no uterine lining, which is essential for a pregnancy to continue. Then, 24 to 28 hours later, you take misoprostol, which will cause your uterus to contract and empty its contents (for example, that aforementioned uterine lining, as well as an embryo or fetus, if you're pregnant). It's these contractions and emptying, similar to that of losing a fetus in an early miscarriage, that result in cramping and bleeding.

To give some context, mifepristone is a "progesterone antagonist." This means it's a contraceptive and is similar to hormonal birth control pills in that its purpose is to prevent pregnancy or interrupt one that has started.

It might sound intense, but rest assured: "Medication abortion (also called the abortion pill) is a safe and effective way to end an early pregnancy," says Kate Shaw, M.D., head of medical at Hey Jane, a telemedicine provider that prescribes abortion pills and can have them sent directly to the patient by mail. "Taken together, these two pills work up to 98 out of 100 times to end an early pregnancy."

When You Can Take the Abortion Pill

"Mifepristone is approved by the FDA to be used with misoprostol for medication abortion up to 77 days [aka 10 weeks] after the first day of your last period," says Dr. Shaw. That means you can only use the abortion pill within the first trimester of your pregnancy. Any time after that, an abortion would have to be performed in a clinic in order to end the pregnancy.

The most common type of in-clinic abortion procedure is a suction abortion, which uses "gentle suction" to empty the uterus and can be used until about 14 to 16 weeks after your last period, according to Planned Parenthood. A dilation and evacuation procedure, requiring suction and medical tools to empty the uterus, can be performed 16 weeks or longer after your last period. (More here: How Late In Pregnancy Can You Actually Have an Abortion?)

Considering the majority of abortions occur within the first nine weeks of pregnancy, medication abortion is a very important option for those who want to terminate in the privacy of their own home, says Dr. Shaw.

However, restrictions on when someone can get an abortion vary from state to state. You can find resources with information about state-level restrictions on medication abortion on the Planned Parenthood and Guttmacher Institute websites.

The Cost of the Abortion Pill

The price you pay for the abortion pill will vary depending on where you get the abortion pill and whether or not you have insurance. Plan C, a resource for finding abortion care, puts cost estimates at anywhere from $40 to $600. Hey Jane's abortion pills cost $250, for example, without insurance.

Where You Can Get the Abortion Pill

Despite the FDA ruling allowing abortion pills to be available by mail and in person, not every state's government is on board with it. Prior to the fall of Roe v. Wade, 19 states in the U.S. did not allow any medication that terminates a fetus to be accessible via mail. Since Roe v. Wade was overturned, many have questioned what the ruling would mean for abortion pill access through the mail.

The legality of accessing abortion pills by mail in states where abortion has been banned or soon will be is currently unclear. However, on December 23, 2022, the Justice Department cleared the U.S. Postal Service to deliver abortion drugs to all states, stating that a piece of legislation called the Comstock Act doesn't prohibit the mailing of abortion pills if the sender doesn't know the drugs will be used illegally.

"Because there are manifold ways in which recipients in every state may lawfully use such drugs, including to produce an abortion, the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully," reads the legal opinion.

The conclusion also applies to other mail carriers, such as FedEx; however, it doesn't address whether or not mailing abortion pills to states where abortion is banned violates federal laws other than the Comstock Act. Legally speaking, access to abortion pills by mail still appears to be murky in some states.

That said, if you live in a state where abortion pills are available, there are more options. You can get abortion pills from your local Planned Parenthood, including via telemedicine, and get your pills by mail or by picking them up at a local clinic or pharmacy. The FDA also now allows retail pharmacies, such as CVS and Walgreens, to offer abortion pills in the U.S. under a regulatory change made on January 3, 2023. Pharmacies must complete a Pharmacy Agreement Form to become certified to dispense abortion drugs. While there was no formal announcement, the FDA updated its website with the new information.

Additionally, you can use Hey Jane as your abortion pills provider. When using Hey Jane, you won't need a prescription; you'll just need to fill out forms regarding your medical history and your consent, provide payment, and speak to a consultant. Plan C is also a super helpful resource for finding both abortion pills and clinics, and it can help you figure out what's available for you based on where you live. (The resource even has instructions and tips for creative ways to get pills if you live in a state with restricted access.)

Possible Side Effects of the Abortion Pill

Although both medications have been proven to be safe, there's always the chance for side effects, no matter what meds you're taking.

"Medication abortion is very safe," says Dr. Shaw. "Serious complications occur in less than one out of every 100 people that take the abortion pills. Occasionally, people will experience nausea, vomiting, or diarrhea after taking the [mifepristone] abortion pill."

Misoprostol, the second medication, usually causes strong uterine cramping and bleeding, like a heavy period, says Dr. Shaw. (For the record, Hey Jane offers anti-nausea pills for potential mifepristone side effects and suggests getting some ibuprofen and/or acetaminophen as well for the second misoprostol pill.)

For most people, the only side effect of the mifepristone is nausea and minimal bleeding. It's the misoprostol that does the most work as it passes the pregnancy tissue out of the body, something that can take four to five hours, or up to 12 hours, depending on the person. Cramps can also continue for a couple of days afterward, but again, it depends on the person.

Just an FYI, "allergies to the abortion medications are rare," says Dr. Shaw. "Reactions occur in only 0.008 percent of cases and are generally mild, but if you experience itching or hives contact your care provider immediately. If you experience facial swelling or difficulty breathing after taking mifepristone or misoprostol call 911 for emergency care."

At any time during your abortion, if you experience side effects or just have general concerns, you shouldn't hesitate to contact your doctor. And, no, abortion pills don't damage your uterus.

"Medication abortion is extremely common and has been widely studied, so we know that it's safe, does not cause depression, does not cause breast cancer, and will not affect your future ability to get pregnant when (and if) you decide the time is right," says Dr. Shaw. "Furthermore, there are many negative consequences associated with denying an abortion to someone who wants one," she adds. For example, the mental, emotional, physical, and financial anguish of being forced to carry a fetus to term.

How to Prepare for a Medication Abortion

It's important to realize that while you're taking just a pill, you're still having an abortion. While the side effects of the abortion pill will vary from person to person, it's paramount to be prepared and not treat it as if it were just any other type of medication.

"When taking the abortion medications, you can complete the entire treatment at home or any place you feel comfortable," says Dr. Shaw. First, it's helpful to have over-the-counter pain medications approved by your healthcare provider, such as ibuprofen or acetaminophen. "Menstrual pads, comfortable clothes, and a heating pad are also great items to have around. If you've got the time before your treatment, consider making yourself a few meals you can throw in the oven or microwave, so that the only thing you'll need to focus on is self-care." (See: The Best Heating Pads for Every Body Part)

After your abortion, you can resume things, such as work and your regular physical activity, when you feel ready, according to Dr. Shaw. For some people, that can happen right away, while others may need more time to rest.

The same goes with sexual activity — only resume it if you feel ready. That said, some medical doctors suggest waiting until the bleeding has stopped, and that can take up to four weeks. Dr. Shaw emphasizes checking in with yourself and assessing your comfort level before you make a decision to become sexually active again. But when you do start having intercourse again, know that you can become pregnant immediately after an abortion.

"The abortion procedure has no impact on fertility," says Dr. Shaw. "Because of this, choose and begin using birth control immediately after your treatment if you do not wish to get pregnant."

And just in case you were wondering, "There is no data that suggests there's a limit on the number of abortions someone could safely have," says Dr. Shaw. (Though, with so many birth control options, you might want to consider one to prevent unwanted pregnancy.)

However, no prevention method is foolproof, meaning unintended pregnancies aren't going to go away. Ultimately, abortion is health care, and access to safe abortion options is vital.

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