Everything You Need to Know Before You Take the Abortion Pill
Although data shows that 2021 was considered the worst year (at least so far), by the majority of U.S. adults, there were some high points. For starters, coronavirus vaccines came along to provide some semblance of normalcy. Some people began traveling again and were able to spend time with loved ones they hadn't seen since 2019, which was also fantastic. Then, on December 16, just two weeks shy of 2022, the U.S. Food and Drug Administration announced that it will permanently — that's right, permanently — allow access to abortion pills by mail. Which, in a country where women's reproductive rights continue to be an ongoing fight, is a huge step.
"The FDA's decision to permanently remove the in-person requirement for dispensing mifepristone, (the first of two medicines used to complete a medication abortion) is a win for science — and abortion access," 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. "The data is clear: mifepristone [also known as RU-486] is extremely safe. By lifting this unnecessary restriction on the medication abortion pill, the FDA rightly categorizes the medication as just as safe — if not more so — as any other medication providers prescribe."
Despite this new ruling, not every state's government — to no surprise — is on board with it. In fact, at the moment, 19 states in the U.S. do not allow any medication that terminates a fetus to be accessible via mail, undermining what the FDA is hoping to accomplish. The reason these 19 states (Texas among them), can get around a federal organization's ruling is they already have laws in place that supersede the FDA's decision. In these states, as long as abortion is still legal, although severely restricted, you must go to a clinic to get the medication. In Texas, for example, the pills are only available up to "5 weeks and 6 days after the start of your last menstrual period," according to the Dallas, Texas Planned Parenthood website. (If you're thinking, "that's not very long at all," you're right. Many people don't even know they're pregnant at that point.)
Regardless, having better access to abortion pills is incredibly important, and this FDA decision is one step in the right direction of making them available for everyone.
Before you take an abortion pill, however, you probably want to know what to expect. Here's how the abortion pill works to terminate a pregnancy, the side effects you can expect, the cost, how to get it, and more.
How Does the Abortion Pill Work?
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 just 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) because it's been widely used in gynecology for multiple reasons — for inducing labor to 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." Meaning, it's a contraceptive and 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 Shaw. "Taken together, these two pills work up to 98 out of 100 times to end an early pregnancy."
When Can You Take the Abortion Pill and How Much Does It Cost?
As more and more states impose restrictions on when a woman can get an abortion — e.g. Texas' extreme Senate Bill 8 — it's also important to know when during gestation 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 Shaw. That means you can only use the abortion pill within the first trimester of your pregnancy. Any time after that, the abortion would have to be performed in a clinic in order to end the pregnancy. (More here: How Late In Pregnancy Can You Actually Have an Abortion?)
But considering that 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 Shaw. (Related: The Abortion I Got at 25 Radically Changed My Life)
As for cost, that 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 Can You Get the Abortion Pill?
If you live in a state where abortion pills are available, you can get an abortion pill 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. Or, you can use Hey Jane as your abortion pills provider; you won't need a prescription, you'll just need to fill out forms regarding your medical history, consent forms, provide payment, and speak to a consultant.
Plan C is a super helpful resource for finding both abortion pills and clinics and can help you figure out what's available for you based on where you live. (They even have 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 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 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 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 Shaw. "Furthermore, there are many negative consequences associated with denying an abortion to someone who wants one." For example, the mental, emotional, physical, and financial anguish of being forced to carry a fetus to term.
How to Prepare for Your Medication Abortion
It's important to realize that while you're taking just a pill, you're still having an abortion. What this means is, you don't take the mifepristone, chase it with a martini, then hit the town. 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 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 work and your regular physical activity when you feel ready, according to 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. 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 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 Shaw. (Though, with so many birth control options, you might want to consider one to prevent unwanted pregnancy.)
Ultimately, abortion is health care, and unintended pregnancies aren't going to go away because nothing is foolproof. Access to safe abortion options isn't just health care, but a human right.