This story has been reviewed by Rathika Nimalendran, MD, a family medicine practitioner and abortion provider based in North Carolina.
Update 12/13/23: Medication abortion is alive and well, but its future is…TBD. Since April, there has been a lot of legal drama around one of the drugs, mifepristone, as two federal judges issued conflicting rulings. Because of this confusing legal morass and back-and-forth of appeals courts, the anti-abortion Supreme Court has now entered the chat. Today, SCOTUS announced that it will make the final ruling on access to mifepristone, which include keeping it available via mail-order (oppose to needing a physician to prescribe it), and the timeframe it can be taken (currently up to 11 weeks of pregnancy). Should SCOTUS rule against keeping mifepristone widely accessible, the decision will go into effect across the country—even in states where abortion is legal.
You can stay up to date on the abortion pill federal rulings here:
With the political firestorm swirling around abortion pills lately, you’d think they were a brand-new invention. In fact, these medications have been available in the U.S. and approved by the U.S. Food and Drug Administration (FDA) for 23 years, and are highly effective as an abortion method in the first 11 weeks of pregnancy. Abortion pills are noninvasive, require zero anesthesia, and are safe enough to take at home. It's no wonder then that they have become the most popular method of abortion, with more than half of abortions in the U.S.—54 percent to be exact—being done with medication in 2020.
In December 2021, the FDA permanently removed a restriction on abortion pills. Now, instead of making patients go to a doctor’s office or clinic to start the medication, doctors can prescribe abortion medication through telehealth consults and ship the pills right to patients’ homes. Telehealth companies are also able to send discreet, mail-order abortion meds. This change, originally brought on by social distancing measures during the pandemic, has allowed scores of people to safely self-manage their abortions in areas with few or zero providers.
Still, 21 states outlaw all abortion care or severely restrict it, with 15 states prohibiting the medication abortion. In these areas, obtaining abortion pills can be more difficult and may even expose patients to legal risks.
Here’s what you need to know about medication abortion, including who can take abortion pills, the physical effects of medication abortion, legal considerations to keep in mind, and organizations that ship abortion pills by mail.
What is the abortion pill?
So, it's actually a pair of medications that work together to end an unwanted pregnancy up to 11 weeks. The first medicine is mifepristone, and it causes the embryo to detach from the uterine wall by blocking the hormone progesterone. You take it like you would any other pill: with a swig of water. (FWIW, previously, the FDA required patients to take this pill at their doctor’s office, but now it's available via Telehealth and without a doctor consult as well.)
The second medicine is misoprostol, a four-tablet dose that you take a day or two after the first pill. You can either insert the pills into your vagina to dissolve, or stick all four under your tongue for roughly 30 minutes to disinegrate. Misoprostol works by emptying the uterus, kind of like a heavy period.
If you’re nine weeks pregnant or less, you may be able to take the misoprostol right after you take the mifepristone. If your pregnancy is 10 or 11 weeks along, you’ll need to wait 24 to 48 hours before taking the misoprostol. After that, you may need to consider an in-person procedure.
How effective is the abortion pill?
Medication abortion is effective for the vast majority of people who go this route, according to stats from Planned Parenthood. In rare cases—which tend to occur later in pregnancies—a second dose of misoprostol pills is needed for full termination. Your provider can discuss your needs in greater detail.
Here’s a closer look at the efficacy rates:
• Up to eight weeks into a pregnancy = 98 percent effective
• Eight to nine weeks = 96 percent effective
• Nine to 10 weeks = 93 percent effective with single misoprostol dose; 99 percent effective with second dose
Who can use the abortion pill?
Medication abortion is a safe and common procedure for terminating first-trimester pregnancies, specifically up to 11 weeks after the first day of your last period.
From a physical standpoint, medication abortions are safe for pregnant people of all ages. Medication abortion is also effective regardless of your weight (unlike Plan B, *sigh*). If you have an IUD, you may need to have it removed before you take abortion pills.
The main reason medication abortion might not be right for you is if you have (or are experiencing signs of) an ectopic pregnancy, a serious abnormality that occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. Ectopic pregnancies require a different form of termination, usually from an in-person provider.
What happens when you take the abortion pill?
If you’re seeing a doctor in person, they’ll likely start by giving you a pregnancy test and an ultrasound to determine how far along the pregnancy is. But again, telehealth appointments with medication by mail are safe and effective, too. In either case, you’ll be screened and receive instructions on how to take the pills.
The two kinds of medication used for an abortion each play a different role in the process. And so each produces different physical effects.
Effects of mifepristone
After you take this first pill, there’s a good chance you won’t notice any changes at all. Some people feel a bit queasy or start bleeding at this point, but most are able to go about their day as normal.
Effects of misoprostol
This is where you’ll want to plan for a day or two of downtime, either at home or in another comfy location. Misoprostol's job is to expel the uterine lining, so it causes bleeding and noticeable cramping—usually beginning one to four hours after you take the four pills. Some people say this phase feels like a normal period, while others experience nausea, intense cramping, and heavy bleeding. If you fall into the latter category, your doctor may be able to prescribe an anti-nausea medication to take with ibuprofen. (Do not take aspirin, which is a blood thinner that can cause more bleeding.)
It’s not abnormal to see some pretty big clumps of tissue or blood clots after taking misoprostol—Planned Parenthood says these can be up to the size of a lemon. On that note, be sure to opt for pads—not a tampon or a menstrual cup—to better allow blood and pregnancy tissue to exit your body.
Bleeding usually subsides four or five hours after it starts, with light bleeding and spotting sometimes continuing up to three weeks after taking the medications. Cramping usually persists for a few days before gradually easing up.
If your state allows medication abortion prescriptions, the doc you saw a doctor in person will likely have you come back in for a follow-up where you’ll get a blood test and possibly another ultrasound to make sure the abortion is complete and you’re healthy. If you consulted through a telehealth service, they may give you recommendations on when to take a home pregnancy test.
Is the abortion pill safe?
Yes, medication abortion is safe. Serious side effects requiring hospitalization happen in fewer than 0.4 percent of cases, which means abortion pills have a better safety record than Tylenol, penicillin, and Viagra.
The most common side effects of the abortion pill are nausea, vomiting, diarrhea, dizziness, fatigue, and a mild fever of up to about 100 degrees.
That said, seek medical care immediately if you experience any of these rare but serious symptoms: a fever of 101 degrees or higher or uncomfortable vaginal discharge that gives off a bad smell. These are signs of a possible infection, which can occur when traces of pregnancy tissue are left behind. Your doctor may prescribe antibiotics or recommend a secondary removal method, such as a vacuum aspiration, to clear out the remaining pregnancy tissue.
While abortion pills are intended to cause bleeding, seek medical attention if you start to experience heavy blood loss—roughly defined as soaking through two or more thick maxi pads in two hours. Doctors can treat the blood loss with more misoprostol or with a vacuum aspiration.
Are abortion pills detectable in my body?
Abortion pills won’t show up on a blood screening or any other lab test. If you’re among the small number of people who experience problems with the medication—and you live in a state that’s hostile to abortion—it’s understandable that you may be concerned. Rest assured: There’s no medical reason to disclose that you took abortion pills, and it’s 100 percent fine to keep that info to yourself. (If you administered your misoprostol vaginally, just be sure to thoroughly clean out any remaining bits and pieces of the pills—which would be detectable—before your exam.)
Are abortion pills legal?
While abortion pills are safe, effective, and 100-percent FDA approved, some states have passed laws that make it difficult to access them. To find out your state’s rules on medication abortion, visit the Guttmacher Institute’s medication abortion page for state-by-state information, or Plan C to see if your state allows for abortion pills.
A few key things to keep in mind:
Gestational limits
Certain states ban the use of abortion pills before the 11-week mark set by the FDA.
• In-clinic requirements: 19 states require you to be in the physical presence of the doctor who prescribed the medication when you take the mifepristone, even though the FDA says people can safely take it without being watched, just like other prescription meds.
Ordering abortion pills online has allowed some people to bypass such requirements and barriers, but you should be aware of the legal risks. The reproductive rights nonprofit If/When/How operates a ReproLegal Helpline at 844-868-2812 that can help answer your legal questions.
How much do abortion pills cost?
If you’re paying for abortion medication completely out of pocket—with no insurance coverage—you can generally expect to pay $250 to $800. If you have insurance, check your plan to see if abortion pills are covered. Note that 11 states ban all insurance providers from covering abortion care, while 17 other states ban abortion coverage for certain types of plans. (Next time open enrollment comes around, you might be able to buy a “rider” that covers abortion.) If you don’t have insurance and are concerned about billing, inquire with your provider about payment options when you first reach out. Clinics may be able to connect you with an abortion fund to help cover costs. Many clinics also accept credit cards.
Where can I get abortion pills?
Abortion pills in-person
If you live in a state where abortion is legal, a medical professional (ideally one you trust) likely will be able to prescribe the pills. If you need to find a new in-person provider, whether in your home state or one you’re traveling to, a good place to start is AbortionFinder.org or ProChoice.org. You can also find providers by calling the National Abortion Federation (the folks behind ProChoice.org) at 877-257-0012 or Planned Parenthood at 800-230-PLAN.
Abortion pills online
If ordering abortion pills to take at home feels like a better option, consider going to PlanCPills.org. They can match you with a telehealth provider that operates in your state, with some of the most common being Hey Jane, Just the Pill, Carafem, and Choix. Each of these telehealth companies will ask you to complete a form with basic medical info, which a doctor or other trained medical personnel will review before prescribing the medication. Then, depending on where you live, the pills will be discreetly mailed to you. Again, if you have questions about the legal risks of ordering abortion pills, contact the ReproLegal Helpline.
Christen A. Johnson is the lifestyle editor at Cosmopolitan where she covers health and wellness, money, career, pets, home, food, travel and more for print and digital. Christen was previously on Cosmo's culture team, where she covered celebrity and entertainment news, awards shows, and interviewed some of your faves, like Megan thee Stallion and Queen Latifah. She wrote Cosmo’s first-ever digital cover story featuring Chlöe Bailey. Before joining the magazine, Christen was a lifestyle features reporter at the Chicago Tribune. Several of her health and style stories made the paper's front page. When Christen isn’t digging through antique stores, she's likely drooling over home renos on HGTV, sharing her latest therapy revelation, redoing old workouts from her college basketball days, or trying to perfect her homemade buttermilk biscuit recipe. Follow her on Insta for BTS ~ editor life ~ tingz!
