The combination of two types of pills–mifepristone and misoprostol is one of the most common and effective abortion methods available.
Mifepristone works to prepare the uterus, by blocking progesterone (a hormone necessary to maintain pregnancy). You take one pill of mifepristone 200mg, and swallow with water.
Mifepristone is irreversible and will end your pregnancy. It will work in your body for 24-48 hours, preparing your uterus for misoprostol.
Misoprostol works by causing the strong uterine contractions necessary to expel the contents of your uterus. You take misoprostol 24-48 hours after mifepristone.
Misoprostol is best absorbed in the soft tissues, like our cheeks or vaginal walls. One dose for misoprostol is 4 pills of 200mcg each.
The pills mimic the process of a miscarriage. The secrets to gauging the level of pain you may experience during an abortion can be found in the intensity (or lack thereof) of your menstruation or previous births/ abortions.
Always trust your body to alert you to anything that doesn’t feel normal. Our team of Rouge Doulas are always here to support you if you have any questions.
Swallow 1 pill of mifepristone (200mg) with water. Most people do not feel the effects after taking mifepristone.
Normally, you can continue with your life as normal. Some people DO report bleeding after taking mifepristone. If you DO start bleeding after mifepristone, you can start taking misoprostol as soon as you wish.
1 dose of misoprostol = 4 pills (200mcg each)
You take misoprostol in one of three ways:
Sublingual (under the tongue)
Buccal (Between the cheeks and teeth)
Vaginal (insert pills deep into the vaginal canal)
IMPORTANT: Misoprostol leaves the bloodstream within 6 hours of taking it. There is no way for anyone to detect it on any kind of test. However, chalky remnants of the pills can be seen in the vaginal canal for days after the pills have been inserted. If you live in a country where abortion is restricted, the buccal or sublingual routes are advised.
For early abortion (less than 12 weeks) 1 dose of misoprostol may be sufficient. Sometimes it is necessary to continue taking more doses every three hours. Try to have at least 8 misoprostol pills on hand for early abortion.
Many people start bleeding 3-9 hours after taking the first misoprostol dose. Some people bleed quite a bit, and the embryo/ fetus passes easily. Others don’t bleed at all right away, or the process can take even a few more days for the body to pass it. If you have any questions during your process, contact a Rouge Doula for support.
It is crucial to pay close attention to your body. Monitor your bleeding, and pay close attention to when the embryo/ fetus passes. Once this has occurred, the majority of the abortion is complete.
If you feel like you have NOT bled enough, you may need to take more misoprostol.
Similarly to first trimester abortion, you take 1 pill (200mg) of mifepristone swallowed with water.
After 24-48 hours, you can begin the misoprostol process.
If you are more than 12 weeks pregnant, you will need to take several doses of misoprostol, every three hours until the process is complete.
For example:
Dose 1 : take 4 pills of misoprostol (200 mcg each)
Wait three hours
Dose 2: take 4 pills of misoprostol (200 mcg each)
Wait three hours
Dose 3: take 4 pills of misoprostol (200 mcg each)
Continue this way until you feel that the process is complete.
Misoprostol was the “first abortion pill”. It was traditionally used to treat stomach ulcers, but had the side effect of causing uterine contractions that could also empty the uterus when taken. Discovered by Brazilian activists in the 1970s, misoprostol has become the “gold star” for miscarriage and abortion care all over the world.
It is safe (aspirin is not very safe) and will not impact your future fertility.
Misoprostol works by causing strong uterine contractions necessary to expel the contents of your uterus.
Misoprostol is best absorbed in soft tissues of the body, like our cheeks or vaginal walls.
One dose for misoprostol is 4 pills of 200mcg each.
There are three ways to take misoprostol: sublingual (under the tongue), buccal (between your cheeks and teeth) or vaginal (deep inside the vagina). It is important these medicines dissolve for at least 30 minutes.
After 30 minutes, swallow the remnants.
If you vomit before 20 minutes, you may need to repeat your misoprostol dosage after your nausea goes away.
If your pills don’t start dissolving within the first 10 minutes, you may need to dip it for 3 seconds in a glass of water.
The whole abortion process can take between 2 days and 2 weeks from the time you take misoprostol, until the time you stop bleeding.
It is important to plan ahead for this, and make sure you have time to rest when you take the misoprostol.
The pills mimic the process of a miscarriage. The secrets to gauging the level of pain you may experience during an abortion can be found in the intensity (or lack thereof) of your menstruation or previous births/ abortions.
Always trust your body to alert you to anything that doesn’t feel normal.
You take misoprostol in one of three ways:
Sublingual (under the tongue)
Buccal (Between the cheeks and teeth)
Vaginal (insert pills deep into the vaginal canal)
IMPORTANT: Misoprostol leaves the bloodstream within 6 hours of taking it. There is no way for anyone to detect it on any kind of test. However, chalky remnants of the pills can be seen in the vaginal canal for days after the pills have been inserted. If you live in a country where abortion is restricted, the buccal or sublingual routes are advised.
For early abortion (less than 12 weeks) 1 dose of misoprostol may be sufficient. Sometimes it is necessary to continue taking more doses every three hours. (Not without mife. Usually we see 12 minimum).
Many people start bleeding 1-9 hours after taking the first misoprostol dose. Some people bleed quite a bit, and the embryo/ fetus passes easily. Others don’t bleed at all right away, or the process can take even a few more days for the body to pass it. If you have any questions during your process, contact a doula for support.
It is crucial to pay close attention to your body. Monitor your bleeding, and pay close attention to when the embryo/ fetus passes. Once this has occurred, the majority of the abortion is complete.
If you feel like you have NOT bled enough, you may need to take more misoprostol.
If you are more than 12 weeks pregnant, you will need to take several doses of misoprostol, every three hours until the process is complete.
For example:
Dose 1 : take 4 pills of misoprostol (200 mcg each)
Wait three hours
Dose 2: take 4 pills of misoprostol (200 mcg each)
Wait three hours
Dose 3: take 4 pills of misoprostol (200 mcg each)
Continue this way until you feel that the process is complete.
(Click to Enlarge)
The abortion Timelines have everything you need to prepare you for your abortion.
Plan ahead!
You will want at least one full day after the time you take misoprostol to allow yourself the time to bleed and process your abortion.
If it is possible, take two, even three days. Your healing process deserves to be prioritized if you are able.
There are several different options for safe abortion. Each have benefits as well as draw backs. If for any reason, your abortion is not complete, a surgical abortion can always safely remove the contents of your uterus.
Mifepristone is generally safe, but can cause complications if you have:
The following medicines can block mifepristone, or cause other exacerbate existing health concerns:
Do NOT take anti-inflammatory medications while taking mifepristone:
Also–strangely enough, do not drink grapefruit juice. It can prevent the mifepristone from blocking progesterone.
Do you know your blood type? This is important to know when you become pregnant. If you are a positive blood type, this section does not pertain to you.
If you ARE a negative blood type, it is important to note that getting a shot called Rhogam after your abortion would be prudent. During pregnancy, problems can occur if you are blood type negative, but the fetus is positive. This is called RH incompatibility. The mother’s body will create antibodies to fight the negative pregnancy and could cause the death of the fetus.
To avoid this, a shot of RhoGAM will prevent the antibodies from forming that could create complications in future pregnancies. If you are RH negative, make a plan with a provider to get a shot of RhoGM within 72 hours after your abortion.
For more information on the RH factor, click HERE to read the American College of Obstetricians and Gynecologists overview.
For those taking abortion pills without having reliable access to an ultrasound or doctor, there is no official way to rule out an ectopic pregnancy. Ectopic pregnancies are those which attach to the inside of the fallopian tube, rather than in the uterus. Ectopic pregnancies left untreated can be incredibly painful and can survive a medical abortion with mifepristone and/or misoprostol.
It is the most secure to have an ultrasound before you take your abortion pills to rule out ectopic BEFORE you start your abortion. An ectopic pregnancy is not viable, meaning it is impossible for it to mature to birth. An ectopic pregnancy left untreated can burst your fallopian tube and create problems for your future fertility.
Ectopic pregnancies should be treated with Methotrexate rather than Mifepristone. If you suspect you have an ectopic pregnancy, or have pain that is unmanageable, it is especially important to seek medical attention. An ectopic pregnancy can be life-threatening, and termination of the pregnancy should not be self-managed.
If you DO NOT have access to an ultrasound before your self-managed abortion, pay attention to your body after the abortion. An ectopic pregnancy will keep growing in your fallopian tube after you have taken your pills, and you may need additional medical help to remove it.
It is important to closely monitor yourself after an abortion. It is normal to continue bleeding for around 2 weeks or more after your abortion, but that should be light bleeding.
If you are bleeding heavier than a normal menstrual period, or have large clots weeks after your abortion, you may need medical attention.
Some signs of infection:
Sepsis can be caused by infection and while after an abortion it is rare, it can be serious. Symptoms of sepsis can be like having the flu at first.
If you have any of the signs below it is important to seek urgent medical advice:
Contact your doula if you think you have signs of infection, and if you are having any of the more serious symptoms above, seek medical care in your area immediately.
Depending on where you are in the world, there are different ways to access pills.
The most important things to consider:
Our favorite companies:
Most verified pill companies can be found at: www.plancpills.com
If you need support accessing pills, or cannot afford pills, our Doula team can help connect you to community groups in your area or country.