A positive pregnancy test can leave you with a long list of questions. What exactly are abortion pills? How do they work? How much bleeding is normal? How long does the process take? Do you need an ultrasound? And what should you do if something does not feel right?
Medical abortion is a well-established way of ending a pregnancy using medicines rather than a surgical procedure. The medicines most commonly used are mifepristone and misoprostol. Misoprostol can also be used on its own in some circumstances.
The process is generally safe when an appropriate method is used, the medicines are quality-assured and the person has access to accurate information and medical care if needed. WHO's current Abortion Care Guideline, published in 2025, provides the latest international evidence-based recommendations.
This guide explains what abortion pills are, how they work, what you may experience and when medical attention is important. It is general health information, not a personal prescription.
What are abortion pills?
"Abortion pills" is the common term for medicines used to end a pregnancy through medical abortion.
The two medicines most commonly associated with medical abortion are:
Mifepristone, which blocks progesterone, a hormone needed to maintain pregnancy.
Misoprostol, which causes the uterus to contract and helps the pregnancy pass through the vagina.
They may be used together or, in certain circumstances, misoprostol may be used alone. The combination of mifepristone and misoprostol is generally more effective than misoprostol alone. The appropriate regimen depends on factors including the duration of pregnancy and the clinical circumstances.
WHO also recognises self-management of medical abortion before 12 weeks in appropriate circumstances, provided people have accurate information, quality-assured medicines, access to trained support and a way to obtain medical care or referral if necessary.
Abortion pills are not the same as emergency contraception
These two types of medicine are often confused.
Emergency contraception is used after unprotected sex to reduce the chance of pregnancy occurring. It does not terminate an established pregnancy.
Medical abortion uses medicines to end an existing pregnancy.
So if a pregnancy test is already positive, taking an emergency contraceptive pill is not the same thing as having a medical abortion.
How do mifepristone and misoprostol work?
Mifepristone
Mifepristone blocks progesterone.
Progesterone helps maintain the pregnancy, so blocking its action causes changes in the uterus and makes the pregnancy more susceptible to misoprostol.
Misoprostol
Misoprostol causes the uterus to contract.
Those contractions produce the cramping and bleeding associated with medical abortion and help the pregnancy pass through the vagina.
This is why cramping and bleeding are expected parts of the process rather than automatically being signs of a complication.
How far along is the pregnancy?
Pregnancy duration is generally calculated from the first day of the last menstrual period, rather than from the date of sex or conception.
For example, if the first day of your last period was eight weeks ago, the pregnancy is generally described as approximately eight weeks' gestation.
Pregnancy duration matters because the recommended approach to medical abortion changes as pregnancy progresses.
WHO's current guidance supports medical-abortion self-management before 12 weeks in appropriate circumstances, although the available evidence for independent self-management is stronger at earlier gestational ages.
If you do not know when your last period started, have irregular periods or think the pregnancy may be further along than expected, a healthcare professional can help determine what assessment is appropriate.
Do you need an ultrasound before taking abortion pills?
Not necessarily.
An ultrasound is not automatically required before every early medical abortion.
A healthcare professional can often estimate pregnancy duration from your menstrual history and other clinical information. An ultrasound may nevertheless be useful when there is uncertainty about the pregnancy's duration or location, or when symptoms suggest a possible complication.
For example, severe abdominal pain, particularly pain concentrated on one side, may require assessment for an ectopic pregnancy.
An ectopic pregnancy develops outside the uterus, most commonly in a fallopian tube. Abortion medicines do not treat an ectopic pregnancy.
The important distinction is therefore not "ultrasound for everyone" versus "ultrasound for nobody". It is whether there is a medical reason for further assessment.
What happens after taking abortion pills?
Everyone's experience is somewhat different, but several effects are expected.
Cramping
Misoprostol causes uterine contractions, so cramping is normal.
For some people it feels similar to strong period cramps. For others, the pain can be considerably stronger, particularly while the pregnancy is passing.
Pain usually becomes less intense after the main part of the abortion has passed.
Bleeding
Bleeding is also expected.
It may be heavier than your usual menstrual period and may include blood clots or pregnancy tissue.
The heaviest bleeding generally occurs around the time the pregnancy passes. Bleeding should then gradually become lighter, although spotting can continue afterwards.
Other side effects
Temporary side effects can include:
nausea;
vomiting;
diarrhoea;
chills or shivering;
headache;
dizziness; and
a temporary feverish feeling.
These effects commonly settle. Persistent fever or feeling increasingly unwell should not simply be dismissed as a normal side effect.
How long does a medical abortion take?
There is no exact timetable that applies to everyone.
Cramping and bleeding often begin within several hours after misoprostol, but the timing varies. The pregnancy may pass relatively quickly, while for others the process takes longer.
After the main bleeding, lighter bleeding or spotting can continue for days and sometimes longer.
For that reason, it is sensible to allow yourself several hours of privacy and rest rather than assuming the entire process will be over immediately.
If there is no bleeding after following the recommended medication instructions, or you continue to experience pregnancy symptoms, contact a qualified healthcare provider rather than repeatedly taking additional medicine without guidance.
What should you have ready?
If you are having a medical abortion, a little preparation can make the process easier.
Consider having:
sanitary pads;
drinking water and food;
appropriate pain relief recommended by a healthcare professional;
a phone with enough battery;
the medicine packaging and instructions;
a private place where you can rest;
someone you trust available for support, if you want that; and
a plan for reaching a healthcare facility if you develop a complication.
If you are travelling or are far from medical care, think about your route to a hospital before beginning the process.
The goal is not to make the experience frightening. It is simply sensible preparation for something that involves bleeding and cramping.
When should you seek urgent medical help?
Most medical abortions do not lead to serious complications, but serious problems can occur and need prompt treatment.
Seek urgent medical attention if you experience:
very heavy bleeding;
fainting or severe weakness;
severe or worsening abdominal pain;
severe pain mainly on one side;
shoulder-tip pain, particularly with abdominal pain or fainting;
difficulty breathing;
persistent or high fever;
foul-smelling vaginal discharge together with increasing illness; or
a general condition that is getting worse rather than better.
Heavy bleeding is particularly important. Clinical guidance commonly uses soaking more than two large sanitary pads per hour for two consecutive hours as a warning threshold requiring medical assessment.
Do not wait for a routine follow-up appointment if you feel seriously unwell.
What is an ectopic pregnancy?
An ectopic pregnancy happens when a pregnancy develops outside the uterus.
It cannot develop normally and can become life-threatening if it ruptures and causes internal bleeding.
Possible warning signs include:
severe or persistent abdominal pain;
pain concentrated on one side;
shoulder-tip pain;
dizziness or fainting; and
weakness associated with abdominal pain or bleeding.
Abortion pills do not treat an ectopic pregnancy.
If these symptoms occur, seek urgent medical care rather than taking additional abortion medicine and waiting for the symptoms to disappear.
How do you know whether the abortion was successful?
Bleeding alone does not always prove that an abortion is complete.
Depending on the circumstances, follow-up may involve:
discussion of symptoms with a healthcare professional;
a pregnancy test at the appropriate time;
a clinical examination;
an ultrasound when medically indicated; or
another follow-up method recommended by the healthcare provider.
WHO states that routine follow-up is not necessarily required after an uncomplicated medical abortion when the person has clear information about warning signs and access to appropriate care. Follow-up remains important when there are concerns about incomplete abortion, ongoing pregnancy or complications.
Can abortion pills fail?
Medical abortion is highly effective, but no medical treatment is 100% effective.
An ongoing pregnancy or incomplete abortion can occasionally occur.
If you continue to have symptoms of pregnancy, have concerns that the abortion was incomplete or are unsure what is happening, contact a healthcare professional.
Do not assume that taking more tablets is automatically the right solution.
Are abortion pills safe?
Medical abortion is considered a safe and effective method when an appropriate regimen is used and quality-assured medicines are available.
WHO's current guidance supports medical abortion and recognises self-management before 12 weeks in appropriate circumstances, provided people have accurate information, quality-assured medicines, trained support when needed and access to a healthcare facility and referral services.
"Safe", however, does not mean completely risk-free.
Important complications include heavy bleeding, infection, incomplete abortion and complications associated with an ectopic pregnancy.
The practical lesson is simple: know what is normal, know what is not, and know where to get help.
Can abortion pills affect future fertility?
An uncomplicated medical abortion does not normally cause infertility.
Fertility can return relatively quickly after an abortion, meaning another pregnancy is possible soon afterwards if contraception is not used.
Serious untreated complications, particularly infection, can cause reproductive problems. This is one reason why severe symptoms should not be ignored.
What about contraception after an abortion?
Ovulation can return soon after an abortion.
If you do not want another pregnancy, speak with a healthcare professional about contraception. Depending on your circumstances, options may include:
condoms;
contraceptive pills;
injections;
implants;
intrauterine devices; and
other longer-acting or permanent methods.
A healthcare provider can explain which options are appropriate for you and when each can be started.
Abortion pills vs surgical abortion
Medical and procedural abortion are different approaches.
| Medical abortion | Procedural abortion |
|---|---|
| Uses medicines | Uses a medical procedure |
| Causes uterine contractions and bleeding | Pregnancy tissue is removed through a clinical procedure |
| Often used in early pregnancy | Can be appropriate at different pregnancy durations depending on the procedure and local regulations |
| Cramping and bleeding occur as part of the process | The procedure itself is performed by trained healthcare professionals |
| May be completed outside a healthcare facility in appropriate circumstances | Usually takes place in a healthcare facility |
| Follow-up depends on the circumstances | Follow-up depends on the procedure and individual circumstances |
The appropriate method depends on factors such as pregnancy duration, medical circumstances, availability, local regulations and personal preference.
Common questions about abortion pills
How early can abortion pills be used?
Medical abortion is used in early pregnancy, with the appropriate regimen depending on gestational age. WHO provides specific recommendations according to pregnancy duration.
Do abortion pills always cause bleeding?
Bleeding is expected with medical abortion, but the amount and timing vary. If there is no bleeding after following the recommended regimen, contact a healthcare provider for advice.
How painful is a medical abortion?
Cramping can range from mild period-like pain to strong cramps. The most intense pain generally occurs while the pregnancy is passing.
Can abortion pills cause infertility?
An uncomplicated medical abortion does not normally cause infertility.
Do I need an ultrasound?
Not necessarily. An ultrasound may be recommended when pregnancy duration or location is uncertain or when symptoms suggest a possible complication.
Can abortion pills treat an ectopic pregnancy?
No. An ectopic pregnancy requires medical treatment and can become life-threatening if it ruptures.
What if I still feel pregnant afterwards?
Pregnancy symptoms may take time to disappear, but persistent pregnancy symptoms or uncertainty about whether the abortion was complete should be discussed with a healthcare professional.
Can I become pregnant again after an abortion?
Yes. Fertility can return quickly after an abortion.
The bottom line
Abortion pills are medicines used to end a pregnancy without a surgical procedure. The two medicines most commonly used are mifepristone and misoprostol, while misoprostol can also be used alone in some circumstances.
Cramping, bleeding and the passage of pregnancy tissue are expected parts of the process. Serious symptoms such as very heavy bleeding, fainting, severe abdominal pain, persistent fever or signs of an ectopic pregnancy require prompt medical attention.
If you are in the United Arab Emirates, there is an additional consideration: abortion is regulated under UAE law, and termination is permitted only in specified circumstances and subject to applicable conditions and procedures.
For anyone considering medical abortion, the safest approach is to use accurate, current medical information, quality-assured medicines and a reliable route to professional care if something goes wrong.
