A medical abortion uses two medications, taken one to two days apart, to end a pregnancy without surgery. The first pill stops the pregnancy from progressing, and the second triggers cramping and bleeding that empties the uterus. The process is FDA-approved for pregnancies up to 10 weeks (70 days from the first day of your last period) and has a success rate between 95% and 98%.
The Two Medications and What They Do
A medical abortion works as a two-step process, with each medication playing a distinct role.
The first medication blocks progesterone, the hormone that maintains the uterine lining and sustains a pregnancy. It acts as a competitive blocker at the body’s progesterone receptors, essentially cutting off the hormonal signal that keeps the pregnancy viable. Without progesterone doing its job, the lining of the uterus begins to break down.
The second medication, taken 24 to 48 hours later, is a synthetic version of a naturally occurring hormone called prostaglandin. It causes the cervix to soften and the uterus to contract, similar to what happens during a heavy period or early miscarriage. These contractions push the pregnancy tissue out through the vagina. The effects are dose-dependent, meaning the strength of contractions and other symptoms scale with the amount taken.
What the Process Looks Like Step by Step
You take the first pill (200 mg) by mouth, usually at a clinic or at home after a telehealth visit. Most people don’t feel much at this stage. Some experience light spotting or mild nausea, but the first pill works quietly in the background.
Between 24 and 48 hours later, you take the second medication (800 mcg). This dose is placed between your cheek and gum (buccally) or inserted vaginally, rather than swallowed. You let the tablets dissolve for about 30 minutes before swallowing any remaining fragments. This is when the active part of the process begins. Cramping and bleeding typically start within one to four hours.
If you’re between 9 and 11 weeks, a second dose of the same medication may be recommended about four hours after the first to increase effectiveness. Even at 7 to 10 weeks, some protocols suggest considering that additional dose.
What Bleeding and Cramping Feel Like
The cramping ranges from moderate to intense and often feels stronger than a typical period. It’s the uterus contracting to expel the pregnancy tissue. You’ll likely pass blood clots, some of which can be surprisingly large, along with tissue that looks different from normal menstrual blood. Most people describe the heaviest cramping and bleeding as lasting several hours, after which it gradually tapers off.
Heavier bleeding is normal with medical abortion compared to surgical options. On average, noticeable bleeding lasts about 9 days, though lighter spotting can continue for up to two weeks. In rare cases, spotting may persist for as long as 45 days. You should seek medical attention if you soak through two or more thick pads per hour for two consecutive hours, as that level of bleeding may signal a complication.
Other common side effects from the second medication include nausea, vomiting, diarrhea, fever, and chills. These are temporary and usually resolve within a few hours.
Managing Pain During the Process
Ibuprofen is the most effective over-the-counter option for managing the cramping. Clinical evidence shows it works better than acetaminophen for this specific type of pain. A typical recommendation is 600 mg every six hours as needed. Taking it as needed rather than on a fixed schedule provides equal pain control with less overall medication use. Importantly, ibuprofen does not interfere with the abortion medications or reduce their effectiveness.
A heating pad on your lower abdomen can also help. Most people find that the combination of ibuprofen and heat is enough, though in some cases a provider may prescribe something stronger as a backup.
How Effective It Is
Success rates are high across the approved window. For pregnancies at 7 weeks or earlier, the complete abortion rate is about 97.5%. For pregnancies beyond 7 weeks (up to the 10-week limit), the rate is about 96%. The difference between those two numbers is not statistically significant, meaning the method works reliably throughout the approved timeframe.
In the small percentage of cases where the medication doesn’t fully work, a follow-up procedure (typically a brief suction aspiration) is needed to complete the process. This is uncommon but is a well-established backup.
Who Should Not Have a Medical Abortion
The most important contraindication is ectopic pregnancy, where a fertilized egg implants outside the uterus, usually in a fallopian tube. A medical abortion will not treat an ectopic pregnancy, and delaying proper treatment for one can be dangerous. This is why an ultrasound or clinical evaluation confirming the pregnancy is inside the uterus is part of the standard process before the medications are prescribed.
The method is also not appropriate for people with certain bleeding disorders, those on long-term blood-thinning therapy, or those with an allergy to either medication. If you have an IUD in place, it needs to be removed before starting the process.
Confirming It Worked
About two weeks after the procedure, you’ll take a low-sensitivity pregnancy test. A standard high-sensitivity test can remain positive for weeks after an abortion because pregnancy hormones take time to clear from your body, so using the right type of test matters. Your provider will typically give you the correct test kit or instruct you on what to look for. If the result is positive, unclear, or you’re unsure how to read it, contact your provider for follow-up, which may include an ultrasound or blood test to confirm the abortion is complete.
Recovery Timeline
Most people feel well enough to return to normal activities within a day or two after the heaviest cramping passes. Some take the day of the second medication off work or school, which is worth planning for. Bleeding continues at lighter levels for about one to two weeks, similar to the tail end of a period.
Your normal menstrual cycle typically returns within four to six weeks. Fertility can return almost immediately, so if you want to avoid another pregnancy, it’s important to start contraception soon after. A follow-up appointment around the two-week mark gives your provider a chance to confirm everything went smoothly and discuss next steps if needed.