The most common side effects of the abortion pill are heavy bleeding and cramping, which are expected parts of the process rather than complications. Most people also experience nausea, diarrhea, or chills in the hours after taking the second medication. These effects are temporary, and serious complications are rare, occurring in fewer than 1% of cases.
The abortion pill is actually two medications taken in sequence. The first blocks a hormone needed to sustain the pregnancy, and the second, taken 24 to 48 hours later, causes the uterus to contract and empty. The side effects differ between the two, and most of the noticeable symptoms happen after the second pill.
Bleeding and Cramping
Heavy bleeding and strong cramps are the primary effects of the second medication and the clearest sign that the process is working. Cramping typically begins one to four hours after taking the second pill and can be intense, often stronger than a normal period. The heaviest bleeding usually lasts several hours, during which you may pass large clots.
After that initial phase, bleeding tapers but doesn’t stop right away. Heavier-than-normal bleeding lasts about 9 days on average. Lighter bleeding or spotting can continue for up to two weeks, which is considered normal. In rare cases, some spotting persists for as long as 45 days.
Bleeding that soaks through two or more thick pads per hour for two or more consecutive hours is a sign of excessive blood loss and needs immediate medical attention.
Nausea, Diarrhea, and Fever
The second medication causes a range of short-lived effects beyond bleeding. Nausea, vomiting, diarrhea, and chills are all common in the first several hours. A temporary low-grade fever is also normal during this window. These symptoms generally resolve within 24 hours.
Fever or chills that persist beyond 24 hours after taking the second medication are not a normal side effect. Prolonged fever, especially combined with worsening abdominal pain or foul-smelling vaginal discharge, can signal an infection and requires prompt medical evaluation.
Managing Pain
Ibuprofen is the most effective over-the-counter option for managing cramping during a medication abortion. A Cochrane review found that a single dose taken alongside the second pill likely reduces pain more effectively than acetaminophen. Taking ibuprofen does not interfere with the medication or reduce its effectiveness.
The optimal dose isn’t fully settled, but research suggests a higher single dose (around 1600 mg) is more effective at reducing pain scores than a lower dose (800 mg), which performed only slightly better than a placebo in one trial. There was no meaningful difference between taking ibuprofen preventively versus waiting until pain starts at the 800 mg dose. A heating pad applied to the lower abdomen can also help alongside medication.
Hormonal Shifts After the Process
Pregnancy hormones don’t drop to zero immediately. You may notice breast tenderness or a milky discharge from the breasts for a couple of days afterward. These symptoms resolve on their own as hormone levels return to baseline.
Emotionally, responses vary widely. Studies consistently show that the most common feeling is relief, though some people also experience sadness, regret, or a mix of emotions. All of these reactions are normal. Hormonal shifts in the days following can amplify mood changes. If emotional symptoms interfere with your daily functioning for more than a couple of weeks, talking to a healthcare provider can help.
Incomplete Abortion
In a small percentage of cases, the medication doesn’t fully empty the uterus. Signs of an incomplete abortion include prolonged heavy bleeding, persistent cramping, and continued symptoms of pregnancy. A follow-up appointment, typically scheduled one to two weeks after taking the pills, confirms whether the process is complete, usually through an ultrasound or blood test.
If tissue remains, a brief aspiration procedure may be needed to complete the process. This is a known possibility rather than a dangerous complication, and it’s one reason follow-up care matters.
Serious but Rare Complications
Severe complications from the abortion pill are uncommon. FDA post-marketing data covering approximately 5.9 million women who used the medication in the U.S. through 2022 recorded 32 deaths and roughly 1,049 hospitalizations over the full 22-year reporting period. The FDA notes that these events cannot be definitively attributed to the medication itself due to gaps in information about other health conditions and treatments.
One of the rarest and most serious risks is a specific type of bacterial infection. A small number of fatal cases have involved a toxin-producing bacterium that causes a form of toxic shock. These cases were notable for an unusual presentation: no fever, but severe drops in blood pressure and fluid buildup. This infection is extraordinarily rare, but it underscores why worsening symptoms after the initial recovery window, particularly increasing pain, weakness, or feeling faint without fever, should not be ignored.
Why Ectopic Pregnancy Matters
The abortion pill does not work on ectopic pregnancies, where a fertilized egg implants outside the uterus, most commonly in a fallopian tube. An untreated ectopic pregnancy can rupture and cause life-threatening internal bleeding. The pills may mask symptoms by causing their own bleeding and cramping, potentially delaying diagnosis.
This is why pregnancy location is confirmed before the pills are prescribed, typically through ultrasound or blood testing. If you experience sharp, one-sided abdominal or pelvic pain, shoulder pain, or dizziness and lightheadedness after taking the medication, these can be signs of an ectopic pregnancy that needs emergency treatment.
Effects on Future Fertility
A medication abortion does not reduce your ability to get pregnant in the future. Research from the National Academies of Sciences found that women with a prior abortion were actually less likely to need fertility treatment than women in their first pregnancy, with no association between abortion and secondary infertility.
Studies also found no increased risk of pregnancy complications like high blood pressure, preeclampsia, or abnormal placenta placement in subsequent pregnancies after an early abortion. There was no significant association between a single abortion before 13 weeks and preterm birth in a later pregnancy. The one nuance: research has found a modest increase in the risk of very early preterm birth (before 28 weeks) among women who have had three or more prior abortions, though even that association was not found specifically with multiple medication abortions.
Fertility can return quickly. Ovulation may resume within two weeks of a medication abortion, which means pregnancy is possible again almost immediately.