After Visit Questions
Nothing on this page purports to be medical advice. If you are unsure, it is best to contact us or another healthcare provider to determine the medically appropriate course of action for a particular circumstance.
How-to instruction cards:
Less than 64 days (less than 9 weeks)
Here are answers to the most common questions from our patients. Please see if your question is already answered before you call us. The emergency phone line is on the card in your bag.
Bleeding Questions
-
On the day you take misoprostol, please contact us if you think you are bleeding too much. Soaking two maxi-pads an hour for two hours in a row means you need treatment. We give you extra misoprostol tablets for this purpose. Contact us for advice -- we respond 24/7.
It is difficult to judge bleeding by what you see in the toilet. It is easier to measure how much blood you see on your maxi pads.
In the days after you take misoprostol, there is a very, very wide range of normal bleeding patterns. Anywhere from days to weeks of light to moderate bleeding is normal. It can stop and start up again; that’s normal too.
Contact us if you are bleeding much heavier than your regular period, continue to pass large clots, or if you feel dizzy. Misoprostol can also help in this situation. Don't throw away your extra pills for 6 weeks in case you need them!
It is okay to use tampons, but if you are bleeding heavily, please use maxi-pads so you can better measure the amounts.
-
The amount of blood can vary a lot, depending on how many weeks the pregnancy is.
For 5 weeks or less, bleeding may only fill a half of a maxi-pad, but can be heavier.
At 6 weeks, bleeding should be like a period, at minimum, but can be heavier.
At 7 weeks or more, it is normal to have clots and bleeding much heavier than a period. The clots can be quite large.
At 10 weeks or more, it is common to see a recognizable fetus, if you look carefully. It is not necessary to examine tissue or clots. You will know it worked if you pass clots and your pregnancy symptoms go away within a week.
After the abortion, there is a very, very wide range of normal bleeding patterns. Some people just bleed for a day, and some people have period-like bleeding for days or weeks.
Bleeding can stop and start up again; that’s okay. Bleeding may increase with exercise and decrease with rest. It can take 1-3 months for the period to re-start in its normal frequency.
-
If you only have light spotting or no bleeding for 6-24 hours after taking misoprostol, then it may not have worked. You need to repeat the dose.
Just like the first time: first, take 4 tablets of ibuprofen (200 mg each) and nausea pills (ondansetron). After 30 minutes, use 4 tablets of misoprostol; (in between cheek and gum, two each side).
If you do not experience any bleeding after the second round of misoprostol, contact us.
-
Your next period may come anytime in the next 2 weeks to 2 months. It is normal and common for your first period to be much heavier than usual. Do a pregnancy test if you do not have your normal period after 6-8 weeks, and call us if it is still positive.
It is possible to get pregnant again within days after using mifepristone, before your pregnancy test turns negative and before your next period. Let us know if you would like information about contraception (birth control).
Your periods may be irregular for several months after a pregnancy. We do not recommend using menstrual cycle tracking as your primary method of birth control.
-
Bleeding can last for days or weeks after taking mifepristone. Sometimes the blood can cause an odor.
If you feel well with no fever or pain, you can wait to see if it goes away on its own.
If the odor persists or you are worried, you can contact us, or go to a clinic to get an exam.
Pain/Cramping Questions
-
The uterus is a strong muscle and can cause intense cramping and pain as it squeezes. Misoprostol will make your uterus squeeze very hard.
Cramping or pain is a good sign that the medications are working as expected. The pain is usually in your lower stomach, hips and can radiate into your legs. Pain typically lasts 2-8 hours on the day you take misoprostol.
If you do not have an ultrasound showing a pregnancy in your uterus, and have any of these symptoms, contact us right away and go to the emergency room:
severe pain on one side
severe pelvic pain not improving with medications,
severe dizziness or
shoulder pain
If your pregnancy was in the uterus, intense cramping and pain is common in the hours after taking misoprostol. Here are things that help:
Ibuprofen 800 mg (four 200 mg tablets) every 6-8 hours
Tylenol (acetaminophen) up to 2 tablets every 6 hours. It is safe to take this with ibuprofen
Use a heating pad or hot water bottle
Take a hot bath or hot shower -- this can make a big difference!
Go on a gentle walk, or do stretches. Moving your body helps the pain.
Massage your lower belly, legs and low back.
Contact us if your pain is not improving with any of the methods above.
-
Cramping and pain is different for everyone. It can be very intense. Sometimes it is barely noticeable. Pain can come and go over hours to days.
See above, "what can I do for pain" for helpful suggestions.
If you are worried about your pain and you are not sure it is normal, contact us!
-
Usually cramping and pain is the most intense in the first day after using the misoprostol pills.
Mild to moderate cramping can come and go over hours to days, especially if you are having bleeding.
Contact us if you are not getting better with ibuprofen, or if the pain is interfering with your daily activities.
Nausea Questions
-
Nausea is a common and expected side effect of misoprostol. It also is a pregnancy symptom. Take ondansetron 30 min BEFORE using misoprostol and up to every 6 hours as needed.
Nausea from pregnancy should go away within a few days after the pills. Contact us if you still feel nausea after 3-7 days.
Keep up with small sips of fluids often. Staying hydrated helps!
Contact us if you are unable to keep down any fluids or have severe dizziness.
-
Mifepristone works best if it is in your body for 30 minutes. If you vomited within 25 minutes after taking mifepristone, please contact us.
Misoprostol is absorbed through the cheeks. Nausea is a common and expected side effect. Nausea often means the misoprostol was absorbed and is working. Contact us if you vomited within 25 minutes after placing them in your cheeks or your vagina.
Vomiting AFTER you swallow the miso is common -- it still will work.
It is common for the miso pills not to dissolve all the way.
Helpful tip: Swish and swallow what is left of miso using your favorite drink (soda, milk, juice -- anything with flavor) -- it masks the taste of the pills.
Contact us with questions!
Follow-Up Questions
-
You have bleeding
Your pregnancy symptoms go away within a week
Your home pregnancy test is negative at 5 weeks.
The final sign that everything is complete is a negative home pregnancy test.
If your ultrasound showed a pregnancy in the uterus: There is no need to take a pregnancy test before 5 weeks. Pregnancy hormones stay in your system for weeks and can cause the test to show positive, even when you are no longer pregnant. Contact us if still positive at 5 weeks.
If your ultrasound showed an empty uterus (because of very early pregnancy, less than 5 weeks): take your test at 2 weeks; contact us if still positive.
Helpful tips: drink a lot of water before taking the test. Use an inexpensive two-line test (the kind we give you in your bag.) They are less likely to show a false positive.
Not sure the pills worked? Pregnancy test still positive, longer than expected? Contact us! We can help.
-
Did you take the pills less than 5 weeks ago? Please wait until 5 weeks – it can take that long to turn negative.
If there was a faint line, then retake the test in a couple of days. Drink a lot of water before taking the test. Use an inexpensive two-line test (the kind we give you in your bag.) They are less likely to show a false positive.
We can do a repeat ultrasound if you are unsure – or refer you to a safe place to go.
We do NOT recommend using a Crisis Pregnancy Center, even though they advertise free ultrasounds. The American Medical Association warns that these are not true medical clinics, they give false information, and can share your private data without asking. -
It is not necessary to have another ultrasound if you have bleeding/passing clots and your pregnancy symptoms are going away.
Not sure if it worked? Contact us! We offer free ultrasounds, or can refer you to a safe place close to home.
We do NOT recommend using a Crisis Pregnancy Center, even though they advertise free ultrasounds. The American Medical Association warns that these are not true medical clinics, they give false information, and can share your private data without asking.
-
Mifepristone is NOT considered reversible. We agree with the American College of Obstetrics and Gynecology that claims regarding abortion “reversal” treatment are not based on science and do not meet clinical standards.
No reliable science shows damage to a developing fetus from mifepristone. Out of 100 pregnancies, 3 will have an anomaly (birth defect), without any exposure to medications. It does not appear that mifepristone increases this risk (see NIH reference).
If you decide not to take misoprostol and your pregnancy continues, we recommend you start prenatal vitamins and get prenatal care. Let us know if you need a referral.
Taking mifepristone without taking misoprostol can increase the chance of heavy bleeding that requires emergency treatment (Obstetrics and Gynecology, 2019 Dec) If you start bleeding, please contact us. We recommend starting misoprostol right away, to help your uterus squeeze and stop the bleeding, and prevent the need for emergency care.
Do not throw out your misoprostol! You may need it later.
-
There are no food restrictions-- you can eat or drink what you like.
Alcohol may make nausea worse and may affect your ability to cope with pain, but it does not affect the process. THC or cannabis does not affect the process.
It is okay to have sex when you feel ready. Your fertility returns within a week – let us know if you want information about contraception (birth control).
You can do exercise when you feel ready. Sometimes exercise increases bleeding – contact us if you have concerns.
It is okay to sit in a bathtub, even when the bleeding has started, as that can help pain and cramping.
-
Fertility comes back within a week after medication abortion. It is possible to get pregnant again, even before the period comes back.
Most birth control methods can be started at any time.
The Depo Provera shot works best if you wait two days after taking mifepristone – but it is okay to start sooner if that works best for you.
IUDs can be placed after the pregnancy is expelled.
Starting birth control pills within a few days after an abortion not only protects against pregnancy, but it also decreases the total number of bleeding days after an abortion. (Oral contraceptives following abortion: systematic review and meta-analysis. Contraception. 2016;93(7):514-523)
-
Medication abortion is very safe (Aiken 2021). Most people do not need to seek medical care after a medication abortion.
Whether an early pregnancy loss (miscarriage) is caused naturally or it is caused by pills, the treatment is the same, if medical care is needed.
When seeing a medical provider, many people choose to keep the pills private, and just share what they are experiencing (like bleeding or pain).
Some people have experienced discrimination and delayed care when the word “abortion” is in the chart.
It is okay to maintain your privacy about your abortion, if you need medical care.
The abortion pills are not detectable by any medical test now available in the US.