Are The Early Term Abortion Medications Safe?
The medications used to carry out the Abortion Pill process in the first trimester of pregnancy are very safe.
Over 5 million Abortion Pill procedures have been performed in the US since Sept. 2000 with less than a 1% incidence of complications or side effects.
The maternal death rate is 11 to 14 times higher with delivery of a term pregnancy verses having a first trimester termination of pregnancy using the abortion pill.
Using the medication abortion procedure does not affect the ability to conceive in the future or cause premature labor, premature rupture of membranes, low birth weight or Preeclampsia.
The abortion pill does not cause breast, cancer or increase Psychological illnesses (depression or anxiety).
What Is Medication Abortion?
The Abortion Pill or medical abortion procedure is commonly carried out using the combination of two medications taken in order:
- First Pill – Mifepristone (Mifeprex, Mifegyne, RU 486, Early Options, French Pill).
- Alternative First Pill – Methotrexate Medication (tablets; injectable).
- Second Pill – Misoprostol (Cytotec).
The medications used, the expected effects, and the appropriate follow-up depend on the stage of pregnancy and each patient’s medical circumstances.
How Does The Abortion Pill Work?
Mifepristone:
Mifepristone’s Mechanism Of Action (MOM) works by blocking the hormone Progesterone that is responsible for the growth of early pregnancy.
Mifepristone binds (attaches) to the Progesterone receptors on the uterine wall. This causes the breakdown of blood vessels responsible for supplying adequate nutrition and oxygen to the pregnancy.
Methotrexate:
Methotrexate Mechanism Of Action (MOM) is to stop the growth of placental tissue (Cytotrophoblasts) that is responsible for its spread and growth. The placental tissue slowly dies and the pregnancy tissue succumbs.
Misoprostol:
Misoprostol is a Prostaglandin E1 tablet. Its Mechanism of Action (MOA) works by binding to the Prostaglandin receptors on the Uterine wall. This causes Uterine contractions and the fetal tissue is expelled.
What Are The Side Effects And Complications Of The Abortion Pill?
The most common side effects are the following:
- Allergic Reaction To Medication.
- Nausea and Vomiting.
- Headaches.
- Shivering and Chills.
- Jaw pain.
- Lower Abdominal and back pain.
- Vaginal discharge (clear, yellow).
- Yeast infection.
- Vaginal Bleeding.
Rare side effects – Significant adverse events:
- Vaginal Hemorrhage – bleeding more than 2 pads an hour for 2 hours in a row.
- No bleeding within 24 hours of taking Misoprostol.
- Failed procedure – The most common is failure of the medications to work and the pregnancy remains and or continues to grow. An example would be the ultrasound shows a fetus with an active fetal heartbeat or a gestational sac that continues to grow since mifepristone was taken 3 to 4 weeks prior. A repeat dose of Misoprostol can be considered on an outpatient basis up to 14 weeks. After that, a combined outpatient and in clinic abortion pill procedure can be performed.
- Incomplete Abortion – Some of fetal or gestational tissue remains in the Uterus.
- Infection.
- Temperature greater than 100.4 for 24 hours.
- Severe Abdominal Pain not relieved with over-the-counter medications that lasts for more than 24 hours.
- Clostridium Sordellii – Severe infection that may lead to multiple organ failure and maternal death. Infection not unique to Abortion.
The complications are generally cared for by taking antibiotics, repeat of the abortion pill tablets or surgical curretage.
The significant side effects are extremely rare. They occur in 0.65% of abortion pill procedures.
The most common significant adverse event that occurs during the abortion pill process (medical abortion) is the continuation of the intrauterine pregnancy that has a incidence of 0.50%.
If any of the serious side effects occur, women are instructed to call the 24 hour emergency number immediately.
ER visits (0.07%) and blood transfusions (0.01 to 0.04%) are rare.
How Do You Know If The Abortion Pill Worked?
It cannot be determined if the abortion pill procedure is 100% successful until one or the combination of the following occurs at the 3 or 4 week follow-up visit:
- Negative pregnancy test
- Pelvic exam
- Ultrasound (Sonogram)
Over 90% of women are able to tell that the abortion pill procedure was a success due to the resolution of symptoms:
- Nausea and vomiting
- Bloating and gas
- Urinary Frequency and urgency
- Smell sensitivity
- Breast tenderness and Nipple Irritation
- No appetite
Even with the resolution of early pregnancy symptoms, it doesn’t mean the abortion pill process was 100% successful. Thus the reason the 3 to 4 week follow-up visit is vitally important.
What Are the Contraindications of Medical Abortion?
The abortion pill is not the answer for everyone who wants to end a unwanted pregnancy. There are a number of medical conditions or circumstances where the medication abortion should not be used:
- Ectopic pregnancy
- Blood abnormalities
- Taking blood thinner medications
- Porphyria
- IUD in place
- Undiagnosed vaginal bleeding
- Cervicitis
- Recently diagnosed Pelvic Inflammatory Disease
- Chronic usage of steroids
- HIV
- Other significant Immunodeficiency Diseases
- Severe Liver or Kidney Diseases
- Allergic Reaction to any of the medications used
In Summary
The abortion pill remains one of the most extensively studied methods of early pregnancy termination.
Furthermore, in May 2025, the American College of Obstetricians and Gynecologists (ACOG) and several leading medical organizations reaffirmed that mifepristone is a safe and effective medication, with serious complications being rare.
For eligible patients, it provides a highly effective alternative to an in-clinic procedure.
Understanding its effectiveness, potential side effects, and the importance of appropriate medical follow-up can help patients make informed decisions about their reproductive healthcare.
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