How Do Abortion Pills Work? Answers to Frequently Asked Questions.

by Ziva Branstetter

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When the Supreme Court overturned Roe v. Wade and the constitutional right to abortion in 2022, strict bans on the procedure kicked in across the country, leaving women in at least 22 states with fewer options to end pregnancies that in some cases endangered their lives.

ProPublica has uncovered at least two cases of women who died after their state banned abortion. In both cases, the women took pills to end their pregnancies and the abortion did not fully complete, causing complications, as can occur in a small number of cases involving abortion medication.

Their stories speak to the challenges women face when abortion is banned, not the safety of abortion pills when taken properly and with appropriate follow-up care.

We reviewed information from the U.S. Food and Drug Administration and from groups that closely track the latest medical advice and scientific evidence to answer the most frequently asked questions about abortion pills.

What is abortion medication?

What some people call the abortion pill" is actually a combination of two pills - mifepristone and misoprostol - commonly called abortion medication."

Mifepristone tablets are also sold under the brand name Mifeprex, which has been approved by the U.S. Food and Drug Administration since 2000 to be used along with misoprostol to end an intrauterine pregnancy through 10 weeks gestation. (That is measured as 70 days or less since the first day of a patient's last menstrual period.)

Abortion pills are now used in more than 60% of all abortions in the U.S. health care system.

How do abortion pills work?

Mifepristone blocks a hormone called progesterone that is needed for a pregnancy to continue. The FDA-approved regimen is to take 200 milligrams of mifepristone on the first day. Patients are directed to take misoprostol within 24 to 48 hours of the mifepristone. The misoprostol works to expel fetal tissue from the uterus.

In some cases, patients take a regime of misoprostol only to end a pregnancy.

Patients are directed to follow up with a health care provider about seven to 14 days after taking mifepristone or earlier if any unusual symptoms are noted. (See below.)

Are abortion pills safe?

Yes. The FDA first approved Mifeprex 25 years ago, so there's an extensive record of safety involving this drug.

Out of nearly 6 million women who've taken mifepristone since then, only 32 deaths of women who used the drug to terminate pregnancies were reported to the FDA through the end of 2022, regardless of whether the drug played a role in the death.

Of those, 11 involved deaths of women who developed a deadly infection called sepsis. Most of the remaining cases involved intentional and accidental drug overdoses, suicide, homicide and ruptured ectopic pregnancies.

The American College of Obstetricians and Gynecologists has opposed laws and court rulings that limit or ban the availability of abortion pills. Mifepristone has been used safely and effectively for medication abortion for more than two decades. That safety and efficacy is backed up by robust, evidence-based, clinical data and its observed use by millions of people with support from clinicians, including obstetricians-gynecologists," the organization states on its website.

Who should not take abortion medication?

Abortion pills are not approved for use in some pregnancies. According to the FDA, people should not use abortion pills if they:

• Have an ectopic pregnancy (a pregnancy outside of the uterus).
• Have problems with the adrenal glands (the glands near the kidneys).
• Are being treated with long-term corticosteroid therapy (medications).
• Have had an allergic reaction to mifepristone, misoprostol or similar drugs.
• Have bleeding problems or are taking anticoagulant (blood-thinning) drug products.
• Have inherited porphyria (a rare disorder that can affect the liver and other organs).
• Have an intrauterine device in place. (It must be removed before taking mifepristone.)

What are the common side effects of abortion pills? How long do they usually last?

Bleeding and cramping initially are expected. If you have abdominal pain or discomfort, or you are feeling sick - including weakness, nausea, vomiting or diarrhea, with or without fever - more than 24 hours after taking misoprostol, doctors say to contact your health care provider without delay. These symptoms may be a sign of a serious infection or another problem.

In the days after treatment, if you have a fever of 100.4F or higher that lasts for more than four hours, doctors say you should contact your health care provider or visit the nearest emergency room right away. Fever may be a symptom of a serious infection or another problem.

How much bleeding is normal with abortion pills?

Contact your health care provider right away if you bleed enough to soak through two thick full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. If you can't reach your health care provider, go to the emergency room to seek care.

How effective are abortion pills?

Taken as directed, they are highly effective. In about 1 in 100 women, a procedure will be required to remove remaining tissue. That's why it's important to seek follow-up care for any of the symptoms described above.

What happens if abortion pills don't work?

Doctors say you should seek immediate medical attention if you experience any of the unusual symptoms described above. (This patient agreement form required by the FDA describes what to look for.)

While abortion medication is banned in 14 states, it is not a crime to seek medical attention because you took abortion pills. In fact, the federal government requires hospitals to treat urgent medical conditions like infection. Do not avoid seeking help from your doctor or at the emergency room if you have sustained bleeding, pain and/or fever. An infection of this kind is not likely to go away on its own and could be fatal.

Is it legal to order the abortion pills online?

Yes, in some states. In January 2023, the FDA lifted restrictions that prevented patients from obtaining medication abortion pills from a retail pharmacy and allowed them to be dispensed by mail, with certain requirements.

But patients can't legally order abortion medication in 14 states that ban abortion: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. In 15 states, there are various restrictions that make it more difficult for patients to obtain abortion medication.

Some pharmacies and organizations that provide abortion medication through the mail are not approved by the FDA. Patients should exercise caution when ordering pills from unregulated pharmacies to determine whether the medication is authentic and safe.