How To Safely Self-Manage A Medication Abortion At Home

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Abortion Care

How to Safely Self-Manage a Medication Abortion at Home

Medically reviewed by Janet Brito, Ph.D., LCSW, CST-S — Written by Tess Catlett on May 27, 2022

Methods
Preparation
Medication chart
Day 1
Day 2
Days 3–5
Rest and recovery
Pregnancy test
Medical attention
Takeaway

two people talking on a blue sofa — Luis Velasco/Stocksy United

As access to clinical abortion becomes increasingly restricted, more people are turning to self-managed or at-home measures to end a pregnancy.

Although most home remedies aren’t considered safe or effective for terminating a pregnancy, certain prescription medications can be safely administered at home.

In fact, some research suggests that self-managed medication abortion may be as safe and effective as medication abortion performed in a clinical setting.

Self-managed medication abortion refers to a person obtaining and administering “the abortion pill” without the real-time supervision or guidance of a healthcare professional or other clinician.

If you’re not sure how or where to get abortion pills, the advocacy organization Plan C has you covered.
There are legal risks to self-managed at-home medication abortion. Some states restrict access to telehealth abortion or receiving abortion pills by mail.
This means discretion and privacy are absolutely paramount.
If at all possible, tell as few people as you deem necessary about your pregnancy and your decision to terminate the pregnancy.
Clear any internet search, private message, or phone call history that might connect this to you.
Trying to make sense of the limitations in your state? Our state-by-state guide to abortion restrictions can help.

Medication abortion methods

Preliminary data from the Guttmacher Institute suggests that as of 2020, medication abortion accounts for more than half of all abortions in the United States.

The most common form of medication abortion involves taking a combination of mifepristone (Mifeprex) and misoprostol (Cytotec). They work together to cause the pregnancy to pass from your uterus like a heavy period or miscarriage.

Medication abortion using mifepristone and misoprostol is common in the first and second trimesters.If mifepristone is unavailable, taking misoprostol alone is also an option. Misoprostol-only medication abortion is common in the second trimester.With either method, you’ll experience cramping and bleeding. You may also experience strong pain, chills, nausea, or diarrhea. This is to be expected and typically isn’t a cause for concern.

Which method you use and what dosage you need both depend on how far along the pregnancy is.You can determine how far along the pregnancy is by identifying the first day of your last menstrual period — or, if your period is irregular, a rough approximation of when a period would occur — and counting the number of days until the present day.Although mifepristone must be administered orally (swallowed), misoprostol can be administered buccally (inside the cheek), sublingually (under the tongue), or vaginally. This article focuses on oral, buccal, and sublingual administration.

How to prepare for an at-home medication abortion

Technically, the only thing you need to have a medication abortion is the medication. But there are several things that can be helpful to have on hand.

For example, keeping a phone, phone charger, and emergency contact information nearby can help provide peace of mind and ensure that help is only a phone call away should you need it.

Consider writing down the name, address, and phone number for:

a trusted friend or family member
a local cab or taxi company
a local urgent care center
the closest 24-hour emergency room

Although it’s perfectly natural to free bleed during this process, doing so can be messy.

You may find it helpful to stock up on menstrual pads or disposable period underwear designed for use with heavy periods. This can help reduce or eliminate time spent changing or washing clothes and linens.

The following over-the-counter (OTC) medications can help ease any side effects:

acetaminophen (Tylenol) or ibuprofen (Advil) to relieve pain or reduce fever
dimenhydrinate (Dramamine) or sodium citrate dihydrate (Nauzene) to treat nausea
loperamide (Imodium) to treat diarrhea
doxylamine succinate (Unisom) or melatonin to aid in sleep

A stick-on heat therapy patch, heating pad, or hot water bottle can also help soothe cramps. A thermometer can help monitor your temperature and check for fever.

Avoid taking the OTC pain reliever aspirin, or medications that contain aspirin, because it can increase bleeding.

A quick look at common abortion medication protocols

Stage of pregnancy and medication	Day 1	Day 2
Less than 12 weeks pregnant, using mifepristone and misoprostol	Take 200 mg (one tablet) of mifepristone by mouth.	About 24 hours after taking mifepristone, take 800 mcg (four 200-mcg tablets) of misoprostol by inserting two tablets into each cheek pouch (the space between teeth and cheek) or by placing all four tablets under the tongue.
12+ weeks pregnant, using mifepristone and misoprostol	Take 200 mg (one tablet) of mifepristone by mouth	About 24 hours after taking mifepristone, take 400 mcg (two 200-mcg tablets) of misoprostol by inserting one tablet into each cheek pouch (the space between teeth and cheek) or by placing both tablets under the tongue.After 3 hours, take an additional 400 mcg (two 200-mcg tablets) of misoprostol. Repeat the same misoprostol dose again 3 hours later if you have not yet developed any cramping or bleeding.
Less than 12 weeks pregnant, using misoprostol alone	Take 800 mcg (four 200-mcg tablets) of misoprostol by inserting two tablets into each cheek pouch (the space between teeth and cheek) or by placing all four tablets under the tongue.	N/A
12+ weeks pregnant, using misoprostol alone	Take 400 mcg (two 200-mcg tablets) of misoprostol by inserting one tablet into each cheek pouch (the space between teeth and cheek) or by placing both tablets under the tongue.After 3 hours, take an additional 400 mcg (two 200-mcg tablets) of misoprostol. Repeat the same misoprostol dose again 3 hours later if you have not yet developed any cramping or bleeding.	N/A

What to expect during day 1 of a medication abortion

Choose a time — preferably in the morning — when you can rest for a while after taking the medication. The abortion starts when you take the first pill.

Just before or shortly after taking the first medication, put a heavy-duty pad in your underwear. Wear and replace as needed.

Keep acetaminophen or ibuprofen on hand and take the recommended dose on the bottle at the first sign of pain or discomfort. Continue to drink water throughout the day.

If you’re using a combination of mifepristone and misoprostol to complete a medication abortion

Take 200 milligrams (mg) — which is one tablet — of mifepristone by mouth on the first day.

Bleeding and other side effects may not occur for about 24 hours after taking mifepristone.

If you’re using misoprostol alone to complete a medication abortion

If you’re less than 12 weeks pregnant, take 800 micrograms (mcg) — which is four 200-mcg tablets — of misoprostol by inserting two tablets into each cheek pouch (the space between teeth and cheek) or by placing all four tablets under your tongue.

Hold the misoprostol tablets in each cheek pouch or under your tongue for 30 minutes, then wash down anything that’s left with a glass of water. Continue to drink water throughout the day.

If you’re 12 or more weeks pregnant, take 400 mcg (two 200-mcg tablets) of misoprostol by inserting one tablet into each cheek pouch (the space between teeth and cheek) or by placing both tablets under your tongue.

After 3 hours, take an additional 400 mcg (two 200-mcg tablets) of misoprostol. Repeat the same misoprostol dose again 3 hours later if you have not yet developed any cramping or bleeding.

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Illustrations by Maya Chastain

What to expect during day 2 of a medication abortion

Eat a light meal and take the recommended dose of acetaminophen or ibuprofen. Wait at least 30 minutes before moving on to the next step.

If you’re using a combination of mifepristone and misoprostol to complete a medication abortion

About 24 hours after taking mifepristone — if you’re less than 12 weeks pregnant — take 800 mcg (four 200-mcg tablets) of misoprostol by inserting two tablets into each cheek pouch (the space between teeth and cheek) or by placing all four tablets under your tongue.

Hold the misoprostol tablets in each cheek pouch or under your tongue for 30 minutes, then wash down anything that’s left with a glass of water. Continue to drink water throughout the day.

About 24 hours after taking mifepristone — if you’re 12 or more weeks pregnant — take 400 mcg (two 200-mcg tablets) of misoprostol by inserting one tablet into each cheek pouch (the space between teeth and cheek) or by placing both tablets under the tongue.

After 3 hours, take an additional 400 mcg (two 200-mcg tablets) of misoprostol. Repeat the same misoprostol dose again 3 hours later if you have not yet developed any cramping or bleeding.

Side effects usually start within 30 minutes to 10 hours after taking the misoprostol pills. After taking both medications, it usually takes about 2 to 24 hours for the pregnancy to be removed from the body.

If you’re using a combination of mifepristone and misoprostol or misoprostol alone to complete a medication abortion

You should expect to experience cramping. This is because the medication causes strong uterine contractions to help your body pass the pregnancy.

Take 600 mg of acetaminophen or ibuprofen as soon as you begin to feel cramps. Repeat this dose every 6 to 8 hours alongside a light meal until the pregnancy passes and discomfort subsides.

Resting and using a heating pad or hot water bottle may also help.

You should also expect vaginal bleeding — sometimes heavier than your usual period — as the pregnancy leaves your body. It may also contain clots and tissue. Continue using pads for a few more days to help keep track of your bleeding.

These side effects together usually mean the medication is working.

During the first 24 hours after taking misoprostol, it is typical to experience:

nausea
overall weakness
fever
chills
vomiting
headache
diarrhea
dizziness

How to determine if the pregnancy has passed

The sooner a medication abortion is performed, the more likely it is that the embryo (gray or white tissue) will pass unnoticed within a blood clot. Cramping and bleeding will slow after it comes out.

Embryos are less than 1 inch in size until about 9 weeks after the first day of your last menstrual period. At 10 weeks, the cells, now called a fetus, are about 1.5 inches in size and may have recognizable details.

Depending on your comfort level, it may be helpful to enlist someone you trust to look at any clots that pass to determine if the pregnancy has been terminated.

What to expect during days 3–5 of a medication abortion

You may experience a “second wave” of heavy bleeding a few days after passing the pregnancy. Cramping may increase, along with bleeding and clotting, particularly around the 4th to 5th day.

Depending on how you’re feeling, having someone rub your back, sitting on the toilet, or taking a shower may help ease any discomfort.

If you’re experiencing heavy bleeding, gently massage the abdominal, uterine, and pelvic areas for about 10 minutes. You can take acetaminophen or ibuprofen, apply a heating pad, and decrease all other physical activity, too.

If you’re feeling feverish, take your temperature twice daily for 48 hours. It becomes a medical emergency if your temperature reaches 101.4°F (38.6°C) or higher for more than 12 hours in a row.

During this time, you may:

see large blood clots up to the size of a lemon
feel sick to your stomach
have diarrhea
have a mild fever or chills for a little while
have strong cramps
leak a milky nipple discharge (wearing a snug-fitting bra or compression top may help)

Rest and recovery after a medication abortion

Give yourself the grace to process any emotions that may come forth.

Feelings of relief, sadness, joy, or depression are common and may be strong due to the hormonal changes that occur after an abortion. Some people find these feelings don’t last very long.

Cramping will decrease as the hours and days go by.

It’s common to pass clots, especially when getting out of bed, during the first 1 to 2 weeks after a medication abortion.

You may find it helpful to wear menstrual pads or period underwear during this time. This can make it easier to tell how much you’re bleeding.

You can switch to tampons or other period products after the heavy bleeding lets up. Spotting or other light bleeding may last up to 4 weeks or more.

Breast or chest tenderness and swelling may also last up to 2 weeks.

Avoid the following for at least 1 week after a medication abortion:

strenuous physical activity, which can increase cramping and bleeding
penetrative vaginal sexual activity, including fingering and penis-in-vagina sex, which can introduce bacteria to the vulva and vagina
tampons, menstrual cups, or other internal period products, which can make it difficult to monitor bleeding and clots
bath bombs, body wash, or other “feminine” hygiene products that contain fragrance or other ingredients that can irritate the vulva and vagina
nipple stimulation (if you’re experiencing nipple discharge)

Your first period should begin 4 to 8 weeks after the abortion.

How to confirm a medication abortion worked

A false-positive pregnancy test result can happen up to 4 weeks after having a medication abortion.

This is because your hormone levels are still reflecting your previous pregnancy, and it takes a little time for them to go back to their typical levels.

We recommend taking a pregnancy test about 2 weeks after taking all medications or passing the pregnancy. Take note of the date and the result received, then take another pregnancy test the following week.

If the results of the first and second tests are negative, the abortion likely worked as intended.

If the results of the first and second tests are different (i.e., one is positive and one is negative), you may need to take a third test the following week or consult with a doctor or other healthcare professional.

If the results of the first and second tests are positive, a surgical abortion may be needed to help terminate the pregnancy.

When to seek medical attention

Talk with a doctor or other healthcare professional before attempting an at-home medication abortion if you:

are more than 12 weeks pregnant
have symptoms of an ectopic pregnancy
have an IUD
have a blood clotting disorder or severe anemia
have chronic adrenal failure
take steroid medications
are allergic to mifepristone or misoprostol

You may be able to consult with a clinician online or over the phone if you have questions about your eligibility or potential side effects.

A prescribing pharmacy or other healthcare platform may also be able to answer any questions via online chat or email before dispensing the medication.

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If you’ve taken medication to induce an abortion, seek emergency medical attention if you:

don’t experience spotting or bleeding within 24 hours of taking misoprostol
vomit within 2 hours after taking misoprostol and are unable to take another dose
vomit for more than 4 to 6 hours in a row
have a fever of 100.4°F (38°C) or higher for more than 12 hours in a row
pass blood clots for more than 2 hours in a row, or pass blood clots that are larger than a lemon
bleed through two full-size pads every hour for more than 2 consecutive hours, or otherwise bleed heavily for more than 12 hours in a row
develop sudden, severe stomach or shoulder pain alongside overall weakness and fainting
experience bleeding heavier than your usual period for 2 weeks or more
experience symptoms of pregnancy for 2 weeks or more

If possible, take note of the following information and have it ready when seeking medical care:

how many pads you’ve used in the past 1 to 2 hours
your temperature over the past 1 to 2 hours
the name and phone number of an open drugstore you can get to

It’s important to be aware of any laws or restrictions in your state. You might consider describing your symptoms as heavy menstrual bleeding or a possible miscarriage, for example. Complications of a natural miscarriage and a medication abortion are typically treated in the same way. Because of this, there’s no medical reason to tell a doctor or other healthcare professional about a medication abortion.
A healthcare professional is unable to distinguish between the effects of a medication abortion and a miscarriage. There’s no test that can detect misoprostol or determine whether a medication abortion was performed.

The bottom line

Take a deep breath. Whether you’re reading this to help yourself, a friend, a family member, or another loved one through this process, know that you’re not alone.

These resources can offer support before, during, and after an abortion:

Abortion Finder
All-Options
Exhale
National Abortion Federation
National Network of Abortion Funds
Planned Parenthood

Tess Catlett is a sex and relationships editor at Healthline, covering all things sticky, scary, and sweet. Find her unpacking her inherited trauma and crying over Harry Styles on Twitter.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Abortion. (2021).https://www.who.int/news-room/fact-sheets/detail/abortion
Abubeker FA, et al. (2020). Medical termination for pregnancy in early first trimester (≤ 63 days) using combination of mifepristone and misoprostol or misoprostol alone: A systematic review.https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01003-8
Aiken ARA, et al. (2022). Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study.https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00017-5/fulltext
Goh SE, et al. (2006). Induction of second trimester abortion (12-20 weeks) with mifepristone and misoprostol: A review of 386 consecutive cases.https://pubmed.ncbi.nlm.nih.gov/16627037/
How safe is the abortion pill? (n.d.).https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-safe-is-the-abortion-pill
How to have a safe self-managed abortion. (2021).https://www.doctorswithoutborders.org/latest/how-have-safe-self-managed-abortion
If you are pregnant: Information on fetal development, abortion and alternatives. (2019).https://www.health.state.mn.us/docs/people/wrtk/handbook_eng.pdf
Increasing access to abortion. (2020).https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/increasing-access-to-abortion
Induced abortion in the United States [Fact sheet]. (2019).https://www.guttmacher.org/fact-sheet/induced-abortion-united-states
Jones RK, et al. (2017). Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014.https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304042
Jones RK, et al. (2022). Medication abortion now accounts for more than half of all US abortions.https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions
Lin C-J, et al. (2011). The use of misoprostol in termination of second-trimester pregnancy.https://www.sciencedirect.com/science/article/pii/S1028455911001240
Medical management of abortion. (2018).https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf
Medication guide. (2016).https://www.fda.gov/media/72923/download
Moseson H, et al. (2022). Effectiveness of self-managed medication abortion with accompaniment support in Argentina and Nigeria (SAFE): A prospective, observational cohort study and non-inferiority analysis with historical controls.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00461-7/fulltext
Naghshineh E, et al. (2015). The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621653/

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Medically reviewed by Janet Brito, Ph.D., LCSW, CST-S — Written by Tess Catlett on May 27, 2022

How To Safely Self-Manage A Medication Abortion At Home

Abortion Care

Medication abortion methods

How to prepare for an at-home medication abortion

A quick look at common abortion medication protocols

What to expect during day 1 of a medication abortion

If you’re using a combination of mifepristone and misoprostol to complete a medication abortion

If you’re using misoprostol alone to complete a medication abortion

What to expect during day 2 of a medication abortion

If you’re using a combination of mifepristone and misoprostol to complete a medication abortion

If you’re using a combination of mifepristone and misoprostol or misoprostol alone to complete a medication abortion

How to determine if the pregnancy has passed

What to expect during days 3–5 of a medication abortion

Rest and recovery after a medication abortion

How to confirm a medication abortion worked

When to seek medical attention

The bottom line

How we reviewed this article:

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