Abortion Pill Side Effects: What Is Normal and When to Call a Provider

Bleeding and cramping are the most common side effects. They are not complications. They are how the medication works to end the pregnancy. After you take misoprostol (the second medication), your body passes the pregnancy through the vagina, which involves bleeding and uterine contractions.

Other common side effects include:

• Nausea — affects about 60 to 70% of patients. Usually mild and temporary.
• Vomiting — affects about 20 to 40% of patients. Taking misoprostol between the gums and cheeks (not swallowed) reduces this.
• Diarrhea — affects about 20 to 30% of patients. Usually resolves within 24 hours.
• Mild fever or chills — a low-grade temperature is common and typically goes away within a few hours.
• Headache — mild and usually responds to over-the-counter pain medication.

Most of these side effects begin within 1 to 4 hours of taking misoprostol and resolve within 24 hours.

Bleeding heavier than a normal period is expected. During the heaviest phase, which typically lasts 3 to 5 hours, you may soak through one thick pad per hour. You may also pass blood clots, some of which may be as large as a lemon. This is a normal part of passing the pregnancy.

After the heaviest phase, bleeding gradually decreases over the next several days. Light bleeding or spotting can continue for 2 to 6 weeks. Every person is different, but the overall pattern is heavy bleeding for a few hours followed by a gradual tapering.

Use thick maxi pads, not tampons, during this time. Tampons increase the risk of infection during the process. You can switch to tampons after your follow-up visit if the provider confirms the abortion is complete.

Strong cramping is expected after taking misoprostol. The cramps are caused by your uterus contracting to pass the pregnancy. For most patients, the cramping is more intense than a typical menstrual period, especially during the first 3 to 5 hours.

Ibuprofen (600 to 800 mg every 6 to 8 hours) is the most effective over-the-counter option for managing the cramps. A heating pad on your lower abdomen or back can also help. Some patients find that lying on their side or taking a warm shower provides additional relief.

After the heaviest phase passes, the cramping usually decreases significantly. Mild cramps may come and go over the next 1 to 2 weeks as your uterus returns to its normal size.

Most patients complete the abortion pill process without complications. Serious complications are rare, occurring in less than 1% of cases. However, you should know the warning signs so you can get help quickly if needed.

Call the clinic or go to the emergency room if you experience any of these:

• Soaking through 2 or more thick pads per hour for 2 or more hours in a row. One pad per hour is within the normal range. Two or more pads per hour is too much.
• Fever above 100.4°F (38°C) that lasts more than 24 hours. A brief low-grade fever after taking misoprostol is normal. A fever that persists for more than a day may indicate infection.
• Severe abdominal pain not relieved by ibuprofen. Strong cramps are expected, but pain that does not respond to 800 mg of ibuprofen needs medical attention.
• Foul-smelling vaginal discharge. Some odor is normal, but a strong, unpleasant smell may indicate infection.
• No bleeding at all within 24 hours of taking misoprostol. This may mean the medication did not work as expected, and you should contact the clinic.

If your pregnancy was not confirmed to be located in the uterus by ultrasound, be aware that severe pain — especially on one side of the lower abdomen — along with shoulder pain, dizziness, or fainting could be signs of an ectopic pregnancy. An ectopic pregnancy is a life-threatening condition that cannot be treated with the abortion pill. Go to your nearest emergency room immediately if you experience these symptoms.

The most intense side effects happen in the first 3 to 5 hours after taking misoprostol. Here is a general timeline:

• Hours 1 to 4: Cramping and heavy bleeding begin. Nausea, diarrhea, chills, and mild fever are most likely during this window.
• Hours 4 to 8: Cramping and bleeding start to decrease. Most patients feel significantly better by this point.
• Days 1 to 3: Moderate bleeding continues. Cramping comes and goes but is less intense. Nausea and other side effects typically resolve.
• Weeks 1 to 2: Light bleeding or spotting. Occasional mild cramps. Most patients return to normal activities within 1 to 2 days of taking misoprostol.
• Weeks 2 to 6: Spotting may continue. Your next normal period typically returns within 4 to 8 weeks.

Most side effects can be managed at home with simple measures:

• For cramping: Take ibuprofen 600 to 800 mg every 6 to 8 hours. Start taking it before or right when cramping begins. Use a heating pad on your abdomen or lower back.
• For nausea: Eat a light meal before taking misoprostol. Ginger ale, crackers, or ginger tea may help. Take small sips of water to stay hydrated.
• For bleeding: Use thick maxi pads. Have several changes of pads ready. Wear comfortable, dark-colored clothing.
• For chills and fever: Use a blanket. A low-grade fever will typically pass within a few hours.
• General comfort: Rest in a comfortable place. Have entertainment ready (movies, music, a book). Keep your phone nearby in case you need to call the clinic.

The provider at The Center for Women will give you written instructions and a phone number to call if you have questions at any time.

Call The Center for Women at (708) 450-4545 if you have questions or concerns about your symptoms at any time during the process. The clinic provides guidance so you know what to expect and when to seek help.

If you are experiencing a medical emergency (soaking 2 or more pads per hour for 2 or more hours, high persistent fever, or severe uncontrolled pain), go to your nearest emergency room. You can tell the ER staff you are having a miscarriage. The treatment is the same.

The clinic is located at 10215 W. Roosevelt Rd. #101, Westchester, IL 60154. Same-day, evening, and weekend appointments are available for your initial visit.