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 medicine works to end the pregnancy. After you take misoprostol (the second medicine), your body passes the pregnancy through the vagina, and that involves bleeding and cramping as your uterus contracts.

Other common side effects include:

• Nausea: affects about 60 to 70% of patients. It is usually mild and passes on its own.
• Vomiting: affects about 20 to 40% of patients. Taking misoprostol between the gums and cheeks (not swallowed) makes this less likely.
• Diarrhea: affects about 20 to 30% of patients and usually goes away within 24 hours.
• Mild fever or chills: a low fever is common and usually goes away within a few hours.
• Headache: usually mild, and over-the-counter pain medicine helps.

Most of these side effects start within 1 to 4 hours of taking misoprostol and go away within 24 hours.

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

After the heaviest phase, bleeding slows down over the next several days. Light bleeding or spotting can continue for 2 to 6 weeks. Every person is different, but the usual pattern is heavy bleeding for a few hours that then slowly tapers off.

Use thick maxi pads, not tampons, during this time, because tampons raise 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 come from your uterus contracting to pass the pregnancy. For most patients, the cramping is stronger than a typical period, especially during the first 3 to 5 hours.

Ibuprofen (600 to 800 mg every 6 to 8 hours) is the best over-the-counter medicine for the cramps. A heating pad on your lower belly or back can also help, and some patients feel better lying on their side or taking a warm shower.

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

Most patients finish the abortion pill process without complications, and serious problems happen in less than 1% of cases. Still, you should know the warning signs so you can get help fast if you need it.

Call the clinic or go to the emergency room if you have 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 in the normal range, but two or more per hour is too much.
• Fever above 100.4°F (38°C) that lasts more than 24 hours. A short low fever after taking misoprostol is normal, but a fever that lasts more than a day may be a sign of infection.
• Severe belly pain that ibuprofen does not relieve. 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 be a sign of infection.
• No bleeding at all within 24 hours of taking misoprostol. This may mean the medicine did not work as expected, so contact the clinic.

If an ultrasound did not confirm your pregnancy is in the uterus, watch for severe pain, especially on one side of the lower belly, along with shoulder pain, dizziness, or fainting. These could be signs of an ectopic pregnancy, a pregnancy growing outside the uterus. It is life-threatening and cannot be treated with the abortion pill, so go to your nearest emergency room right away if you have these symptoms.

The strongest 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 slow, and most patients feel much better by this point.
• Days 1 to 3: Moderate bleeding continues, and cramping comes and goes but is less intense. Nausea and other side effects usually go away.
• Weeks 1 to 2: Light bleeding or spotting, with an occasional mild cramp. Most patients get back to normal activities within 1 to 2 days of taking misoprostol.
• Weeks 2 to 6: Spotting may continue, and your next normal period usually returns within 4 to 8 weeks.

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

• For cramping: Take ibuprofen 600 to 800 mg every 6 to 8 hours, starting before or right when cramping begins. A heating pad on your belly or lower back helps too.
• For nausea: Eat a light meal before taking misoprostol. Ginger ale, crackers, or ginger tea may help, and small sips of water keep you hydrated.
• For bleeding: Use thick maxi pads and have several changes ready. Comfortable, dark-colored clothing is a good idea.
• For chills and fever: Use a blanket. A low fever usually passes within a few hours.
• General comfort: Rest in a comfortable place with movies, music, or a book nearby, and keep your phone close 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 point in the process. The staff can tell you what to expect and when to get help.

If you are having a medical emergency (soaking 2 or more pads per hour for 2 or more hours, a high fever that will not break, or severe pain you cannot control), go to your nearest emergency room. You can tell the ER staff you are having a miscarriage, because 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.