What is medical abortion?
Medical abortion is a way to end a pregnancy using prescription medications. It's also called nonsurgical abortion, medication abortion and the "abortion pill."
At UCSF Health, we offer medical abortions for confirmed pregnancies up to 11 weeks from the first day of the patient's last menstrual period. Although the Food and Drug Administration (FDA) has approved this method up to week 10 of pregnancy, studies show that it's safe and effective up to 11 weeks.
Pregnancies can be confirmed with a urine test (either at home or in a clinic), a blood test or an ultrasound. The duration of a pregnancy can be determined by an ultrasound or, if certain criteria are met, by the date of the last menstrual period.
How effective is medical abortion?
Medical abortion is about 95 to 98% effective, meaning the pregnancy is completely expelled without any other medical intervention. For comparison, surgical abortion is about 99% effective.
What medications are used?
At the UCSF Center for Pregnancy Options, we prescribe two medications for medical abortion: mifepristone and misoprostol. Mifepristone is taken first, followed by misoprostol.
- Mifepristone. Also known as Mifeprex or RU-486, mifepristone blocks the action of the natural hormone progesterone on the uterus. This makes the uterus sensitive to misoprostol, the second medication.
- Misoprostol. Misoprostol causes the uterus to contract and expel the pregnancy tissue.
What happens during a medical abortion?
The process has three steps:
- Initial evaluation
- Taking the medications
- Confirming the abortion was successful
Initial evaluation
Most patients will have an in-person clinic visit and an ultrasound. However, certain patients can opt to do the evaluation via telehealth (a video visit), without an ultrasound.
In-person evaluation
During this visit, you’ll have an exam and counseling. You will then be given one 200-milligram tablet of mifepristone. Most patients take the pill in the clinic, but you can wait until later if that's more convenient.
Telehealth evaluation
This option is available if you meet all of the following criteria:
- No risk factors for ectopic (tubal) pregnancy
- No symptoms of ectopic pregnancy
- Regular menstrual periods
- Known date of your last menstrual period
- No recent hormonal contraception use
During the telehealth appointment, you'll speak first with clinic staff to confirm basic information, then with the clinician. You can pick up the pills at the clinic or pay for a service that mails them to you.
Taking the medication
One or two days after taking the mifepristone, you'll take four tablets (800 micrograms) of misoprostol. You'll place the tablets either in your vagina or in your mouth, between your cheek and gums. We'll provide detailed instructions on how to do this.
If you are at or past nine weeks of pregnancy, you'll take another four misoprostol tablets three hours later.
Confirmation
We’ll use one of the following three ways to confirm that the abortion was successful:
- Ultrasound. If you had an ultrasound during your initial evaluation, you can choose the follow-up option of having an ultrasound in the clinic six to 14 days later.
- Blood test. Blood is drawn on the day you take mifepristone and again several days later to check hormone levels.
- Urine pregnancy test. We speak with you (either over the phone or in a video visit) to confirm you're having symptoms consistent with a medical abortion. If there are no concerns, you'll take a urine pregnancy test four to five weeks later.
How is medical abortion different from emergency contraception?
Medical abortion is not the same as emergency contraception, also known as the morning-after pill. Emergency contraception keeps you from getting pregnant; once you're pregnant, it no longer works. Medical abortion is used to end a pregnancy.
How are mifepristone and misoprostol used to treat a miscarriage?
Some people experiencing a miscarriage pass the pregnancy without any treatment, but commonly the pregnancy remains in the patient's body for weeks and needs to be removed by either medication or an aspiration procedure. The same medications used for medical abortion are used for miscarriage.
Is medical abortion safe?
Millions of people worldwide have used mifepristone and misoprostol or similar medications to have an abortion. All studies have found that the method is safe and effective. There have been no reports of any long-term risks.
In fact, mifepristone has been studied since the 1990s and is on the World Health Organization's essential medicines list, a catalog of drugs proven to be safe, effective and necessary to meet public health care needs.
There are no indications that medical abortion – or any abortion method used during early pregnancy – affects future fertility.
In the rare event that the medications fail and you then choose to continue the pregnancy, there is a risk of birth defects from exposure to misoprostol. Little is known about how mifepristone affects a developing embryo.
What are the side effects of medical abortion?
Short-term side effects of medical abortion include:
- Strong cramps
- Bleeding
- Nausea and vomiting
- Fever and chills
Heavy bleeding that requires blood transfusion is extremely rare, occurring in less than 0.5% of patients.
How much does a medical abortion cost?
The cost varies by clinic. Some providers charge similar rates for medical and surgical abortions.
Many insurance plans, including Medi-Cal, cover medical abortion. In California, the Abortion Accessibility Act requires insurance providers to cover abortion care (either to end a pregnancy or to treat a miscarriage) without cost-sharing, meaning without requiring co-pays or meeting deductibles.
People without insurance who don't qualify for Medi-Cal can self-pay for either medical or surgical abortion at the UCSF Center for Pregnancy Options.
