How to Manage Pain, Nausea, and Bleeding After a Medical Abortion

After taking mifepristone and misoprostol for a medical abortion, it is common to experience cramping, vaginal bleeding, nausea, diarrhea, chills, or fatigue. These effects can occur as the medicines work and the uterus empties.

Knowing what to expect can make the process easier to manage. It is equally important to know which symptoms are expected and which may require medical attention.

Important: This information is for general education and does not replace instructions from your healthcare professional. If you are concerned about your symptoms or recovery, contact the healthcare professional who provided your care. If you have an emergency or cannot reach your healthcare professional, seek urgent medical attention.

Pain and Cramping: What to Expect

Cramping usually begins or becomes stronger after taking misoprostol because the medicine causes the uterus to contract. For some people, cramps can be stronger than those experienced during a typical menstrual period.

Pain varies from person to person. It is often strongest while the pregnancy is passing and generally becomes less intense afterward.

What cramping may feel like

You may experience:

• Mild to strong cramps in the lower abdomen
• Cramping that comes and goes
• Stronger cramps while the pregnancy is passing
• Milder cramps after the heaviest part of the process

How to manage cramps

The World Health Organization recommends routinely offering pain medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), for medical abortion. Ibuprofen is an NSAID commonly used to manage abortion-related pain. If ibuprofen is appropriate for you, follow the instructions provided by your healthcare professional or on the product label. Do not take more than the recommended amount.

Other measures that may help include:

• Using a heating pad or hot-water bottle on your lower abdomen
• Resting in a comfortable position
• Drinking fluids regularly
• Having someone you trust available for support if you want it

If pain is severe, does not improve with medication, or becomes worse instead of better, contact your healthcare professional.

Nausea, Vomiting, Diarrhea, Chills, and Other Side Effects

Misoprostol can cause temporary side effects such as:

• Nausea
• Vomiting
• Diarrhea
• Chills or feeling feverish
• Headache
• Fatigue

These effects generally improve as the effects of misoprostol wear off.

What may help

You can try:

• Taking small, frequent sips of water or another suitable fluid
• Eating light foods if you feel able to eat
• Resting in a comfortable environment
• Dressing in layers if you experience chills

If you have medication for nausea, use it only as directed by your healthcare professional or according to the medication's instructions.

Contact your healthcare professional if vomiting or diarrhea is severe, prevents you from keeping fluids down, or occurs together with significant weakness, severe pain, or other concerning symptoms.

Bleeding After a Medical Abortion

Vaginal bleeding is an expected part of a medical abortion. Bleeding may be heavier than your usual menstrual period, particularly after misoprostol. You may also pass blood clots or pregnancy tissue.

The amount and duration of bleeding vary from person to person. After the heavier bleeding subsides, lighter bleeding or spotting may continue.

Does bleeding mean the abortion worked?

Not necessarily.

Bleeding and cramping are expected effects of a medical abortion, but they do not by themselves confirm that the abortion was complete. The amount of bleeding can vary considerably, and symptoms alone cannot reliably determine whether the pregnancy has ended.

Follow the follow-up instructions provided by your healthcare professional. If pregnancy symptoms continue or you are concerned that the abortion may not have been complete, contact your healthcare professional.

What about blood clots and pregnancy tissue?

Blood clots can occur during the heavier part of the abortion. You may also see tissue mixed with blood.

The appearance of blood clots or tissue does not by itself confirm that the abortion is complete. Follow your healthcare professional's instructions for confirming that the pregnancy has ended.

When Is Bleeding Too Heavy?

Heavy bleeding can rarely become a serious complication.

The FDA advises contacting a healthcare professional immediately if you soak through two thick, full-size sanitary pads per hour for two consecutive hours.

Seek urgent medical attention if you have heavy bleeding, particularly if you also feel faint, very weak, dizzy, or short of breath.

If you are unsure whether your bleeding is excessive, contact your healthcare professional rather than waiting for it to become worse.

When Should You Seek Medical Attention?

Most people do not experience serious complications, but it is important to recognize warning signs.

Contact your healthcare professional promptly if you have:

• Heavy bleeding, including soaking two thick, full-size sanitary pads per hour for two consecutive hours
• Severe or persistent abdominal or pelvic pain
• A fever of 100.4°F (38°C) or higher that lasts for more than four hours
• Abdominal pain, weakness, nausea, vomiting, or diarrhea occurring more than 24 hours after taking misoprostol, particularly if you feel increasingly unwell
• No bleeding after taking misoprostol, particularly if you continue to have pregnancy symptoms or are concerned that the abortion has not occurred
• Symptoms suggesting that the pregnancy may still be continuing
• Any symptoms that concern you or feel significantly different from what you were told to expect

The FDA identifies prolonged heavy bleeding, persistent fever, and abdominal pain or feeling sick after misoprostol as reasons to contact a healthcare professional promptly.

If you cannot reach your healthcare professional and you are experiencing a medical emergency, go to the nearest emergency department or call emergency services.

Can an Ectopic Pregnancy Cause Problems After Taking Abortion Pills?

Medication abortion with mifepristone and misoprostol does not treat an ectopic pregnancy, which occurs when a pregnancy develops outside the uterus.

The FDA-approved mifepristone regimen is indicated for an intrauterine pregnancy through 10 weeks (70 days) of gestation. Mifepristone with misoprostol is contraindicated when an ectopic pregnancy is known or suspected.

Severe or persistent abdominal pain requires medical evaluation. Seek emergency medical attention if you develop severe pain, feel faint or extremely weak, or have other symptoms that could indicate a serious complication.

Your healthcare professional should determine whether medication abortion is appropriate for you and whether additional evaluation is needed.

What Can You Do During Recovery?

Simple measures can make the recovery period more comfortable:

• Keep sanitary pads available so you can monitor bleeding.
• Rest when you feel tired.
• Drink fluids regularly.
• Eat when you feel able to eat.
• Use a heating pad for abdominal cramps.
• Keep your healthcare professional's contact information available.
• Follow all medication and follow-up instructions you were given.

You can generally return to your usual activities as you feel able, unless your healthcare professional has given you different instructions.

How Long Do Pain and Bleeding Last?

There is no single timeline that applies to everyone.

Cramping is generally strongest around the time the pregnancy is passing and usually becomes less intense afterward. Bleeding may be heavier initially and then gradually become lighter.

Lighter bleeding or spotting can continue after the heavier bleeding has stopped.

Nausea, chills, diarrhea, and other temporary effects associated with misoprostol generally improve as the medicine's effects wear off.

If your symptoms are getting worse instead of improving, or you develop new symptoms that concern you, contact your healthcare professional.

Do You Need Follow-Up After a Medical Abortion?

Follow-up needs can vary depending on your circumstances and the care instructions provided by your healthcare professional.

For the FDA-approved mifepristone regimen, FDA patient information describes follow-up with a healthcare provider approximately 7 to 14 days after taking mifepristone.

WHO's current guidance states that there is no medical need for a routine follow-up visit after an uncomplicated medical abortion when the person has appropriate information and access to additional care if needed. WHO also recommends providing information about symptoms of ongoing pregnancy and reasons to seek additional care, including prolonged heavy bleeding, no bleeding with medical management, pain not relieved by medication, or fever.

Follow the specific follow-up instructions given to you. If you are unsure whether the abortion was successful or whether additional testing is needed, contact your healthcare professional.

Key Takeaways

• Cramping and bleeding are expected during a medical abortion.
• NSAIDs such as ibuprofen can help manage pain when appropriate. Follow your healthcare professional's or the product label's dosing instructions.
• Nausea, vomiting, diarrhea, chills, and fatigue can occur, particularly after misoprostol.
• Bleeding does not by itself confirm that the abortion was successful.
• Soaking two thick, full-size sanitary pads per hour for two consecutive hours requires prompt medical attention.
• A fever of 100.4°F (38°C) or higher lasting more than four hours requires prompt medical attention.
• Severe or persistent abdominal pain should be evaluated.
• Mifepristone and misoprostol do not treat ectopic pregnancy.
• If you are worried about your symptoms, contact your healthcare professional rather than trying to determine on your own whether they are normal.

About Pill Access

Pill Access facilitates access to abortion care and connects patients with licensed healthcare professionals. Licensed healthcare professionals independently review health information and make clinical decisions about whether medication abortion is appropriate.

Pill Access does not independently diagnose, determine medical eligibility, prescribe medication, or provide clinical treatment.

If you have already taken abortion medication, follow the instructions provided by your healthcare professional and seek medical attention if you develop warning signs or are concerned about your symptoms.