Abortion Pills (Medication Abortion): your guide and what to expect

Abortion pills have been FDA-approved for more than 25 years and are about 98% effective, yet there’s still a lot of misinformation and confusion circulating about how they work. It’s completely normal to have questions.

That’s why carafem is here: to offer clear expectations, grounded information, and support at every step.

Curious what actually happens during medication abortion? Or how will you know when the process is complete? Below are the questions we hear most often and exactly what you can expect if you—or someone you care about—chooses this method.

1. How do abortion pills work?

When people say “the abortion pill,” they’re actually talking about medication abortion, a two-step process using mifepristone and misoprostol. It’s now the most common abortion method in the U.S.—about 63% of all abortions—which means this pathway is incredibly normal, safe, and widely used.

The first medication, mifepristone, blocks the hormone progesterone, which a pregnancy needs to continue developing. Most people don’t feel much after this step, though a small number may have very light spotting.

Within 24–72 hours, you take the second medication, misoprostol. Misoprostol causes cramping and bleeding so the pregnancy can pass from the uterus—similar to an early miscarriage. Most people begin to feel cramping and see bleeding within an hour or two, though some take longer, and that’s still normal.

Along with the bleeding and cramping, it’s common to have chills, nausea, diarrhea, or a brief “flu-like” feeling. Many describe the experience as a very heavy, crampy period with some short-lived side effects mixed in.

carafem recommends preparing ahead of time so you can be as comfortable as possible. Thick overnight maxi pads are helpful for the heavier bleeding, and a heating pad or hot water bottle can ease cramping. Your clinician will also provide pain medication and anti-nausea medication so you can better manage symptoms.

For most people, the most intense part—heavier bleeding and stronger cramping—lasts about three to four hours and then eases once the pregnancy has passed. After that, lighter bleeding or spotting can continue off and on until your next period, which typically returns within about four to six weeks.

Medication abortion is a process, but it’s a predictable one. And you’re not expected to figure it out alone—carafem will guide you through every step.

2. What is recovery like after a medication abortion?

People recover differently after a medication abortion, but most feel well enough to ease back into their routine within a day or two. It’s common to feel tired, crampy, or just generally run-down for the first day, and you’ll likely continue to have bleeding or spotting for a while. Lighter bleeding can come and go until your next period—usually in about four to six weeks.

Most people can return to work, school, driving, and everyday activities the next day if they feel up to it. Avoid heavy lifting or intense exercise for a few days and focus on rest, hydration, and nutritious food until your energy levels feel normal again. One reassuring sign: early pregnancy symptoms like nausea, breast tenderness, or fatigue often improve quickly—sometimes within 48 hours.

3. How do I know if the medication abortion worked?

Medication abortion is a process, not a single moment, and everyone’s body moves through it at its own pace. Cramping, bleeding, and passing clots are all strong signs that the medications are working exactly as they should. Cramping, in particular, is actually a reassuring sign—it means the uterus is contracting and emptying the way it’s supposed to.

Bleeding and clotting can continue for one to three weeks, sometimes longer, and that’s completely normal. Another good indicator is that early pregnancy symptoms—like nausea or breast tenderness—start to fade.

carafem does recommend taking a follow-up home pregnancy test, but timing matters. Because pregnancy hormones take a while to leave your system, urine tests can stay positive for 4–5 weeks, even after a complete abortion. For the most accurate result, wait at least that long before testing.

If anything feels unclear or you’re not sure whether what you’re experiencing is normal, you’re never expected to figure it out alone. You can contact your carafem care team anytime — or connect with Cara, our private, 24/7 text-based abortion care companion, for real-time guidance and reassurance.

4. How does medication abortion affect my body?

There’s a lot of misinformation out there, so let’s clear this up: medication abortion does not cause long-term effects on your body. It doesn’t harm your fertility, increase your risk of breast cancer, or cause problems in future pregnancies. These are common myths, not medical reality.

Most people feel physically okay shortly after the process. Some return to their usual routines right away, while others prefer a bit more time to rest—both are completely normal. Light bleeding or spotting can continue for a couple of weeks, and you may want to hold off on heavy exercise or strenuous activity until the bleeding slows down. Staying hydrated and eating nourishing food can help you feel better as your body settles back into its rhythm.

Overall, the best guide is your own body. Take it easy when you need to, move back into daily life when you feel ready, and know that medication abortion is a safe, well-studied option with no lasting impact on your health.

5. Are there any abortion pill side effects?

Bleeding and cramping are normal abortion pill side effects of mifepristone and misoprostol, and they’re also a sign that the medications are working the way they should. On the day you take your second medication, it can help to give yourself some space—many people choose to take time off work or school so they can settle in somewhere comfortable and focus on taking care of themselves.

Because misoprostol can cause heavy bleeding and sometimes diarrhea, being close to a private bathroom often feels easier. Some people choose to take the second dose in the evening or once the house is quiet, so they can move through the more intense part of the process with privacy and as much calm as possible.

It’s completely normal to pass blood clots, usually smaller than a lemon. You may also notice some side effects, such as nausea, chills, diarrhea, a slight increase in temperature, or feeling a bit dizzy. None of these means anything is wrong; they’re a part of how the medications work.

carafem will include 800mg ibuprofen and anti-nausea medication (odansetron) in your comfort kit to help ease the physical symptoms, but it’s also important to acknowledge that this part can be tough. The good news is that there are ways to make it more manageable—from medication support to a heating pad to creating a calm, comfortable space—and your care team is here to support you through every step.

6. How does medication abortion feel physically and mentally?

One of the biggest questions people have is whether a medication abortion hurts—and the most honest answer is that it varies. Just like periods feel different for everyone, medication abortion does too. For some, it’s painful; for others, it’s uncomfortable but manageable. Most people describe it as intense for a few hours but very doable with preparation, support, and the right medications.

Physically, medication abortion often feels similar to an early miscarriage or a heavy period with mild flu-like symptoms. You may have cramping or belly aches, heavy bleeding with clots, nausea or vomiting, diarrhea, dizziness, fatigue, or chills, and a mild fever (99–100°F) on the day you take misoprostol.

These symptoms usually peak over a short window and then ease once the pregnancy has passed. carafem will provide pain and anti-nausea medication to help you stay as comfortable as possible.

When to contact carafem?

Most people move through medication abortion safely at home, but there are certain times when it’s important to check in.

• No bleeding within 24 hours after taking misoprostol
• Very heavy bleeding, such as soaking through two pads an hour for two hours in a row
• Flu-like symptoms that are getting worse, not better, after 24 hours
• Something just feels off, or you’re unsure what your symptoms mean

Some people simply need an extra dose of misoprostol—your clinician will guide you if that’s the case. carafem is here 24/7 to help you feel safe and supported through every step.

Taking care of your mental health

Medication abortion isn’t just a physical process—it can bring up emotions, too. Many people feel relieved. Others feel sadness, uncertainty, or a mix of several feelings at once. All of these responses are valid, and there is no “right” way to feel afterward.

If your emotions start to make daily life difficult, or you just want space to talk things through, it’s completely okay to reach out for help. Confidential, judgment-free support is available through organizations like Exhale, All-Options, and Connect & Breathe, where trained volunteers will talk or text with you about whatever you’re feeling.

You deserve care—physical and emotional—and you don’t have to navigate any part of this experience alone.

7. How do I access medication abortion care?

If you’re exploring your options, carafem offers two safe, modern, confidential ways to get medication abortion — so you can choose the approach that fits your life.

For abortion pills by mail or virtual care:

You can learn more about getting a medication abortion, abortion pills online, via our Immediate Evaluation.

For in-clinic care:

If you prefer to take the first medication in person or want support from a clinician on-site, you can find information about an abortion clinic near you in your local area.

Both options are medically sound, private, and supported by carafem’s expert care team — so you can choose the path that feels right for you.