Medical Abortion Care

Overview

A medical abortion is the use of medicines to end a pregnancy. Usually two medicines are used. You take one medicine. Within 2 days after the first medicine, you take the second medicine. The timing depends on how the doctor tells you to use them.

What is a self-managed medical abortion?

In a self-managed medical abortion, you get and use abortion pills without working with a doctor. They are usually the same medicines used in a medical abortion done under a doctor's care.

People choose to self-manage a medical abortion for many reasons. Usually it's because they couldn't access abortion care through a doctor. This can happen if you can't get an abortion where you live. Or maybe telehealth abortion visits aren't available where you live. Or maybe you weren't able to get permission from your guardian.

People who have a self-managed medical abortion often wonder what to expect, what to watch out for, and how to know it worked. So if you learn about medical abortions, you will know how to take care of yourself. Be sure to call your doctor or get care if you're having problems after a self-managed abortion.

After a medical abortion, you may have:

• Bleeding and cramping that start within a few hours after you take the second medicine.
  • Cramps may be intense. You can take ibuprofen (such as Advil or Motrin) to help with pain. Do not take aspirin unless your doctor prescribed it.
  • Bleeding may be heavier than a regular period and may include some clots until the pregnancy has passed. The heaviest bleeding should stop 1 to 2 hours after you pass the pregnancy tissue.
• Bleeding or spotting for up to 2 weeks.
• Cramping for up to a few weeks.

Caring for yourself at home

Carefully follow all of your doctor's instructions after you've had an abortion.

If you didn't get instructions, follow this general advice.

• Do not rinse your vagina with fluids (douche).

  This could increase your risk of infections that can lead to pelvic inflammatory disease.

• Take any medicines your doctor has prescribed.

  Take them exactly as instructed.

• Ask your doctor when you can return to normal activities or strenuous exercise.

  Most people can return to normal activities 1 to 2 days after an abortion.

• Ask your doctor when it's okay to have vaginal sex.

  You can get pregnant in the weeks after an abortion. If you don't want to get pregnant, talk to your doctor about birth control options.

When should you call a doctor?

Your doctor will give you information about what to expect after an abortion. Normal symptoms that most often occur include:

• Irregular bleeding or spotting for as long as the first few weeks.
• Cramping for up to a few weeks.
• Nausea and vomiting for 4 to 6 hours after using abortion pills.
• Fever for up to 4 hours after using abortion pills.

Follow your doctor's instructions on what to do at home.

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have severe vaginal bleeding along with light-headedness or nausea.
• You have chest pain, are short of breath, or cough up blood.
• You feel you cannot stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Go to the Talk Suicide Canada website at https://talksuicide.ca for more information.

Consider saving these numbers in your phone.

Call your doctor now if you have any of these symptoms after an abortion:

• Severe bleeding. Any abortion usually causes bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the belly that isn't relieved by pain medicine, rest, or heat
• Hot flushes or a fever that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden belly swelling or fast heart rate
• Vaginal discharge that has increased in amount or smells bad

Call your doctor for an appointment if you have any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• No menstrual period within 6 weeks after the procedure
• Still feeling pregnant or having pregnancy symptoms
• Signs of depression. Hormonal changes after a pregnancy can cause depression that requires treatment.
• You are not getting better as expected.

Medical abortion is safe and rarely causes any problems. Possible problems include:

• Failure to end the pregnancy.
• Tissue remaining in the uterus.
• Moderate to severe bleeding.
• Infection.

Follow-up exam

You will take a pregnancy test at home or have an ultrasound or a lab test to make sure the abortion worked. You will be told when to do this.

If you got and used abortion pills without working with a doctor (self-managed abortion), you should take a pregnancy test about a month after the abortion to make sure it worked.