This guide was compiled in 2024 after reviewing multiple trusted sources. It was created by experienced abortion doulas and licensed healthcare providers. This guide is only intended for self-managed abortions that occur before 12 weeks gestation.
Self-managed abortion is an abortion with pills without a prescription, with or without the involvement of a healthcare provider. Research shows that people can safely and effectively self-manage an abortion with pills when they have accurate information about the dosing regimen and when to seek treatment for complications. Research also shows that abortion is safe without an ultrasound to confirm how far along the pregnancy is.
In other parts of the world, abortion medications are sold over the counter. Your medications will be coming from one of these countries. These medications typically come in a kit that contains one mifepristone pill and four misoprostol pills, though they may also be in separate packages. Depending on how far along your pregnancy is, you may also require more misoprostol than what is in one kit (see instructions for dosing guidelines). If you are purchasing these medicines on your own, many sellers have an option to purchase extra misoprostol if you need it.
The combo kits sometimes have peculiar names like “Anti-Preg Kit,” “The Unwanted Kit”, or “DivaAbort.” Despite their names sounding a little funny, research proved that these are legitimate medications nearly all of the time. The boxes may be squished due to the shipping methods, but this should not harm the medications themselves. When you receive the medications, check to see that…
- The blister pack is intact. If the blister pack is not intact, contact us immediately. An open blister pack can make the medications less effective.
- The medications are within their expiration date, which should be printed on the blister pack.
If you’re ordering the pills for yourself, please read this guide on how to buy abortion pills that are safe and effective.
What does the process of purchasing pills look like?
Abortion pills are typically sold on the web. Because abortion pills are cheap and over-the-counter in other countries, some people obtain bulk quantities of these pills and sell them online at a higher price. These are clandestine businesses, so the process of providing payment looks a little different. Most businesses have you submit the order on their website, then follow up via email with a selection of payment methods and instructions to pay. The payment methods usually include Paypal, Venmo, wire transfers, bitcoin, etc. After submitting the payment method, they have you send a screenshot of the payment as proof you paid. After recieving proof of payment, they ship your order. Some places provide a tracking number, others don’t. The average price of a medication abortion from a clandestine business is $30-70 USD, though some sellers have much higher prices. Plan C maintains a listing of these sellers.
There are also websites that provide prescriptions for a fee, such as Aid Access. The payment process is nearly identical to the clandestine businesses, but they have you answer a short medical questionnaire before approving your order. These services usually cost more money and sometimes have longer shipping times but may supply more pills. The average price of getting pills through these organizations is $150-300 USD.
Then there are community based organizations like ours, who ship or drop-off pills at low or no cost to people who need them. These organizations may have connections to get cheap pills in bulk or may purchase pills the same way anyone else would.
How many pills do I need?
You only need one mifepristone pill, but the number of misoprostol you need is determined by how many weeks you’ve been pregnant. To know how many pills you need, please read the dosing instructions provided by the M+A Hotline.
How do I know how many weeks I’ve been pregnant?
You can calculate it yourself or your provider may give you an ultrasound and tell you. The calculation is determined based on the first day of your last menstrual period. Count the number of days since the first day of your last menstrual period, then divide it by 7. You could also simply use an online calculator. We recommend this one: https://www.womenonweb.org/en/pregnancy-calculator
Who should NOT use abortion pills?
Mifepristone is not recommended for people using long-term steroids, such as Dexmethasone or Prednisone. However, if you are on these medicines you can complete a misoprostol only abortion. The instructions for a misoprostol only abortion are slightly different, so we recommend reviewing M+A Hotline’s guide which is linked above.
You also should not use abortion pills if you have a bleeding disorder, chronic adrenal failure, are allergic to mifepristone or misoprostol, or have an ectopic pregnancy.
If you have an ectopic pregnancy, the pills will not hurt you but they also won’t work. An ectopic pregnancy is a life-threatening medical emergency and you will need surgical intervention.
What if I have an IUD?
Having an IUD placed can increase the chances that you have an ectopic pregnancy. If you use abortion pills with an IUD, it can make the cramping more intense. It is safer to have your IUD removed before using abortion pills, but having an IUD is not necessarily a contraindication. If you need your IUD removed, please contact us and we’ll get you connected with providers who can do this.
Can I take abortion pills while breastfeeding/chestfeeding?
Yes. According to the National Library of Medicine, both Misoprostol and Mifepristone are safe for nursing families.
I’m trans and using testosterone hormone replacement therapy. Can I use abortion pills safely?
Yes. Mifepristone works by blocking progesterone. Misoprostol works by inducing uterine contractions. Neither of these medicines interact with testosterone.
When to go to the emergency room
Complications are very rare (less than 1%), but it’s still important to know what to do in an emergency.
It’s time to visit the ER if…
- If you start to bleed heavily and you soak more than two maxi-pads in an hour for two hours in a row, seek medical attention at an emergency room.
- If you pass large clots (bigger than a lemon) for more than 2 hours.
- If you think you are hemorrhaging – blood is “just pouring out” and you are feeling dizzy, weak, or light-headed.
It’s time to call your doctor if…
- Misoprostol may cause fever or chills in the first 24 hours. If you experience fever and chills after 24 hours, fever or chills may be a sign of an infection.
- You have weakness, nausea, vomiting, and/or diarrhea that lasts more than 24 hours after taking misoprostol.
If you are concerned about potential legal consequences for self-managing an abortion, we advise you to say you think you’re having a miscarriage when seeking emergency care. There is no blood test or other lab test to tell if mifepristone or misoprostol have been in your body.
What to expect with mifepristone
After taking mifepristone most people do not experience side effects, although some people feel nauseous or have bleeding/spotting. A small percentage of people (less than 5 percent) have heavy bleeding and pass the pregnancy after mifepristone.
Information on taking misoprostol
One to three days after you took mifepristone, you will place the misoprostol inside your cheeks near the gumline or under your tongue and let them dissolve. The number of misoprostol tablets you need to take is determined according to the dosing guidelines for your pregnancy. It is important that you let them dissolve under your tongue instead of swallowing them whole, because swallowing them whole can make them slightly less effective.
You may also place the pills in your vagina and let them dissolve, however, we do not recommend this if you are concerned about legal consequences. If you have complications and need to visit an ER, there may be pill remnants in your vagina still there if the physician decides you need a vaginal exam, which could be evidence that you attempted an abortion.
Preparing for your misoprostol dose
- You should have your phone with you and be near a bathroom for the day.
- Eat when you can and drink plenty of water during the day.
- The process usually takes between 5 and 7 hours, but can be longer, so it’s important to take this into consideration when choosing a time to start the misoprostol.
- Make sure you have a box of maxi-pads. Do not use tampons or menstrual cups until at least one week after taking your last misoprostol dose.
What to expect after the misoprostol
Cramping, moderate to heavy bleeding, and moderate pain are normal parts of the abortion process as your uterus passes the pregnancy. Most patients pass blood clots.
- Cramping usually starts one to four hours after you place the misoprostol in your cheeks or vagina.
- Bleeding usually starts between 30 minutes to four hours after you place the misoprostol in your vagina. However, it can take up to 24 hours for some people.
- Heavy bleeding and strong cramps usually last between one and four hours.
For pain: resting and using a heating pad or hot water bottle may help. Ibuprofen or Tylenol usually helps with the pain.
- Over-the-counter pain medicines: You may take these medicines according to the instructions provided by the manufacturer. You may take the first dose of pills as soon as you want for the pain.
Other misoprostol side effects
The following side effects are not dangerous and usually only last one to four hours. If any of these side effects make you very uncomfortable, you may treat your symptoms with over-the-counter medicines.
- Nausea
- Vomiting
- Diarrhea
- Fever and chills (can last up to 24 hours)
Frequently Asked Questions About Pain Levels and Bleeding
I’m in a lot of pain. Is this normal?
Usually yes, but depending on your other symptoms it can be a sign of a problem. Prolonged pain can be one sign of an incomplete abortion (which we discuss later in the guide). Ultimately, you know your body best. If you have severe pain that isn’t controlled by over-the-counter pain medicine, you may want to call your provider or the M+A Hotline. Misoprostol is the same drug used to ripen the cervix for labor with full-term pregnancies. The contractions it causes can be really intense for some people, while others feel less pain.
What if I am not feeling much pain? Should I be concerned?
This doesn’t mean it’s not working. For some people this is the worst pain they’ve experienced, and for others they’ve had period cramps that were much worse.
What is normal bleeding like after taking these pills?
People often bleed for several weeks after they use the abortion pills. The bleeding can be steady or on and off. It can also be with or without cramping.
Some people bleed right up to their next period. That first period is sometimes extra heavy. All of these patterns are normal.
I’m not sure I bled enough after I took the pills.
Bleeding is less important than the passage of pregnancy tissue (which often looks like menstrual clots). Some people bleed less, some bleed more. The bleeding is often lighter if the pregnancy was less than 6 weeks. If you can identify that tissue passed, it worked. Sometimes people don’t see the tissue in the mix of the blood, which is normal too.
I took the misoprostol as directed and I had no bleeding, cramps, or passage of pregnancy tissue. What do I do?
You may need an extra misoprostol dose or two. Contact Autonomy Iowa City ASAP and we may be able to help you with this and give some guidance.
In a small number of cases (5% or less), abortion pills may not work. In these cases, you may need a surgical abortion. We can help refer you to providers outside of Iowa and connect you with the resources to get there.
How to tell if the abortion is complete
Most people have bleeding and painful cramping. As you pass the pregnancy, the bleeding is usually heavy and the cramping very strong. This usually lasts one to four hours. Most people pass some blood clots in the toilet and the pregnancy is often in one of those clots. After the pregnancy passes, the cramps decrease and the bleeding slows down significantly.
Within a few hours after passing the pregnancy, cramps and bleeding should be much improved.
After 4 weeks have passed since the abortion, take a pregnancy test. If the pregnancy test is still positive after 4 weeks, see a physician.
Incomplete abortion
An incomplete abortion is when the pregnancy has terminated but there is still pregnancy tissue left in your uterus. These are rare, but can result in an infection. If you have abdominal pain that does not go away after a few days, severe pain, fever, or prolonged excessive bleeding, you may have an incomplete abortion. You may also still have a positive pregnancy test after 4 weeks. If you suspect you have an incomplete abortion, you need to seek medical care as soon as possible.
After the abortion is complete
Unfortunately, there aren’t standardized guidelines on abortion aftercare instructions.
Some providers say to avoid baths or swimming for up to 2 weeks, while others see no issue with submerging yourself in water during your abortion and afterward.
Some providers say you can have sex whenever you feel ready, as long as you wait until heavy bleeding stops to have penetrative sex (this includes anything going inside your vagina). Some sources suggest waiting at least 2 weeks to have penetrative sex. Delaying sex might prevent infection and it might not, but we need more research on it to be sure.
Some say you can resume regular activities immediately, while others say to rest for at least a day after your abortion.
When will my period begin?
Your next period should begin four to seven weeks after the procedure. You can get pregnant before then and should use birth control if you have sexual intercourse. Your first few cycles may be irregular.
If you use a cyclic hormonal birth control method you should start the method the same day as your abortion. Your next period should occur during the fourth week of the contraceptive cycle.
Do I need a RhoGAM shot?
In short, most of the time no. For most people, the evidence does not support needing a RhoGAM shot for pregnancies ended at or before 12 weeks. This is based on the World Health Organization guidelines. If your pregnancy is later than 12 weeks, you should arrange to have a RhoGAM shot within 3 days of your abortion.
RhoGAM is an injection given to pregnant people who have an Rh-negative blood type (For example, O negative, A negative, etc.). People with Rh negative blood types may experience Rh incompatibility during their pregnancies. Rh incompatibility happens when a pregnant person is Rh negative and their fetus is Rh positive. If the fetus’ blood comes into contact with yours during a pregnancy or delivery, your body can build antibodies against the Rh factor. This can lead to potential complications in future pregnancies because your immune system will mount an attack against those Rh positive red blood cells. If you self-managed an abortion that was more than 12 weeks, you may be able to get a RhoGAM shot from your healthcare provider if you ask. We recommend asking Emma Goldman Clinic in Iowa City if you need this.
Does having an abortion effect my future health?
Abortion does not affect future fertility, increase your risk for breast cancer, or cause problems for future pregnancies such as birth defects and miscarriage.
Serious, long-term emotional health issues after an abortion are rare and more common in people who wanted to be pregnant but had to have an abortion for health reasons. They are also more common in people who were not supported by loved ones in seeking an abortion. The most common experience people have after an abortion is feeling relieved.
Who to call if you have medical questions
Autonomy Iowa City has medical professionals on our team that can answer questions, but our services are not 24 hours a day. We strongly encourage you to download Signal before your abortion to communicate questions to us, which is a free end-to-end encrypted texting app. If you use this app, we can protect your privacy more easily. We may also be able to work with outside organizations to help you find a skilled abortion companion/doula to guide you through this process.
If you need a phone call, call the M + A Hotline at 1-833-246-2632 or visit their website at https://mahotline.org/ to speak with a clinician during their operating hours.
Sources
Aiken, A. R., Romanova, E. P., Morber, J. R., & Gomperts, R. (2022). Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study. The Lancet Regional Health. Americas, 10, 100200. https://doi.org/10.1016/j.lana.2022.100200
American College of Obstetrics and Gynecologists. (October, 2020). Medication abortion up to 70 days of gestation: Practice Bulletin Number 225. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-of-gestation
Endler M, Lavelanet A, Cleeve A, Ganatra B, Gomperts R, Gemzell-Danielsson K. Telemedicine for medical abortion: a systematic review. BJOG. 2019 Aug;126(9):1094-1102. doi: 10.1111/1471-0528.15684. Epub 2019 Apr 25. PMID: 30869829; PMCID: PMC7496179.
Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Mifepristone. 2022 Aug. Available from: https://www.ncbi.nlm.nih.gov/books/NBK584985/
Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Misoprostol (Cytotec®) 2022 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK583257/
Murtagh, Chloe et al. (2018). Exploring the feasibility of obtaining mifepristone and misoprostol from the internet. Contraception, Volume 97, Issue 4, 287 – 291. https://doi.org/10.1016/j.contraception.2017.09.016
Planned Parenthood. (n.d.) How safe is the abortion pill? Retrieved from https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-safe-is-the-abortion-pill
Ralph LJ, Baba CF, Biggs MA, McNicholas C, Hagstrom Miller A, Grossman D. Comparison of No-Test Telehealth and In-Person Medication Abortion. JAMA. Published online June 24, 2024. doi:10.1001/jama.2024.10680
Raymond EG, Bracken H. Early medical abortion without prior ultrasound. Contraception. 2015 Sep;92(3):212-4. doi: 10.1016/j.contraception.2015.04.008. Epub 2015 Apr 24. PMID: 25916975.
World Health Organization. Medical management of abortion. Geneva: WHO; 2018. Available at: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1. Retrieved March 3, 2020.
Sources From Whom We Used Multiple Articles
Ipas, https://www.ipas.org/
Miscarriage + Abortion Hotline, https://mahotline.org/
Plan C, https://www.plancpills.org
Safe2Choose, https://safe2choose.org/
Self-Managed Abortion, Safe and Supported (SASS), https://abortionpillinfo.org
Women on Waves, https://www.womenonwaves.org/en/
Women on Web, https://www.womenonweb.org/en/