How do I know if my medical abortion was successful?

Not surprisingly, one of the most popular questions we get in regard to medical abortion is,"How do I know if it worked?" Medical abortion is super effective when done correctly;  the combination of mifepristone and misoprostol works 98% of the time when someone is less than 9 weeks pregnant, and misoprostol is successfully used 85% of the time. The earlier in pregnancy you are when you use the pills, the more likely it is that they will work.  Nevertheless, it's totally normal to be anxious about whether or not your abortion is complete - after all, the point is to not be pregnant after using the pills.

Here's how you can tell if your medical abortion was successful.

You had bleeding and cramping. Bleeding is an important part of a medical abortion - it's how the fetal tissue leaves the body, and cramping is essential for the uterus to return to its normal size. You can use pain killers, such as ibuprofen, to counteract the pain as soon as you take the misoprostol. A heating pad can also be a great help.

Bleeding should commence 1 - 4 hours after taking misoprostol. Sometimes, it can take up to 24 to 72 hours after the misoprostol, but if there's no bleeding after 72 hours, the abortion didn't work. This could be because the pills weren't taken correctly, you have an ectopic pregnancy, or you weren't pregnant in the first place.

It's normal for the bleeding to be heavier than your period, and for the bleeding to have large clots in it. Bleeding usually starts 2-5 hours after the misoprostol and slows down within 24 hours. It can continue for up to 4 weeks, but this isn't dangerous unless it's severe -more than 2 or 3 pads used every hour for more than 2 or 3 hours. If you experience this, you should definitely see a doctor. Other red flags include abdominal pain that doesn't go away after you take painkillers, a fever that last more than 24 hours, or any vaginal discharge that's abnormal for you.

Your pregnancy symptoms go away within a few days of the abortion. Symptoms include needing to pee a lot , nausea,and breast tenderness. It may take up to 3 weeks for your breast tenderness to go away if you were more than 12 weeks pregnant. You might see the embryonic sac during your abortion, but you also might not, so don't assume this means your abortion didn't work.

Keep in mind:

If you take a pregnancy test right away after your abortion and it's positive, don't panic! Human chorionic gonadotropin, the pregnancy hormone, may take a while to leave the body at first, so you should wait 3-4 after medical abortion to take a test. You can also get an ultrasound 2 weeks after the abortion or a blood pregnancy test 4-5 days after to confirm you're not longer pregnant.

Your period should return 4-8 weeks after your abortion.

If you are planning on taking the pills at home, make sure you can be as comfortable as possible and that you have one person available, whether in person or on the phone, in case you need anything. Purchase ibuprofen and, if you're nervous about being nauseous after taking pills, have an antiemetic on hand. If possible, avoid going to work or school until the heaviest bleeding and cramping is past, and have a plan for getting to a medical facility if necessary. Medical abortion is safe, but part of taking care of yourself means making sure you can get medical care if you need it. If you do go to a hospital or clinic, you don't need to tell anyone that you took the abortion pill -  a healthcare professional cannot tell the difference between a natural miscarriage and an abortion induced by abortion pills.

The most important thing you can do after your abortion is listen to your body, especially while you're bleeding and cramping. Pay attention to anything that doesn't feel right, while also keeping in mind what you know about how medical abortion works and what to expect. Be kind to yourself.  You deserve to feel safe and supported.

Women Help Women is here to answer your questions about self-managed abortion. WHW can help you access the pills, as well as give you scientific, stigma-free information about how they work, and what to expect.