This is by far the most common question we get. There is a very, very wide range of normal bleeding patterns and amounts after taking the medications. Though the heaviest bleeding is usually in the first 1-2 days, it isn’t the same for everyone. Many people can have light bleeding throughout or off/on bleeding. Bleeding may not follow a consistent pattern. That is absolutely fine.
We see a large portion of people very early in their pregnancies. Please note many people who are 5 weeks or less may have minimal bleeding. That is normal, common, and expected.
We determine your gestational age by the first day of your last menstrual period, not the day you got pregnant. You can use our pregnancy calculator to find out how many weeks ago that was.
Medication abortion is very safe and effective through 11 weeks from the first day of our last period. If you are more than 9 weeks when you take mifepristone (the abortion pill from the box) you will need to take both doses of misoprostol.
I started bleeding after taking mifepristone (the abortion pill in the little box). Should I still use the misoprostol?
YES! Please use the four misoprostol pills even if you start bleeding beforehand. Many patients have some amount of bleeding between mifepristone from the little box and misoprostol. You must still use the misoprostol.
None of the medications in your kit have interactions. It is safe to take them together. The main exception is waiting 24-48 after taking mifepristone from the little box before you place the four misoprostol pills in your cheeks.
There are no major interactions with the medications in your kit and most prescription medications. The nausea medication ondansetron has a minor interaction with common antidepressants and antibiotics. But the risk to people who are healthy enough to be pregnant in the first place and on the dose we prescribe is not concerning.
Do not take the prescription ibuprofen with other types of ibuprofen. This includes aspirin and all over-the-counter pain medicines except Tylenol (acetaminophen); it also includes prescription NSAIDs (naproxen, meloxicam, diclofenac, and indomethacin). If you are not sure if your prescription pain medicine is in this category, please contact your pharmacist or your usual doctor.
Please use the ondansetron in your kit up to every 6 hours for nausea. If this is not enough, you can take Benadryl (diphenhydramine) up to 50mg (2 tabs). Benadryl is available over the counter as an allergy medication and can make you very sleepy. Liquid versions of Benadryl can help if you can’t swallow the pill form. Do not use this method if you are taking antidepressants, anti-seizure medications or long term antibiotics. Do not drive or operate heavy machinery when using Benadryl.
Nausea is an unfortunate and common side effect of misoprostol. So long as the misoprostol was placed in your cheeks for at least 30 minutes, everything is working as expected. The vomiting is a sign that the medication was adequately absorbed. There is no reason to repeat misoprostol pills after vomiting so long as they were in your cheeks for 30 minutes, even if they were not fully dissolved.
Mifepristone – the abortion pill from the little box – needs to be in your stomach about 60 minutes to be absorbed. Please call us if you vomited mifepristone after less than 1 hour of taking it. Otherwise no intervention is needed.
Please don’t hesitate to take the anti-nausea pills in your kit. You can add Benadryl (diphenhydramine) to help calm the stomach and help you sleep through the some of the cramping. Do not drive while taking this over the counter medication as it makes you very sleepy.
A drug store pregnancy test can take up to 6 weeks to turn negative after an abortion. This is because the drug store tests detect a very low hormone level, and your body takes time to clear the pregnancy hormone. Please do NOT take a pregnancy test until you receive a reminder text to do so.
We ask that you wait at least 2 days or until your bleeding gets lighter before you switch to tampons. This helps us determine how much you are bleeding if you call us about very heavy bleeding. Tampons do not hold much blood and make it harder to track.
No restrictions on penetrative sex or swimming/bathing.
A medication abortion less than 8 weeks from your last period will look like a medium-heavy period. There is nothing to look for as there is nothing recognizable. People more than 8 weeks may see recognizable tissue. This is often embedded in clots, which are very common. Blood is meant to clot when it is sitting still.
The second round of misoprostol is not necessary for most patients. The second dose is only useful if you have had no bleeding at all (not even spotting) after a full 24 hours. If in doubt, just set it aside and call us during normal business hours to discuss.
Only patients who are more than 9 weeks from their last menstrual period are instructed to use the second dose after 4 hours regardless. Use our pregnancy calculator if you aren’t sure how far into your pregnancy you are. If you had an ultrasound, go by the ultrasound instead.
It can take anywhere from 4 weeks to 4 months for your periods to get back to a predictable schedule. We do NOT advise using ovulation tracking as your primary method of birth control until you’ve had at least 2 months of predictable cycles. It is possible to get pregnant again before your next period and before your pregnancy test turns negative.
Your next period may come anywhere from 2 weeks to 2 months later and is almost always heavier than usual, sometimes by a lot. That is common and will clear on its own.
There are no food or drink restrictions while using any of the medications in your kit. You may eat and drink as you normally would.
It is safe to continue breastfeeding while using the medications, including mifepristone . You do not need to stop breastfeeding or “pump and dump”. Breastfeeding during your abortion may improve your bleeding and recovery time.
There are no restrictions on sex or any other activities. It is fine to have penetrative sex, exercise or swim if you feel up to it. Please use pads only the first few days as it makes it easier to track how much you are bleeding.