Medical Abortion

UCSF Health supports medication abortion from the time a person confirms pregnancy up until 11 weeks from the last menstrual period. Although this method is FDA-approved to 10 weeks, studies show safety and efficacy through 11 weeks.

Medication abortion is about 95 percent to 98 percent effective, causing the pregnancy to completely pass without the use of instruments. In comparison, aspiration abortion is effective about 99 percent of the time.

Medications for abortion

The pills prescribed for medication abortion at the UCSF Center for Pregnancy Options are mifepristone followed by misoprostol.

Mifepristone, also known as "Mifeprex" or "RU-486," blocks the action of the natural hormone progesterone on the uterus. This makes the uterus sensitive to misoprostol, the second medication. Misoprostol causes the uterus to contract and leads to bleeding and cramping.

How a medical abortion works

A medication abortion involves an initial evaluation, taking of the prescribed medication, and confirmation that the abortion was successful.

The first evaluation usually involves a clinic visit and ultrasound, though for people who meet certain criteria, this visit can be done by telehealth if the person prefers.

Initial evaluation

Clinic medication abortion. Come to the office visit for an exam and counseling. You will be given and instructed to take 200 milligrams, or 1 tablet, of mifepristone. This is usually taken in the clinic, but can be taken later to optimize timing for you.

No-test (telemedicine) medication abortion. This option is available for people who have: (1) no risk factors for ectopic (or "tubal") pregnancy, (2) no symptoms of ectopic pregnancy, (3) regular periods, (4) a known day of last menstrual period, and (5) no recent use of hormonal contraception. All of these must apply to you to skip the clinic evaluation. You will have a video visit with clinic staff to confirm information, then a video visit with the clinician. You can get the pills by driving by the clinic to pick them up or by paying for a service to mail them to you.

Taking the medication

One or two days after you take the mifepristone, you'll place four tablets, or 800 micrograms, of misoprostol in your cheeks or vagina. You will be given instructions on how to do this.

If you are at 9 weeks or more of pregnancy, three hours later you will use another four misoprostol tablets.

Follow-up care

To confirm that the abortion was successful, you can get evaluated in one of three ways:

• For people who had an initial ultrasound, a follow-up ultrasound can be done in the clinic 6 to 14 days later.
• A blood test can be done the day you take mifepristone and repeated several days later to confirm passage of the pregnancy.
• A phone call or telemedicine visit can confirm appropriate symptoms and if there is no concern, you do a urine pregnancy test 4 to 5 weeks after passing the pregnancy.

Medication abortion vs. emergency contraception

Medication abortion is not the same as emergency contraception, also referred to as the "morning-after pill" or "EC." Emergency contraception keeps you from getting pregnant. Therefore, after you are pregnant, EC is no longer effective. Medication abortion, on the other hand, is used to end a pregnancy.

Medication abortion vs. miscarriage treatment

The same medications for abortion can be used to treat miscarriage, with minor differences.

During a miscarriage, even though the pregnancy has ended, the pregnancy material can sometimes remain in the patient’s body and pose a risk to the patient's health. When this happens, these medications can help to expel it.

Safety and side effects

Mifepristone has been studied for over 25 years. Millions of pregnant people all over the world have used mifepristone and misoprostol or similar medications to have an abortion. Mifepristone is on the World Health Organization's list of "Essential Medications." All studies have shown the method to be safe and effective; there have been no reports of any long-term risks. Heavy bleeding requiring blood transfusion is extremely rare, occurring in less than 0.5 percent of patients.

Short-term side effects of a medical abortion include:

• Strong cramps
• Bleeding
• Nausea and vomiting
• Fever and chills

There is no evidence of long-term risks with mifepristone when used for medical abortion and no long-term effects have been associated with misoprostol.

There are no indications that any of the early abortion methods affect future fertility.

In the rare event that the medications don't work and you choose to continue the pregnancy, there would be a risk of birth defects from exposure to misoprostol. Little is known about the effect of mifepristone on a developing embryo.

Cost and insurance

The cost of a medication abortion varies by clinic. Some providers charge similar rates for medication and aspiration abortions. Many insurance companies, including Medi-Cal, will cover the cost of a medication abortion. The California Abortion Accessibility Act requires that all California-licensed insurance health plans cover care to end a pregnancy (miscarriage and abortion) without cost-sharing (no copays or deductibles).

The UCSF Center for Pregnancy Options offers a self-payment option for both medication and aspiration abortion for people without insurance who do not qualify for Pregnancy-services Medi-Cal (up to 213% of the federal poverty level).