Medication abortion · evidence-based
A plain-English guide to the WHO-recommended protocol — before, during, and after. Sources cited at every step.
Treatment for a medication abortion that needs follow-up is identical to treatment for a spontaneous miscarriage. Tell the ER: "I'm having a miscarriage." You do not have to disclose taking pills. Providers cannot test for mifepristone or misoprostol after they leave the system (4–24h).
"I'm having a miscarriage." Nothing more. Call Repro Legal Helpline 1-844-868-2812 from a phone you trust before talking to police if anyone asks.
When the WHO and ACOG say medication abortion is appropriate.
For free, confidential clinical guidance: M+A Hotline 1-833-246-2632 (Miscarriage + Abortion, 8am–11pm ET, all 50 states). Medical pros, not legal.
Per ACOG 2024: Rh testing and RhoGAM are no longer routinely needed for medication abortion before 12 weeks. If a clinician insists, that's your decision — but it's not a clinical requirement.
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Source: WHO 2022 Abortion Care Guideline, recommendation 27. ACOG Practice Bulletin 225 concurs.
Pick 2–3 days when you can rest at home. Have someone you trust nearby or reachable. Stock:
Swallow 1 mifepristone 200 mg tablet with water. You can eat normally. You will likely feel nothing. Some people have light spotting. Most have no symptoms at all.
What it does: blocks progesterone, which the pregnancy needs to continue.
4 misoprostol 200 mcg tablets (800 mcg total), placed under the tongue (sublingual) or between cheek and gum (buccal). Hold for 30 minutes — do not swallow them whole. After 30 minutes, swallow whatever's left with water.
Take 800 mg ibuprofen 30 minutes before the misoprostol. This blunts cramping significantly.
If bleeding hasn't started in 24 hours, take a second dose of 4 misoprostol 200 mcg tablets the same way. WHO endorses this repeat-dose protocol when needed.
Cramping usually starts within 30 minutes to 4 hours. Bleeding follows. The cramps are real — heavier than period cramps for most people. Heating pad on low abdomen + ibuprofen + a warm bath or shower help. Curl up. It's normal to pass large clots, including grape-to-lemon-sized tissue. This is the pregnancy passing.
Most people pass the pregnancy within 4–6 hours of taking misoprostol. It can take up to 24 hours. Bleeding then tapers but continues lighter for 1–2 weeks.
Other normal symptoms: nausea, mild fever or chills (under 100.4°F, lasting under 24h), diarrhea, fatigue. These come from misoprostol and pass within a day.
Bleeding tapers from heavy → moderate → spotting over 1–2 weeks. Light cramping for a few days. Most people return to normal activity within 1–3 days. Avoid tampons and penetrative sex for 1–2 weeks (infection risk while the cervix is open).
You may have tender breasts and pregnancy symptoms for up to a week — hormones taper gradually.
Take a pregnancy test 4 weeks after misoprostol. Earlier than that, hCG is still detectable from the prior pregnancy and a positive doesn't mean it failed.
If still positive at 4 weeks, contact a clinician or the M+A Hotline. Possibilities: incomplete (treatable with another misoprostol dose or aspiration) or continuing pregnancy (rare, ~1–2%).
Vetted lines from If/When/How — Repro Legal Helpline. Use what fits.
"Hi. I'm having a miscarriage. My last period was around [date]. I'd like care."
That's enough information for triage. You are not legally required to volunteer how the bleeding started. The treatment for a medication abortion that needs follow-up is identical to the treatment for a spontaneous miscarriage — it's the same workup, the same orders, the same code.
"I'd like to call my lawyer first."
Then dial 1-844-868-2812 — Repro Legal Helpline. Free, confidential, lawyer-staffed, all 50 states. They will tell you, in real time, what to say and what to refuse to answer.
EMTALA — federal law 42 U.S.C. § 1395dd — requires every U.S. emergency department to provide stabilizing treatment, regardless of state abortion law, ability to pay, or immigration status.
If you're told they "can't" treat you because of state law: ask for the supervisor, document the time and the name, and call the Repro Legal Helpline from inside the building.
HIPAA does protect your medical record from your employer, school, and insurance company. HIPAA does not protect against subpoenas — police can compel records.
Your safest position: minimal disclosure, immediate legal counsel, and a clinician who is your advocate. Most ER doctors won't ask about pills — and providers cannot test for mifepristone or misoprostol after they leave the system (4–24 hours).
Cramping is the hardest part for most people. These actually work.
Ibuprofen 600–800 mg 30 minutes before misoprostol, then every 6–8 hours as needed. Maximum 3,200 mg/24h. Better than acetaminophen for uterine cramping (RCT evidence).
Acetaminophen 500–1000 mg alongside ibuprofen — different mechanism, additive relief. Or naproxen 500 mg twice daily as an alternative NSAID.
Heating pad on low abdomen or back · warm bath · hot herbal tea · a friend on the couch · podcast or audiobook · ginger tea or candies for nausea.
Avoid aspirin (increases bleeding). Skip cannabis if you're alone — it can worsen anxiety and disorient you when you may need to assess yourself.
The science is clear: most people feel relief.
The 5-year Turnaway Study (UCSF) followed 1,000 people who sought abortions. Relief was the dominant emotion, immediately and over time. 95% felt their decision was right. Mental-health outcomes were better than for those denied care.
If you do have hard feelings — grief, sadness, ambivalence — that's normal too. Both can be true. Free, judgment-free post-abortion talklines:
Searches for "abortion pill," "mifepristone," "misoprostol" can become evidence in the U.S. states with bans. Read our safe-browsing guide. Use Tor for sensitive research, Signal for sensitive messages, ProtonMail for sensitive email. Do not Google any of this from a phone signed into a personal account.
If anyone in authority asks: "I'm having a miscarriage." Then call Repro Legal Helpline 1-844-868-2812. Free, confidential, all 50 states.
This page is information, not medical advice. The dosing reflects WHO 2022 and ACOG 2020 guidance for medication abortion up to 12 weeks LMP. For individualized clinical guidance, contact the M+A Hotline. For legal questions, contact the Repro Legal Helpline. Last reviewed 2026-04-25.
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