How to manage the side effects of an abortion with pills

An abortion with pills involves the drug misoprostol. If you’re taking misoprostol, you’ll experience expected effects and possibly some side effects too. Here’s a quick guide on how to manage the possible side effects. You can find more information on how to use abortion pills here.

General tips

1. Remember that side effects are temporary.

Most side effects from misoprostol only last a few hours. If you’re taking misoprostol alone (and not using a regimen that includes the drug mifepristone), you’ll take misoprostol more than once and side effects may occur with each dose.

2. Stay hydrated.

Health-care providers report that people who are well-hydrated on the day they take misoprostol often feel better and endure the side effects of misoprostol more easily. Anyone taking misoprostol should drink plenty of non-alcoholic beverages throughout the entire abortion process.

How to manage side effects

Self-care strategies and medications can both be used effectively. All the medications listed below are available without a prescription at pharmacies. The brand names mentioned are common in the United States, but you may find other brand names depending on where you live.

Painful cramping

Self-care

Use a heating pad or hot water bottle on your abdomen.

Medication

Use one of the following medications, not both, and do not take for more than three days in a row.

• Ibuprofen 200mg (brand names: Motrin, Advil): Swallow 2 tablets every 6-8 hours as needed
• Naproxen sodium 220mg (brand names: Aleve): Swallow 2 tablets every 12 hours as needed

Note: Because acetaminophen (brand names: Tylenol) is less effective than ibuprofen or naproxen sodium, it is not recommended for relieving pain and cramping.

For best results, start taking pain medication as soon as you take the misoprostol. Remember that pain will lessen or disappear when your body has finished expelling the pregnancy. You don’t need to take more pain medication if your pain has stopped.

Nausea and vomiting

Self-care

You may choose to eat a light snack (toast or crackers, for example) to help settle your stomach prior to taking misoprostol.

Medication

Use one of the following medications, not both, if you experience nausea and vomiting.

• Dimenhydrinate 50mg (brand names: Dramamine): Swallow 1-2 tablets every 4-6 hours, but no more than 8 tablets in 24 hours. There are chewable options if you prefer. Note: This medication will cause some sleepiness.
• Doxylamine succinate 25mg (brand names: Sleep-Aid, Unisom, ZzzQuil Ultra): Swallow 0.5 (half) to 1 tablet every 12 hours. Note: This medication will cause some sleepiness.

Diarrhea

Self-care

To prevent diarrhea, it may be helpful to eat food and drink liquids when you take misoprostol.

Medication

Loperamide 2mg (brand names: Imodium A-D): Swallow two pills (4mg) after first onset of diarrhea, followed by 2mg after each unformed stool, but do not exceed 8mg per day.

Fever

Self-care

Apply a cool compress to your forehead, neck or body as needed.

Medication

Acetaminophen 500mg (brand names: Tylenol): Swallow 1-2 tablets every 4-6 hours, but do not exceed 3,000mg (6 tablets) daily

Note: Acetaminophen is effective for relieving fever and chills caused by misoprostol.  If you’re also taking ibuprofen or naproxen sodium for pain (see above), you can take acetaminophen at the same time to treat fever.

Anxiety

Self-care

Going through the process of an abortion with pills—regardless of the severity of side effects—can make a person feel anxious. To help manage your anxiety, you might try listening to music, meditation, prayer, or relaxation and imagery exercises. Having a support person, friend or doula present may also help. You might also try drinking a soothing, non-caffeinated beverage, such as chamomile (manzanilla) tea.

Medication

Doxylamine succinate 25mg (brand names: Sleep-Aid, Unisom, ZzzQuil Ultra): Swallow 0.5 (half) to 1 tablet every 12 hours. Note: This medication will cause some sleepiness.

When should I seek help?

Beginning the day you take the misoprostol, if you have any of the following symptoms, see a health worker for additional care:

• Heavy bleeding or soaking more than 2 large sanitary pads per hour for 2 hours in a row, especially if you feel dizzy, lightheaded, and increasingly tired.
• Severe cramps or abdominal pain (the pain doesn’t decrease at all after taking painkillers, or you are unable to perform any regular home activity).
• Feeling lightheaded, confused or like you might faint.

The day after you take the last misoprostol pills, if you experience any of the following, you should see a health worker for additional care:

• Fever
• Severe belly pain
• Feeling very sick, with or without fever
• Persistent and severe nausea or vomiting
• Unusual or bad-smelling vaginal discharge

NOTE: If you experience no bleeding or have little bleeding within 24 hours after taking the last misoprostol pills, it may mean the medicines did not work and you are still pregnant. To be certain, go to your nearest health worker for more help.