What happens to your period after abortion with pills?

One of the FAQs we get a lot about medication abortion is when the next period will come and what it will be like. While everyone’s body responds a little differently to any kind of medication, here’s what you can expect, menstruation-wise, after taking abortion pills.

What is a medication abortion?

Mifepristone and misoprostol are the two FDA-approved medications used for medication abortion — a safe and effective way to end a pregnancy — through 10 weeks/70 days gestation. Misoprostol can also be used on its own for termination of pregnancy, but the combination of abortion pills is what’s typically prescribed by clinics in the U.S.

Both medications are extremely safe and effective. In fact, when comparing their rate of severe adverse outcomes with Tylenol, Viagra, and childbirth, abortion pills are significantly lower risk. Taking abortion pills also doesn’t have a long-term impact on fertility, mental health, or other health outcomes. 

Research also shows that when medication abortion is prescribed through telemedicine, it’s just as safe and effective as getting the pills in person.

What kind of bleeding can you expect after a medication abortion?

Heavy bleeding, along with cramping, is one of the two main signs that a medication abortion is working to end a pregnancy. Some people may experience during and post-abortion bleeding and cramping that’s significantly more intense than their normal period, while others may experience the symptoms and side effects that feel similar to a regular period and premenstrual syndrome (PMS). Either is considered “normal.” 

Bleeding is also often accompanied by blood clots or the passage of tissue (usually white or gray in color). How small blood clots are, or how much tissue is passed, depends on the gestational age of the pregnancy.

Taking over-the-counter ibuprofen (Tylenol if you’re allergic to ibuprofen) and using a heating pad can help with aftercare cramping. Alternating ibuprofen with Tylenol every 3-4 hours (without going past daily limits) may be even more effective than just ibuprofen alone.

What kind of bleeding after a medication abortion needs medical attention?

It’s important to follow up with a healthcare professional immediately if vaginal bleeding soaks through two or more maxi pads an hour for more than two hours. 

Using tampons or menstrual cups after a medication abortion are not recommended because keeping track of the amount of bleeding can be more challenging.

What happens to your menstrual period after a medication abortion?

After taking abortion pills, the uterine lining is thin and ready to start the menstrual cycle from the beginning — though it’s possible to get pregnant from unprotected penis-in-vagina sex right away. 

Your first period after a medication abortion may begin about 4-8 weeks later, but light bleeding from the medication could still be happening on and off within that time. It may also be an especially heavy period.

If you decide to go on a hormonal birth control method after your medication abortion, you won’t experience vaginal bleeding until the placebo week in the pill pack (the last seven pills). (Bleeding while on hormonal birth control isn’t a “true” period because ovulation won’t have occurred most of the time.)

What if your period doesn’t go back to “normal” after a medication abortion?

First: Everyone has a different “normal” when it comes to periods. 

After an abortion, it’s not uncommon for the next few cycles to have somewhat irregular periods as pregnancy hormones leave the body. Typically, pregnancy hormones will be gone by 4-6 weeks after an abortion.

How do you know if you’re still pregnant after a medication abortion?

There are a number of ways to confirm that medication abortion ended a pregnancy:

  • Symptom-checking: One of the first signs a medication abortion worked is a stop to pregnancy symptoms (e.g., breast/chest tenderness, nausea, fatigue, etc.). At Juniper Midwifery, we’ll check in with you after you take your pills to make sure you’ve had cramping and bleeding as expected and are no longer feeling pregnancy symptoms.
  • Pregnancy testing: For the first 1-4 weeks after taking abortion pills, pregnancy testing may be inaccurate because there are still pregnancy hormones in the body. We’ll include a medical grade home urine pregnancy test in your medication package and recommend using it four weeks after you have taken the pills to confirm that you’re longer pregnant.
  • Ultrasound: If you continue to feel pregnancy symptoms for more than two weeks after taking the pills, it’s important to get in touch with your provider. An ultrasound performed at a clinic can also confirm successful completion of an abortion at least one week after taking the pills. Juniper Midwifery patients can reach out to their clinician for next steps.

Need abortion care? Juniper Midwifery can help

Juniper Midwifery is a telemedicine clinic offering virtual abortion support in New York, New Jersey, Connecticut, California, and New Mexico. All patients are cared for by the two founding midwives and women’s health experts.

If you’re currently less than 10 weeks pregnant and need to access abortion care in New York, New Jersey, Connecticut, California, or New Mexico, Juniper Midwifery can help. After completing an intake assessment, our clinicians will review your information to make sure medication abortion is right for you. Once your prescription is confirmed, it’ll take about 2-4 business days for your medication to arrive. (You can also expedite shipping for $25 when checking out for guaranteed 1-2 business day shipment). 

Need additional reproductive healthcare? Juniper Midwifery patients who would also like a consultation and prescription for contraceptives can get them for free.
For any of our patients who need additional support or medical advice, our clinicians are here for you. Please reach out whenever you need to. Organizations like the Reprocare Healthline, All-Options, Exhale Pro-Voice, and Connect & Breathe also run free, anonymous, and nonjudgmental helplines for emotional support for callers and texters accessing abortion care.