January 3, 2024
How to take abortion pills vaginally, buccally (between the cheeks & gums), and sublingually (under the tongue), how long they take to dissolve, and what to expect after a medication abortion.
Abortion pills, known as medication abortion, are a safe and effective way to end a pregnancy. A huge benefit of abortion pills is that you can complete the abortion privately—and with telehealth providers like Hey Jane, without leaving your home at all.
Having a medication abortion involves taking two FDA-approved medicines over a couple of days. Mifepristone, the first of the two abortion pills, will stop the pregnancy from growing by blocking the hormone progesterone. Misoprostol, the second type of pill taken, causes the uterine cramping and bleeding to pass the pregnancy and empty the uterus.
Below are the steps to take the abortion pills:
Swallow one mifepristone (200 mg) pill with water.
Most people feel fine after taking this pill. You can continue all of your regular activities. You may have some vaginal bleeding but may not — either is okay.
It’s unlikely, but if you throw up within the first 30 minutes after taking it, please contact your provider. If you throw up after 30 minutes, you don’t need to contact us because the medicine has been absorbed.
Note: If you’re been feeling nauseous with the pregnancy, you can take one ondansetron (anti-nausea) pill under your tongue and let it dissolve before starting Step 1. This medication is provided in your shipment from Hey Jane.
You can take the second type of pill, misoprostol, several different ways: vaginally, buccally (between your cheeks and gums), and sublingually (under your tongue). All methods of taking misoprostol are equally effective, but can cause more nausea when taken sublingually (under the tongue) and the least nausea when taken vaginally.
Option 1: Vaginal
This method causes the least nausea because while pretty flavorless, the pills are very chalky and can be difficult to keep in your mouth for 20+ minutes if they are already feeling queasy during the pregnancy. However, this route might not be the best option if you have started bleeding as the vagina does not absorb it as well in the presence of blood.
If taking misoprostol vaginally, you can start Step 2 immediately, or up to 72 hours, after Step 1.
Option 2: Buccal (between your cheeks and gums)
This method causes more nausea than the vaginal method, but less than the sublingual method. If taking misoprostol buccally, you can start Step 2 at 24-48 hours after Step 1.
Option 3: Sublingual (under your tongue)
This method causes more nausea because misoprostol is absorbed SO well under the tongue that it can start working faster and as a consequence, be much more intense. This route can therefore cause more side effects. If taking misoprostol sublingually, you can start Step 2 at 24-48 hours after Step 1.
Choose a time to start Step 2 when you’ve had a good meal and plenty of rest, as bleeding and cramping usually start a few hours after Step 2. 30 minutes before taking your misoprostol pills, take 800 mg of ibuprofen (pain medicine) by swallowing with water and one ondansetron pill (anti-nausea medicine) under your tongue. The ondansetron dissolves in your mouth and does not need to be swallowed. These medicines will help decrease some of the GI side effects, like nausea, that are common with misoprostol, as well as help decrease cramping.
You must complete Step 2 even if you have started bleeding.
Place 4 (four) misoprostol pills (800 mg) inside your vagina OR between your cheeks and gums for 30 minutes. Below we go over the different ways to take them—choose the one you prefer. The medicine works equally well across each option, but can cause more nausea when taken sublingually (under the tongue) and the least nausea when taken vaginally.
First, go to the bathroom to empty your bladder and wash your hands.
Either in a squatting position or lying on your back or side, use your finger to push 4 misoprostol pills, one by one, deep into your vagina at least one finger’s distance inside. After the pills are inserted, lie down and wait for 30 minutes.
Do not use lube if inserting the pills vaginally. Instead, you can moisten the pills with a little water prior to inserting to make vaginal administration easier.
After 30 minutes, the medicine is absorbed. If the pills fall out after 30 minutes, it is ok and the pills can be thrown away.
Put 2 misoprostol pills on one side of your mouth between your cheek and gums (think the place where you used to hide chewing gum), and the other 2 misoprostol pills on the other side of your mouth. Wait 30 minutes for the pills to dissolve, then swallow what is left of the pills. It is okay to swallow your saliva as the pills dissolve.
Put 4 misoprostol pills under your tongue and hold them there with your mouth closed so the pills stay in place. Wait 30 minutes for the pills to dissolve, then swallow what is left of the pills. It is ok to swallow your saliva as the pills dissolve.
Depending on how many weeks along the pregnancy is and on how much you bleed after Step 2, you may or may not need to take additional pills as described in Step 3.
You only need to complete Step 3 if:
(Note: It is common for bleeding to be lighter than a period for people that are earlier in their pregnancy, typically 6 weeks or less).
Repeat Step 2 by taking the extra 4 misoprostol pills either buccally (between your cheeks and gums) or sublingually (under your tongue). Wait 30 minutes for the pills to dissolve, then swallow what is left of the pills.
You can also take the 4 misoprostol pills vaginally, but only if you have not started bleeding yet. After 30 minutes, the medicine is absorbed. If the pills fall out after 30 minutes, it is ok and the pills can be discarded.
Mifepristone, the first medication taken, is swallowed with water and does not need to dissolve in your mouth. Misoprostol, the second medication, takes about 30 minutes to be absorbed, regardless of how you take the pills. After 30 minutes, you can throw out any remaining pills if taken vaginally, or swallow any remaining pills if taken buccally (between your cheeks and gums) or sublingually (under your tongue).
You should have cramping and bleeding after taking the second medication, misoprostol, usually as heavy or heavier than your period. This may include clots or tissue.
Your pregnancy symptoms such as nausea and breast soreness should start to decrease 24 hours after you have completed treatment, and resolve completely in the weeks after.
A pregnancy test will stay positive for about 4 weeks after the treatment (even if you are no longer pregnant), so it’s important not to take one sooner.
Remember that each person’s experience is different and symptoms can vary from person to person.
Heavy bleeding and strong cramps usually start about 4-6 hours after taking the second medicine, misoprostol, but can take up to 24 hours. Once bleeding starts, it can last for a few hours (typically around 6 hours). Heavy bleeding does not usually last more than 24 hours, and then it gets lighter. It’s normal to have bleeding or spotting for a few days or weeks after treatment. It may start and stop a few times, but should get lighter over time.
Bleeding can be very heavy, even heavier than your period, and can include clots ranging in size. With pregnancies 6 weeks or less, it is common for bleeding to be lighter than a period. Use heavy flow menstrual pads so you can tell how much you’re bleeding. You can use tampons when the heavy bleeding lets up.
You may see pregnancy tissue that comes out with the bleeding, which can look like a shiny blood clot or can be white or gray in color. It is safe to dispose of the pregnancy tissue in the same way you would pads or tampons, or to flush it down the toilet, but you may also choose to dispose of it in a different manner that reflects your personal or cultural values.
It is ok if you do not see anything - that does not mean the treatment isn’t working.
Your period should come back in 3-8 weeks, but this is different for each person. People usually ovulate about 2 weeks before a period, which means you can get pregnant immediately after an abortion.
Pain and cramping:
Strong cramping is a normal part of the treatment and usually starts a few hours after taking the second medicine, misoprostol.
Here are some things that can help:
You will cramp less as the hours and days go by and once the pregnancy has passed.
Other common symptoms:
Do something that makes you feel good! Whether this process was a big deal for you or just another day, take some time to listen to your body, and do something nice for yourself. It's safe to go back to your regular activities - school, work, driving, exercise - as soon as you feel up to it. You can have sex whenever you are ready (more about sex after an abortion here), and can use tampons or menstrual cups once your bleeding has lightened up.