Abortion pill

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

The abortion pill is one way of ending an unwanted pregnancy. It contains the active ingredient mifepristone. It inhibits the body's own hormone progesterone, which is essential for the development and maintenance of pregnancy. However, the abortion pill can only terminate an early pregnancy - not one that is further advanced. Read the most important questions and answers about the abortion pill here!

What is the Abortion Pill?

The abortion pill is a tablet with the active ingredient mifepristone. It can be used to carry out a medical termination of pregnancy (abortion). However, this is only possible in early pregnancy. As the pregnancy progresses, the abortion pill loses its effectiveness.

No morning-after pill!

The abortion pill must not be confused with the morning-after pill. Depending on the preparation, this must be taken no later than 72 or 120 hours after unprotected sexual intercourse and primarily inhibits or delays ovulation - i.e. prevents pregnancy from occurring. This means that the morning-after pill is not an abortion pill.

How does the abortion pill work?

The active ingredient in the abortion pill - mifepristone - is an artificial hormone. It blocks the effect of the body's own hormone progesterone, which is essential during pregnancy: it prepares the lining of the uterus for the fertilized egg cell to implant and ensures that the pregnancy is maintained. If the progesterone effect is now inhibited by the abortion pill, the cervix opens, the uterine lining and the fruit sac with the embryo detach and can - as with a menstrual period - be rejected.

Mifepristone also makes the lining of the uterus more receptive to another drug that the woman receives to increase the effect of the abortion pill: She also receives an artificial prostaglandin (e.g. misoprostol). This is a labor-inducing agent that stimulates contractions of the uterus and thus promotes the rejection of the pregnancy tissue.

Who will get the abortion pill?

Medical abortion with mifepristone is only possible up to the 63rd day after the start of the last menstrual period, i.e. up to the 9th week of pregnancy. However, the abortion pill is not simply available in the pharmacy and with a prescription. Rather, it may only be dispensed by approved clinics and medical practices that are allowed to perform abortions. Before the termination, a consultation and then a three-day waiting period are required by law. Pregnant women who are interested in a medical abortion therefore need a consultation appointment no later than the beginning of the ninth week after the last menstrual period.

An abortion with tablets (mifepristone, prostaglandin) is only possible if these legal requirements are met - provided there are no medical reasons against it.

Medical reasons against a drug termination

Termination of pregnancy with mifepristone and prostaglandin tablets is not possible in the following cases:

Suspected pregnancy outside the uterus (such as ectopic pregnancy)
chronic adrenal failure
congenital porphyria (a group of rare metabolic diseases)
severe, untreatable, or untreated asthma
known allergy to one of the ingredients of the medication (mifepristone, prostaglandin, etc.)
Copper IUD or hormone IUD lying in the uterus (medical termination is only possible after the IUD has been removed)

In the case of liver failure, kidney failure and malnutrition, the abortion pill is not recommended as a precaution because there are no relevant studies.

Decision on a case-by-case basis in the event of impaired blood clotting

In women who have a bleeding disorder or who are currently being treated with blood-thinning medication (such as Marcumar, heparin), medical termination of pregnancy could cause dangerously heavy bleeding. The doctor must therefore decide on a case-by-case basis whether it would be better to end the unwanted pregnancy with suction instead of an abortion pill.

How is the process?

The medical abortion with the abortion pill usually takes place in several steps, which include three visits to the doctor in addition to the consultation:

1. Advice

If you want to have an abortion - regardless of whether it is medicinal (with the abortion pill) or instrumental (suction) - you must first seek advice from a state-approved body, for example "Pro Familia". Contact information for recognized advice centers in your area can be found here.

With the mandatory consultation, the legislator wants to ensure that you are fully informed before making your decision - about the options for termination as well as support options if you do decide in favor of the child. You also have the opportunity to talk to the consultant about any doubts, fears and wishes - the consultant is subject to confidentiality.

In any case, the conversation should be conducted with an open mind: The counselor should / may not influence you in one direction or the other, but only help you to make your own decision for or against pregnancy.

At the end of the consultation, you will be given a consultation slip. It is the written confirmation that you have been advised according to Paragraphs 5 and 6 of the Pregnancy Conflict Act. Your name and the date of the consultation are also noted on it. There is nothing there about the content of the consultation. The presentation of the advice form is a prerequisite for a doctor or a clinic to be able to give you the abortion pill.

Sometimes, at the end of the interview, the counselor recommends a pregnant woman to meet again before giving her the counseling slip. He may only do this, however, if there is still enough time to terminate the pregnancy within the legally permitted period (12 weeks after conception) if the woman so wishes.

2. Preliminary examination

At the earliest three days after your consultation, you can come to the doctor's practice or clinic for an initial appointment, which is allowed to perform abortions. You must have the following documents with you:

Advice certificate (or the certificate of an abortion permitted for medical or criminological reasons, e.g. if the mother-to-be's life is at risk or the pregnancy is the result of rape)
Insurance card
possibly blood group proof
If you are entitled to financial support for the abortion, you may have a certificate of cost coverage

The doctor will do an ultrasound scan to see how advanced your pregnancy is. He will also clarify whether you have any medical reasons against using the abortion pill (plus the additional prostaglandin preparation). He will ask you, among other things, whether you have any previous illnesses (such as asthma, kidney disease), whether you are using any medication, and if so, which ones.

If nothing speaks against a medicinal abortion, the doctor will explain the exact procedure and the possible side effects of the abortion pill and the prostaglandin preparation.

3. Taking the abortion pill

After the preliminary examination and the interview, the doctor will give you the abortion pill - either one tablet of 600 mg mifepristone or three tablets of 200 mg each. You must take these under his supervision. You can then go home - with precise instructions from your doctor as to what you should do in the event of any health problems (e.g. excessive abdominal bleeding).

Most women develop bleeding similar to their normal menstrual period approximately 24 hours after taking the abortion pill. A few women (three percent) even get heavier bleeding, which already sheds the embryo and uterine lining - something that normally only happens after the prostaglandin preparation has been administered. The planned second visit to the doctor, where this preparation is actually administered, should then still be taken.

4. Prostaglandin administration

The second appointment at the doctor's office or clinic is scheduled 36 to 48 hours after taking the abortion pill. At this appointment you will receive a prostaglandin preparation:

Up to the 49th day of pregnancy (i.e. 7th week of pregnancy) the prostaglandin is administered as a tablet by mouth. The tablet can be held in the cheek or under the tongue until it dissolves. The active ingredient is then absorbed into the blood through the mucous membrane.
If you are already in the 8th or 9th week of pregnancy, the prostaglandin is introduced as a tablet through the vagina.

After the administration of the prostaglandin preparation, you will remain under medical supervision for about three hours. In most women, the intended miscarriage occurs within this period of time - the lining of the uterus and the embryo nested in it are expelled by bleeding.

If no bleeding has set in at the end of the three-hour observation period, the doctor usually gives a second dose of prostaglandin. For every fourth woman it takes more than 24 hours before the pregnancy is terminated.

For women who are Rh negative, the doctor will also inject a drug that prevents the formation of antibodies against the Rh factor. Otherwise there could be complications in a later pregnancy with a Rh-positive child. Read more about it here.

Before you can go home, you will be given information on how to behave in the next few days (e.g. not having sexual intercourse). They also give you a phone number to call if you have any questions.

5. Follow-up examination

About 14 to 21 days after the termination of pregnancy with the abortion pill and prostaglandin, a follow-up check-up in the doctor's office or clinic is due. It is very important: the doctor uses an ultrasound or blood test to check whether the pregnancy has really ended completely. It is possible that the termination did not work - the pregnancy continues. Or there is still residual pregnancy tissue in the uterus.In such cases, a new administration of medication or an operation (suction) may be necessary.

Abortion Pill: Benefits & Risks

An abortion with the mifepristone pill and prostaglandin preparation is successful in approximately 95 percent of the cases. In contrast to instrumental abortion (suction), it usually does not require anesthesia and no surgical intervention (which also carries the risk of damaging the uterus). Drug termination is also possible very early in pregnancy. It also has no effect on the woman's fertility, provided that it proceeds without complications. In this respect, there is nothing to prevent a later desire for children.

The disadvantage is that the medical termination extends over several days and thus takes longer than an instrumental termination. Women have to be prepared for an average bleeding time of 12 days. Light bleeding (spotting) can last up to four weeks, rarely longer.

Despite bleeding, you should not use tampons for the first few days after the cancellation to avoid infection in the abdomen. Sex is not recommended in the first few days for the same reason. Your doctor will give you more detailed advice on how to do this.

Side effects & complications

The most common side effects of drug abortion with abortion pills and prostaglandin include cramping abdominal pain, nausea, vomiting, diarrhea and circulatory problems. If necessary, the doctor will prescribe medication for you.

After the medical abortion, the withdrawal bleeding rarely lasts so long that medical treatment is necessary (scraping). Pregnancy tissue (placenta) left in the uterus also carries the risk of infection. This is why the follow-up examination after an abortion is so important.

Overall, complications after an abortion (with tablets or suction) are rare.

Abortion Pill: Cost

In general, the following applies: The costs for an outpatient termination of pregnancy (regardless of whether with tablets or suction) are between 350 and 600 euros. A medical abortion costs less than an instrumental abortion. Whether and to what extent the costs are covered by another agency (e.g. health insurance company) initially depends on whether the termination takes place according to the counseling regulation (as described above) or due to a medical or criminological indication.

Medical abortion according to the counseling regulation

In this case, a woman usually has to pay for the medical abortion out of her own pocket. Only a small part can be billed with a health insurance certificate for women with statutory health insurance, such as the cost of medical advice before the medical termination.

However, if a woman is socially needy, the federal state in which she lives pays for the abortion. However, she must submit the application for reimbursement to her health insurance company in advance. This will confirm the assumption of costs in writing, if the conditions are met, and then take care of the financial processing. The woman must bring the confirmation with her to the doctor's practice or clinic at the first appointment.

Even if you are socially needy but do not have statutory health insurance, you can apply for the cost of the abortion to be reimbursed at a statutory health insurance company of your choice in your place of residence.

What does "socially needy" mean?

For the period between July 1, 2020 and June 30, 2021, the following applies: A woman is classified as socially needy if her available personal income does not exceed EUR 1258 per month and her personal assets are not available for short-term use. The income limit increases by 298 euros for every minor child living in the woman's household. In addition, a further increase in the limit value by a maximum of 368 euros is possible if the woman pays more than 368 euros in rent for her accommodation.

You can get more information about the reimbursement of costs in the event of an abortion from a pregnancy (conflict) counseling center, for example "Pro Familia".

Drug abortion if there is a medical or criminological indication

An abortion due to a medical or criminological indication is covered by health insurance for women with statutory health insurance.

Private health insurances usually only cover the costs of a termination if there is a medical indication. In the case of a criminological indication, you should ask your own private insurance to what extent it is possible to cover the costs.

What do the women feel?

Abortion is a psychologically stressful situation for most women, regardless of which method of termination they choose. Many women consider abortion pills and prostaglandin tablets to be at least physically more gentle than abortion using instruments. In addition, some feel more self-determination and responsibility when using medication than with surgery under anesthesia, while this does not apply to other women.

It is also differently perceived that the termination of pregnancy using the abortion pill and prostaglandin preparation takes longer than the instrumental termination. The fact is: women experience abortion with tablets in all phases more consciously than suction under anesthesia. In addition, the medical termination of pregnancy with its termination bleeding is similar to a miscarriage. For some women this represents an additional emotional burden. For others, on the other hand, the direct, intense experience of the termination of pregnancy helps to process it emotionally.

Mental consequences?

Studies have shown that abortion alone does not increase the risk that a woman will develop a mental disorder later - regardless of whether the pregnancy was terminated with an abortion pill or suction. It is crucial that women receive good medical and emotional care in this exceptional situation. Then they do not develop psychological problems more often than women who carry an unwanted pregnancy to term, as the current study situation shows.

However, unfavorable circumstances can increase the risk of mental problems after an instrumental or medicinal abortion. These include, for example, stressful living conditions such as experiences of violence or poverty, but also pressure from the partner or family to terminate the pregnancy. Even if a woman does not receive sufficient social or emotional support or is forced to keep the abortion a secret, this can lead to emotional problems.

Give yourself time to make a decision

The legislature only grants a punishable termination of pregnancy a limited time frame. As long as this is not almost exhausted, women should take the necessary time to decide whether they want to terminate an unwanted pregnancy and, if so, how - using an abortion pill and prostaglandin preparation or suction. Sensitive and open-ended discussions with a doctor or pregnancy conflict counselor can help the woman with this.

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