Bleeding after taking abortion pills: What you need to know
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Bleeding after taking abortion pills is normal—but how much is too much? Learn what to expect and when to reach out to your care team for support.
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Bleeding is a normal and expected part of a medication abortion. For many people, it’s also the most visible sign that the pills are working. But how much bleeding is normal? What if you don’t bleed at all? And when should you check in with a provider?
Here’s what you need to know about what bleeding can look like after taking abortion pills, what’s considered typical (and not), and when it’s time to reach out for help.
How mifepristone and misoprostol work
A medication abortion or “the abortion pill” actually involves two medications: mifepristone and misoprostol.
- Mifepristone blocks the hormone progesterone to stop the pregnancy from growing
- Misoprostol causes the uterus to cramp and empty pregnancy tissue, and can be similar to a very heavy period depending on how far you are.
Bleeding usually starts after taking misoprostol, though some people notice light spotting after mifepristone.
Bleeding is a sign the pills are working
Heavy bleeding is normal after taking misoprostol. This usually means the abortion is progressing. You might:
- Pass blood clots or tissue (up to the size of a golf ball)
- Have a heavy flow (heavier than your period)
- Soak through several pads during the peak
- See some pregnancy tissue
The heaviest bleeding typically starts within 1 to 4 hours after taking misoprostol and lasts about 4 to 6 hours. It should start to slow down once the pregnancy has passed.
You may experience spotting or light bleeding for a few days or weeks after treatment. It may start and stop a few times, but should get lighter and lighter.
What if you only have light bleeding?
If your pregnancy is 6 or less weeks along, you may experience bleeding lighter than a period. This is common and normal, but you can always connect with your provider with any concerns.
What if you don’t bleed?
If you’ve only taken mifepristone so far, it’s okay not to have bleeding yet. Spotting or no bleeding at all is normal before misoprostol.
If it’s been 24 hours since you took misoprostol and you haven’t bled, reach out to your provider as soon as possible. In rare cases it could mean the abortion pills didn’t fully work, and you may need additional medication or a follow-up. In other cases, not bleeding may mean that the pregnancy is actually outside of the uterus. This is a very serious pregnancy complication called ectopic pregnancy and needs to be evaluated in person ASAP.
How much bleeding is too much?
While heavy bleeding is expected, there are signs that the bleeding may be too heavy or unsafe. Call your provider right away—or go to the ER—if you:
- Soak through 2 or more maxi pads per hour for 2+ hours in a row
- Pass clots larger than a lemon
- Feel lightheaded, dizzy, or faint
- Notice signs of infection like fever, chills, or a foul-smelling discharge
Is spotting after the abortion normal?
Yes—spotting or light bleeding can continue for a few days or weeks after a medication abortion. Most bleeding will happen in the first one to two weeks and should get lighter over time, though some people experience bleeding for longer.
If something doesn’t feel right—like ongoing bleeding after 2 weeks, cramping, or other symptoms—it’s a good idea to check in with your provider.
What does tranexamic acid do to your period?
Tranexamic acid helps your blood to clot, which will reduce the bleeding. It comes as a tablet that you take during your period. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the amount of prostaglandin in the lining of your uterus, as prostaglandin seems to contribute to heavy bleeding and pain.
