The first step in a non-surgical (medical) abortion, often called an abortion by pill, is a comprehensive clinic visit and evaluation.

When you arrive at the facility, you will be greeted by a professional, supportive staff who are there to answer your questions and guide you through every step of the process. You’ll complete a confidential medical history questionnaire so the doctor can better understand your health, address your unique concerns, and determine whether the abortion pill is a safe option for you.

After registration, our team will perform basic testing to confirm your pregnancy and assess your overall health. This typically includes:

• A urine pregnancy test
• A blood test
• A sonogram (ultrasound)

The doctor must make sure that you are at least five weeks into the pregnancy so that an ectopic pregnancy (a pregnancy developing outside the uterus) can be safely ruled out by sonogram. Ectopic pregnancy is a serious medical condition. As the pregnancy grows in the fallopian tube, it can rupture and cause heavy internal bleeding. In these situations, the abortion pill is not effective and emergency medical care is required.

If the pregnancy is not seen clearly on the sonogram, you may have additional blood tests to check the level of pregnancy hormone (hCG) in your bloodstream. These hormone levels help the doctor determine whether:

• You are simply too early in pregnancy for the abortion pill, or
• You may be at risk for an ectopic pregnancy.

This is why you cannot safely use the abortion pill before about five weeks into a pregnancy and why it is so important to come in for an evaluation as soon as you think you are pregnant. If an ectopic pregnancy is diagnosed early, it can sometimes be treated non-surgically with medication or other medical management, depending on your situation.

You must also be at less than 10 weeks gestation for the non-surgical abortion to be most effective. Beyond this point, the success rate drops and the chances of needing a follow-up procedure increase. In some cases, even when the abortion pill is used correctly, not all pregnancy tissue leaves the uterus. If this happens, a simple in-office surgical procedure is required to complete the abortion. This occurs in only a small percentage of patients under 10 weeks, which is why providers are more cautious about offering the abortion pill for pregnancies beyond that point.

Your clinic visit is also an important time for your doctor to address your emotional and psychological needs, as well as any medical conditions that might affect your eligibility for the abortion pill. Certain medications or health issues can make a medical abortion less effective or increase your risk of complications. It is very important to tell your doctor about:

• All prescription and non-prescription medications you take
• Any bleeding or clotting disorders
• Other significant medical conditions

This allows your provider to make sure that a medical abortion is safe and appropriate for you.

This visit is also your opportunity to ask detailed questions about how the abortion pill works and what you are likely to experience at home. You can take time to confirm your decision not only about having an abortion, but also about whether you prefer a non-surgical abortion or a surgical/aspiration procedure. Your provider will explain the benefits, risks, and expectations of each option so you can make an informed choice.

Once you and your doctor are both confident that you are a good candidate and that you are ready to proceed, you will take the first abortion medication in the office. This medicine is taken under medical supervision because of federal safety regulations governing how it can be prescribed and dispensed.

The first medication works by blocking the hormone needed to maintain a pregnancy, allowing the pregnancy to stop developing. Some patients may experience mild side effects such as dizziness, nausea, or light spotting, but many do not have significant symptoms at this stage. Your provider will review possible side effects with you and explain what is considered normal and when to call the clinic.

Before you leave, the doctor will give you a second medication to take at home, according to the instructions you receive during your visit. This second medication causes the uterus to contract and expel the pregnancy, usually resulting in cramping and bleeding similar to a heavy period. You will be given clear written and verbal guidance on:

• Exactly when and how to take the second medication
• What level of bleeding and cramping is expected
• Which symptoms are normal and which require immediate medical attention
• How to reach the clinic or on-call provider if you have concerns

Throughout this process, your clinic team remains your primary source of support and medical guidance. They are there to help you feel safe, informed, and confident about your decision and your care.

For the second step of the abortion pill process, we recommend choosing a time when you can be at home, comfortable, and relaxed. Plan to be near a bathroom and in a quiet, private space where you won’t feel rushed. Once you feel ready, you will place the tablets of the second medication inside your cheeks (between your cheek and gums) and allow them to dissolve, following the instructions given by your provider.

This second medication causes your uterus to contract and expel the pregnancy tissue. Many patients start to experience cramping and bleeding within one to four hours after taking it, but the timing can vary. Every body is different, and your experience may not be exactly the same as someone else’s. You are encouraged to take the pain medication recommended by your provider to help manage cramping during this phase of the medical abortion process. Even with pain relief, you should expect to feel some degree of cramping. The goal of the medication is to make the process less intense and more manageable, not to remove all sensation.

You may also find that resting, lying down, and using a heating pad or hot water bottle on your lower back or abdomen can help reduce discomfort. If the pain medication you were advised to use does not seem to help at all, or if the pain becomes severe, contact the clinic to discuss your symptoms with a nurse or doctor.

As the medication begins to work, you will usually experience heavy, period-like bleeding and pass blood clots. At times, these clots can be quite large. This can be a normal part of a non-surgical abortion, but if you ever feel unsure or worried, you can reach out to our team for guidance. At Parkmed NYC, we have highly trained, compassionate staff available 24 hours a day to support you and answer your questions throughout the abortion pill process. You are encouraged to call anytime, day or night, seven days a week. You are not alone during this experience.

It is very important to watch the amount of bleeding you are having. If you are completely soaking through more than two maxi pads per hour for two hours in a row, contact Parkmed NYC as soon as possible. This amount of bleeding is considered heavy and could be a sign of a serious problem that requires prompt medical attention.

As part of your medical abortion care, it is our practice to prescribe preventive (prophylactic) antibiotics. You should take the first dose when you begin to bleed, as instructed, to help reduce the risk of infection. Because your cervix is slightly open during the process, taking antibiotics as directed is an important part of protecting your health.

The pregnancy tissue usually passes without being clearly noticed because you are still early in the pregnancy. It may appear as a larger blood clot or may be seen as a small, whitish piece of tissue. This can be normal. Try not to be alarmed if you think you see the pregnancy tissue. However, simply seeing tissue pass does not guarantee that the process is 100% complete. The only way to confirm that the medical abortion is fully successful is through your follow-up visit and any recommended testing.

If at any point during this process you develop a fever higher than 100.4°F (38°C) for more than 24 hours, or if you have vomiting that lasts four to six hours or longer, please contact the clinic right away to speak with a nurse or doctor. These symptoms can be signs that you need additional medical evaluation.

After the pregnancy tissue has passed, it is common to have period-like bleeding for several days or even weeks. Light to moderate bleeding and spotting during this time is usually normal. However, if the bleeding becomes heavy again, or if you are concerned about the amount or duration of bleeding, you should contact our clinic. We may recommend that you come in earlier than planned for follow-up care to make sure you are healing properly and that the medical abortion is complete.

Throughout your non-surgical abortion with the abortion pill at Parkmed NYC, our priority is your safety, comfort, and peace of mind. We encourage you to stay in touch with us, ask questions, and let us know how you are feeling at every stage of the process.

The Follow-Up Visit After a Non-Surgical (Medical) Abortion