Yes, the abortion pill can fail, but it is uncommon. Medication abortion using mifepristone and misoprostol is highly effective, especially when used early in pregnancy and according to a healthcare provider's instructions. In FDA-reviewed clinical data, about 97% of patients had a complete medical abortion, while ongoing pregnancy occurred in less than 1% of cases in the studied regimen.
However, no medication works 100% of the time. Sometimes the pregnancy continues, or some pregnancy tissue remains in the uterus. This is called an incomplete abortion and may require additional medication, monitoring, or an in-clinic procedure.
Knowing the signs of an incomplete abortion can help you recognize when you need medical care.
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Yes, but rarely. Watch for continuing pregnancy symptoms, very little bleeding, worsening pain, or a pregnancy test that stays positive longer than expected.
The abortion pill can fail, but failure is uncommon. A medication abortion can result in an ongoing pregnancy or an incomplete abortion where some pregnancy tissue remains in the uterus.
Possible signs that an abortion may not have been completed include pregnancy symptoms that continue or become stronger, very little or no bleeding after taking the medication, persistent or worsening abdominal pain, heavy or prolonged bleeding, fever or chills that persist, a pregnancy test that remains positive longer than expected, or an ultrasound or blood test showing an ongoing pregnancy or retained tissue.
Symptoms alone cannot always tell you whether an abortion was successful. A healthcare professional may recommend follow-up testing, such as a pregnancy test, blood hCG testing, or ultrasound, depending on your situation.
If you have severe pain, very heavy bleeding, fainting, severe weakness, or other emergency symptoms, seek urgent medical care.
Mifepristone blocks the hormone that maintains pregnancy; misoprostol then triggers the contractions that empty the uterus, typically over several hours to a few days.
The term abortion pill generally refers to medication abortion. The most common regimen uses two medications: mifepristone and misoprostol.
Mifepristone blocks progesterone, a hormone needed to maintain pregnancy. Misoprostol then causes the uterus to contract and expel the pregnancy tissue. Our guide on how the abortion pill works explains this mechanism step by step, and what is a medication abortion covers the process from start to finish.
The California Department of Public Health explains that medication abortion generally involves taking medications up to 48 hours apart and that the process can take several hours to a few days.
The FDA currently approves mifepristone, when used with misoprostol, for ending an intrauterine pregnancy through 10 weeks of gestation, as covered in FDA-approved abortion pills and medical abortion up to 10 weeks.
Because the appropriate regimen can depend on how far along the pregnancy is and individual medical circumstances, it is important to follow the instructions provided by a qualified healthcare professional. Our guides on abortion pill: what to expect and what to expect when you take abortion tablets walk through what that typically looks like.
Around 97% of patients complete the abortion with medication alone, and only about 0.7% end up with an ongoing pregnancy, though the odds shift slightly with gestational age.
Medication abortion is highly effective, but the likelihood of success can vary with gestational age and the medication regimen used.
FDA-reviewed clinical data for mifepristone followed by misoprostol through 70 days of gestation found:
The FDA data show that most people complete the abortion without needing a surgical procedure.
The chance of medication abortion failure also tends to increase as pregnancy duration increases. ACOG notes that medication abortion failure, including ongoing pregnancy or retained tissue requiring uterine aspiration, increases with advancing gestational age, although failure rates remain low. Our guides on abortion pill at 5 weeks vs. 8 weeks and how far along you can take the abortion pill explain how gestational age affects the experience.
This is one reason getting an accurate pregnancy timeline and appropriate medical guidance before taking the abortion pill matters. See is medication abortion right for me and who should not take the abortion pill for eligibility considerations, and is the abortion pill safe for the broader safety picture.
An incomplete abortion means the pregnancy ended but some tissue remains, which is different from an ongoing pregnancy where development continues.
An incomplete abortion occurs when some pregnancy tissue has not been expelled from the uterus after an abortion.
It is different from an ongoing pregnancy. In an incomplete abortion, the pregnancy has ended, but some pregnancy tissue remains. In an ongoing pregnancy, the pregnancy continues after the medication abortion. In a complete abortion, the pregnancy has ended and the uterus has adequately emptied.
The World Health Organization describes incomplete abortion as a situation where not all pregnancy tissue has been expelled and notes that common symptoms can include heavy or prolonged vaginal bleeding and abdominal pain.
An incomplete abortion does not automatically mean something has gone seriously wrong. Depending on your symptoms and clinical findings, healthcare providers may recommend waiting for the remaining tissue to pass, additional medication, or an aspiration procedure.
Some bleeding, cramping, nausea, and fatigue are expected. These same symptoms become concerning when they're severe, persistent, or show up together.
It is important to understand that some bleeding, cramping, nausea, fatigue, and other symptoms are expected after medication abortion. The following signs become more concerning when they are severe, persistent, or occur together.
If symptoms such as nausea, breast tenderness, or fatigue continue, it may be worth contacting your healthcare provider.
However, pregnancy symptoms do not disappear immediately after an abortion. Pregnancy hormones can remain in your body for some time, so continuing symptoms alone do not prove that the abortion failed. Our guide on what happens after taking abortion pills covers this general recovery pattern.
If you continue to feel pregnant, your provider may recommend follow-up testing.
Some bleeding is generally expected after misoprostol. If you have little or no bleeding after taking the medication, contact your healthcare provider for guidance. Our guide on bleeding and cramping after a medication abortion covers what's typical.
Minimal bleeding does not necessarily mean that the abortion failed, but it can be a reason to assess whether the medication worked.
Cramping is a normal part of medication abortion because misoprostol causes the uterus to contract.
Pain that becomes severe, persistent, or progressively worse should not be ignored.
Severe abdominal pain can have several possible causes, including complications that require medical evaluation. An ectopic pregnancy is particularly important to rule out because medication abortion does not treat an ectopic pregnancy. Our article on abortion pill side effects vs. complications covers this distinction further.
Bleeding is expected during medication abortion, but extremely heavy bleeding can be dangerous.
The FDA labeling advises seeking immediate medical attention for prolonged heavy vaginal bleeding, defined as soaking through two thick full-size sanitary pads per hour for two consecutive hours.
Heavy bleeding can occur with incomplete abortion or other complications and may require medical treatment. Our guide on spotting vs. bleeding after abortion can help you tell the difference between expected and excessive bleeding.
A fever that persists, particularly after the expected medication-related side effects have passed, can indicate an infection.
The FDA advises clinicians to consider infection when a person develops sustained fever of 100.4°F (38°C) or higher for more than four hours, severe abdominal pain, pelvic tenderness, or significant illness after medication abortion.
If you have a persistent fever, severe weakness, worsening pain, or feel seriously unwell, contact a healthcare provider promptly. See when to call a doctor after the abortion pill for the full list of warning signs.
A positive pregnancy test does not automatically mean that the abortion failed.
Pregnancy hormone levels decline gradually after an abortion, and a standard home pregnancy test can remain positive for some time.
That is why the timing and type of follow-up test matter. Depending on your circumstances, a healthcare provider may use a specially timed pregnancy test, blood hCG testing, or ultrasound to determine whether the pregnancy has ended.
ACOG notes that a decrease in serum hCG of at least 80% over 6 to 7 days after starting mifepristone and misoprostol indicates a successful abortion.
Follow-up testing, not symptoms alone, is the reliable way to confirm success. Not every patient needs an ultrasound, since the right method depends on your specific situation.
The most reliable way to determine whether the abortion pill worked is through appropriate follow-up rather than relying only on symptoms.
Your healthcare provider may recommend a specially timed pregnancy test to check whether pregnancy hormones have fallen sufficiently, blood hCG testing to measure hormone levels at different points and confirm they're decreasing as expected, or an ultrasound when there is concern about an ongoing pregnancy, retained tissue, ectopic pregnancy, or another complication.
You do not necessarily need an ultrasound after every medication abortion. Follow-up requirements depend on the medication regimen, pregnancy duration, symptoms, and your healthcare provider's assessment.
These are related but distinct outcomes, and each one calls for a different response, from no treatment at all to additional medication or a procedure.
These conditions are related but not identical.
The appropriate treatment depends on your symptoms, examination and testing, pregnancy duration, and personal preferences. WHO guidance recognizes expectant management, medical treatment with misoprostol, and vacuum aspiration as options for incomplete abortion in clinically stable patients.
You still have options: another dose of medication, an in-clinic procedure, or, in some cases, monitoring the situation rather than intervening right away.
If testing shows that the pregnancy is ongoing, you are not without options.
A healthcare provider may discuss another dose or course of medication, an in-clinic aspiration procedure, expectant management in selected situations, or follow-up monitoring. Our comparison of the abortion pill vs. surgical abortion explains what that in-clinic path involves.
ACOG states that incomplete medication abortion may be managed with repeat misoprostol, uterine aspiration, or expectant management depending on the clinical circumstances and the patient's preferences. Ongoing pregnancy can also be treated with additional medication or uterine aspiration.
If you have taken misoprostol and the pregnancy continues, tell your healthcare provider. Misoprostol exposure during an ongoing pregnancy has been associated with certain fetal abnormalities, so appropriate counseling and follow-up are important.
Very heavy bleeding, severe or worsening pain, fainting, or a high persistent fever mean it's time for urgent care, not a wait-and-see approach.
Some symptoms after taking the abortion pill require urgent attention.
Seek emergency medical care if you experience very heavy bleeding, such as soaking two thick full-size pads per hour for two consecutive hours; severe or worsening abdominal or pelvic pain; fainting or feeling like you may pass out; severe weakness or dizziness; persistent high fever; severe illness or confusion; or symptoms that make you concerned something is seriously wrong.
One particularly important warning sign is severe abdominal or pelvic pain, especially if it occurs with dizziness, fainting, or shoulder pain.
An ectopic pregnancy occurs outside the uterus and can be life-threatening if it ruptures. Mifepristone and misoprostol do not treat an ectopic pregnancy.
When in doubt, it is safer to contact a healthcare professional or seek emergency evaluation. Our guide on abnormal vaginal bleeding covers a related set of warning signs worth knowing.
Yes, fertility can return quickly, and many contraceptive methods can be started right around the time of the abortion.
Yes. Fertility can return quickly after an abortion, as explained in does abortion affect future pregnancies or cause infertility.
If you do not want another pregnancy, talk with a healthcare provider about contraception. Many birth control methods can be started around the time of medication abortion, depending on the method and your medical circumstances. ACOG notes that most contraceptive methods can be initiated immediately, while IUD timing depends on completion of the abortion.
You can learn more about different options in our guide to birth control methods, effectiveness, safety, and side effects.
If you are deciding between different methods, you may also want to review our information about birth control pills: how they work, types, benefits, and risks.
These are not the same thing. One ends an existing pregnancy; the other only works to prevent one before it starts.
The abortion pill and emergency contraception are not the same thing.
Medication abortion ends an existing pregnancy. Emergency contraception helps prevent pregnancy after sex and does not end an established pregnancy.
If you are unsure whether you are pregnant, a pregnancy test can help determine your next step. For information about pregnancy-test timing, see our guides on when you can reliably take a pregnancy test after unprotected sex and pregnancy tests at two weeks: when to test.
If you are looking for emergency contraception rather than abortion medication, you can also learn more about when to take Plan B.
Yes, for eligible patients, with medication sometimes available by mail after a telehealth consultation.
Yes. Medication abortion remains available in California, and eligible patients may be able to receive abortion medication through a telehealth visit, as explained in telehealth abortion safety and privacy and how telehealth abortion works in California for out-of-state patients.
The California Department of Public Health states that patients may be able to receive abortion medication by mail after a telehealth visit with a qualified provider.
California also protects the right to abortion before viability and allows abortion at any time when necessary to protect the patient's life or health. California residents and people traveling to California can access abortion services, and people of any age can independently consent to abortion care under California law. Our page on the importance of confidentiality in abortion care explains how that privacy is protected, and how late you can have an abortion in California covers the state's broader legal timeline.
For someone who prefers privacy, convenience, or the ability to complete an early medication abortion at home, a telehealth consultation can be an accessible way to discuss eligibility, medication instructions, expected symptoms, follow-up, and warning signs.
Her Smart Choice offers abortion care and telehealth consultations to help you understand your options and receive appropriate medical guidance. See abortion care in Los Angeles and first abortion clinic visit in Huntington Park for what an in-person visit looks like, and how much the abortion pill costs in Los Angeles for pricing.
Call your provider, describe your timeline and symptoms, and follow their testing recommendations rather than guessing or self-treating.
If you are worried that the abortion pill did not work, do not take additional medication on your own without medical guidance.
Instead, contact your abortion provider, explain when you took mifepristone and misoprostol and what symptoms you have experienced, tell them how much bleeding and pain you have had, follow their recommendations for pregnancy testing, blood testing, ultrasound, or another evaluation, and seek emergency care if you have severe pain, very heavy bleeding, fainting, or other emergency symptoms.
Remember that bleeding patterns vary. Having little bleeding does not automatically mean the abortion failed, and having a positive pregnancy test soon afterward does not necessarily mean you are still pregnant.
Proper follow-up can provide a much clearer answer. Our checklist of do's and don'ts after the abortion pill covers additional aftercare guidance for this stage, and if you're near the upper edge of the eligible gestational window, abortion at 11 weeks pregnant and breastfeeding safety address two other common special-circumstance questions.
Yes, but failure is uncommon. FDA-reviewed clinical data for mifepristone and misoprostol through 70 days of gestation found a complete medical abortion rate of 97.4% in U.S. clinical trials, with ongoing pregnancy occurring in 0.7% of cases.
Possible signs include continued pregnancy symptoms, little or no bleeding, persistent symptoms of pregnancy, or a follow-up test showing an ongoing pregnancy. Symptoms alone cannot confirm failure.
An incomplete abortion can involve prolonged or heavy bleeding and abdominal pain, but symptoms are not enough to diagnose it. A healthcare provider may use an examination, ultrasound, or laboratory testing to determine whether pregnancy tissue remains.
Yes. Pregnancy hormones can remain in your body after an abortion, so a standard pregnancy test may stay positive for a period of time. Follow your provider's instructions about when and how to test.
A provider may recommend additional medication, monitoring, or an in-clinic aspiration procedure depending on whether the pregnancy is ongoing, tissue remains, and what you prefer.
Often, yes. Depending on the clinical situation, options can include waiting for the tissue to pass naturally or using additional medication. Vacuum aspiration is another option when clinically appropriate.
Seek emergency care for very heavy bleeding, severe or worsening abdominal pain, fainting, severe weakness, or concerning persistent fever or illness.
Eligible patients in California may be able to receive medication abortion through a telehealth visit, with medication potentially delivered by mail.
The abortion pill can fail, but most medication abortions are successful. When failure occurs, it may involve an ongoing pregnancy or an incomplete abortion where pregnancy tissue remains.
The most important thing is knowing the difference between expected abortion symptoms and warning signs that require medical attention. Heavy bleeding, severe pain, persistent fever, fainting, or feeling seriously unwell should never be ignored.
If you are unsure whether your abortion was successful, a healthcare provider can help determine what is happening and discuss the safest next step. Her Smart Choice can provide abortion care and telehealth consultation support so you can get medical guidance without unnecessary delays.
If you are also thinking about preventing another pregnancy after abortion, explore our complete guide to birth control options.
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