In 2012, the abortion pill — also known as medication abortion or medical abortion — made up nearly 21 percent of all abortion procedures in the US, and that number is only growing since the FDA relaxed guidelines on the procedure in 2016. The procedure is non-invasive, doesn’t require anesthesia, and can almost always be carried out from the comfort of your home. To shed some light on this safe and effective procedure, here are all the basics on medication abortions.

What it is

A medication abortion is not just one “abortion pill,” but a combination of two medications prescribed by a physician that work together to terminate a pregnancy and shed the uterine lining. The two medicines used are mifepristone and misoprostol. Mifepristone, which is taken first, works by blocking progesterone — a hormone necessary to sustain pregnancy — and causing the embryo to detach from the uterine wall. Misoprostol is taken within a day or two after taking the first pill, usually at home, and works by causing cramping that empties the uterus, kind of like a period.

According to stats from Planned Parenthood, a medication abortion is 98 percent effective up to eight weeks into a pregnancy. From 8-9 weeks, it’s about 96 percent effective, and then 93 percent effective from 9-10 weeks.

Who can use it

Medication abortion is a safe (and common) procedure for terminating first-trimester pregnancies. In 2016, the FDA extended the window of approval for medication abortions from seven weeks to 10 weeks, or about two months after the first day of your last period. After 10 weeks (or on day 71 after the first day of your last period), you can opt to have an in-clinic abortion. People under 18 are able to have medication abortions, though most states require some sort of parental consent (in some cases, you need consent from two parents).

How to get it

This part gets tricky because states keep changing their regulations surrounding medication abortion. For the most part, medication abortion is available nationwide at clinics like Planned Parenthood (you can search their site to see if your local clinic provides the procedure). Locally, your regular OB/GYN or local county health clinic may also be able to provide a medication abortion. To find a provider nearby, you can call the National Abortion Federation or check online at the Safe Place Project. Both of those resources allow you to search anonymously if you have privacy concerns.

Different states have different laws regulating when and how someone can actually get a medication abortion. A slight majority of states have mandatory waiting periods ranging anywhere from 24-72 hours between receiving abortion counseling and beginning any type of abortion procedure. In Texas — a state with some of the most restrictive laws surrounding abortion care — the law requires a mandatory, in-person consultation appointment with a physician at least 24 hours before taking the first pill. But that requirement doesn’t exist in states like Florida, Connecticut, and Delaware, all of which have fewer restrictions. Several states also require you to be in the physical presence of the doctor who prescribed the medication.

What to expect

Your physician will give you a pregnancy test and, in some states, perform a mandatory ultrasound to determine how far along you are. You’ll get written instructions from your physician on how to take the pills. Most people don’t experience any side effects after taking the first pill, mifepristone, but it’s not unusual to feel nauseous or start bleeding. Because its job is to cause the uterine lining to shed, misoprostol should cause a lot of bleeding and cramping within one to four hours of taking the first dose. Some people say this cramping feels “like normal period cramps” and don’t experience intense bleeding, but you may feel nauseous and experience intense cramping and heavy bleeding (think, soaking through a maxi pad).

It’s not abnormal to see large clumps of tissue or blood clots after taking the misoprostol (Planned Parenthood says these can be up to the size of a lemon). The bleeding should start to subside after a few hours, usually around four to five, but can take longer. Cramping will continue for a day or two and decrease in intensity with time. If you’re feeling pain or nausea, your doctor can prescribe an anti-nausea medication and you can take ibuprofen — just don’t take aspirin, which is a blood thinner and can cause more bleeding.

Bleeding and spotting might continue for two to three weeks after the abortion. Your doctor will have you come back in for a follow up, where you’ll get a blood test and possibly another ultrasound to make sure the abortion was complete and you’re healthy.

What the side effects are

Most people compare medication abortion to the feeling of an early miscarriage — so the primary physical effects are bleeding and cramping. But other side effects include nausea, vomiting, diarrhea, dizziness, fatigue, and a mild fever up to about 100 degrees. If you have a fever higher than that, or the day after you take the misoprostol, you should call your doctor immediately. The risk of infection with a medication abortion is very low but not totally impossible. You doctor can prescribe antibiotics if you have an infection.

How safe it is

An oft-cited Princeton study from 2012 found that less than 1 percent of people who got medication abortions at Planned Parenthood from 2009-2010 had a serious side effect or incomplete abortion. The most common adverse outcome is that the abortion is incomplete, and patients can then decide between taking more medication or having an in-clinic abortion.

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Hannah Smothers Hannah writes about health, sex, and relationships for Cosmopolitan, and you can follow her on Twitter and Instagram

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