Do you have to take medication after an abortion?

Post-Abortion Medication: What You Need to Know

You do not necessarily have to take medication after an abortion, but pain medication (ibuprofen and acetaminophen) is strongly recommended for symptom management, and antibiotics are recommended before surgical abortion to prevent infection.

Pain Management After Abortion

For Surgical Abortion

• Pain medication is recommended but not mandatory for managing post-procedure cramping and discomfort 1
• Ibuprofen 600-800 mg every 6-8 hours with food is the first-line recommendation for the first 24 hours post-procedure 2
• Acetaminophen 650-975 mg every 6-8 hours can be used alone or in combination with ibuprofen 2
• Most women experience mild-to-moderate pain that resolves within days to weeks 2

For Medical Abortion

• Pain intensity is typically high during medical abortion, with median pain scores of 75/100 and 57.7% of women experiencing severe pain 3
• Ibuprofen 600 mg plus paracetamol 1000 mg should be taken simultaneously with misoprostol administration and repeated up to three times daily as needed 3
• 93.5% of women need additional analgesics beyond prophylactic pain medication during medical abortion 3
• Women with history of dysmenorrhea, baseline anxiety, or those experiencing vomiting during abortion are at higher risk for severe pain 3

Important caveat: Prophylactic pain medication (ibuprofen or acetaminophen with codeine) given before pain onset does not prevent severe pain during medical abortion 4

Antibiotic Use After Abortion

For Surgical Abortion

• Antibiotics should be given BEFORE, not after, surgical abortion 5
• Doxycycline given up to 12 hours before the procedure is the recommended prophylactic regimen 5
• Pre-procedure antibiotics reduce infection rates to less than 1% 5
• Post-procedure antibiotics have not been shown to be effective for prophylaxis and are not recommended 5

For Medical Abortion

• Routine antibiotics after medical abortion remain controversial with no universal requirement established 5, 6
• Treatment-dose antibiotics may decrease the rare risk of serious infection, but the number-needed-to-treat is very high 5
• When doxycycline is prescribed (7-day course), adherence is poor with only 28.3% achieving perfect adherence 6
• Women prescribed doxycycline experience significantly more vomiting (25.2% vs 18.5%) compared to those not given antibiotics 6

Critical distinction: The evidence strongly supports pre-procedure antibiotics for surgical abortion but does not support routine post-procedure antibiotics for either surgical or medical abortion 5

Rh Immunoglobulin (Required for Rh-Negative Women)

• All Rh-negative women MUST receive anti-D immunoglobulin after abortion to prevent alloimmunization 1
• Recommended dose: 50 mcg for incomplete or complete abortion 1
• This is mandatory, not optional, as 32% of spontaneous abortions present with fetomaternal hemorrhage 1

Post-Abortion Monitoring

Warning Signs Requiring Medical Attention

• Fever (may indicate infection) 1, 7
• Foul-smelling vaginal discharge 1
• Worsening pain beyond expected cramping 1
• Heavy bleeding (soaking through more than 2 pads per hour for 2 consecutive hours) 1

Follow-Up Care

• Clinical follow-up to confirm complete resolution 1
• Contraceptive counseling to prevent unintended pregnancy 1
• Psychological support as needed 1

Common Pitfalls to Avoid

• Do not prescribe post-procedure antibiotics for prophylaxis as they lack evidence of efficacy 5
• Do not forget Rh immunoglobulin in Rh-negative women—this is a critical preventive measure 1
• Do not underestimate pain management needs for medical abortion—most women require more than basic analgesics 3
• Do not assume prophylactic pain medication prevents severe pain during medical abortion—it does not 4

Bottom Line

Medication after abortion is recommended but not universally required: pain medication (ibuprofen/acetaminophen) should be offered to all women for symptom management, Rh immunoglobulin is mandatory for Rh-negative women, but routine post-procedure antibiotics are not supported by evidence and should not be prescribed 1, 5.