Background: Current approaches to pain management are inadequate for both aspiration and medication abortion. Our recent placebo controlled trial found that an easily taught auricular acupuncture protocol led to much lower maximum pain during aspiration abortion compared to usual care (median scores 39.5 versus 71 on a 100-point Visual Analog Scale). The intervention also substantially reduced patient anxiety. This trial is to evaluate whether auricular acupuncture can reduce the maximum pain experienced during medication abortion. The proposed treatments could dramatically improve the patient experience during medication abortion. State regulations often limit who can administer acupuncture using needles; therefore, we will also study an auricular acupressure approach that uses no needles and is thus not subject to the same regulations. Methods: We will randomize 150 women seeking medication abortion to auricular acupuncture with needles (as in the previous trial), acupressure (with gold beads), or placebo. All participants will receive usual care comprising dispensing enough oral ibuprofen to allow maximum dosing (up to 2400 mg per day) for four days after receiving mifepristone. Proposed analysis: We will assess pain and anxiety via two-way text messaging for four days, with additional assessments at a return visit one week after mifepristone. The analysis will compare patient-reported pain and anxiety in the three randomization groups. If effective, these interventions have the potential to dramatically reduce pain with medication abortion, reduce medication abortion-related opioid use. Simple, straightforward training means these approaches could be widely available.