The abortion pill is actually two different medications taken one to two days apart. The first pill, mifepristone, is swallowed as a single tablet. The second medication, misoprostol, is placed inside your cheeks (not swallowed) 24 to 48 hours later. The entire process happens over a few days, and the FDA approves it for pregnancies up to 10 weeks from the first day of your last period.
Step 1: Mifepristone
On the first day, you take one 200 mg tablet of mifepristone by mouth with water. This pill works by blocking the hormone progesterone, which a pregnancy needs to continue developing. You can eat and drink normally before and after taking it. Most people don’t feel much at this stage. Some experience light nausea or spotting, but significant bleeding usually doesn’t start yet.
Step 2: Misoprostol, 24 to 48 Hours Later
The second step involves four small tablets of misoprostol, totaling 800 mcg. You do not swallow these right away. The most common method is buccal administration: place two tablets between your gum and cheek on each side of your mouth (four tablets total). Let them dissolve for 30 minutes, then swish and swallow whatever remains. Some providers instruct vaginal placement instead, where you insert all four tablets deeply with your fingers.
Timing matters. You need to take the misoprostol no sooner than 24 hours and no later than 48 hours after the mifepristone. Taking it outside that window can reduce how well the process works.
What Happens After the Second Pill
Bleeding and cramping typically begin one to four hours after taking misoprostol. The heaviest bleeding, often with blood clots, occurs over the next several hours. This is the medication working to empty the uterus, and the intensity is significantly heavier than a normal period for most people. Plan to be at home with access to a bathroom, comfortable clothing, heating pads, and thick maxi pads (not tampons) during this time.
After the initial heavy phase, expect heavier-than-normal bleeding for one to two days. It then gradually tapers over the following two to three weeks. Light to moderate spotting can continue for several weeks total. Everyone’s timeline varies, but the most intense part is usually contained within that first day after misoprostol.
Managing Pain and Side Effects
Cramping is the most common side effect, and it can be intense. Ibuprofen is the standard recommendation for pain relief. The World Health Organization and most providers recommend taking it alongside or shortly before the misoprostol. Over-the-counter doses of 400 to 600 mg are typical starting points, though research suggests higher doses may be more effective for this specific type of cramping. Ibuprofen does not interfere with how the medications work.
Other common side effects include nausea, vomiting, diarrhea, chills, and a mild fever. These are caused by the misoprostol and usually resolve within a few hours. Having light snacks, water, and anti-nausea remedies nearby can help. Avoid alcohol for one to two weeks after the procedure.
Signs That Need Medical Attention
Some bleeding is expected and necessary, but certain patterns signal a problem. Soaking through two or more thick pads per hour for two consecutive hours is too much bleeding. A fever above 100.4°F that lasts more than 24 hours, or any fever that develops days after the process, could indicate infection. Foul-smelling discharge is another warning sign. If you have no bleeding at all within 24 hours of taking misoprostol, the medication may not have worked.
Confirming It Worked
A standard home pregnancy test can stay positive for weeks after an abortion because the pregnancy hormone takes time to leave your body. To avoid a misleading result, wait at least two weeks before testing. Use a low-sensitivity pregnancy test if one is provided to you, as these are designed to only detect higher hormone levels. A positive test at the two-week mark may mean the abortion was incomplete, and you should contact your provider.
Most medication abortions are successful. The combination of mifepristone and misoprostol is FDA-approved through 70 days (10 weeks) of gestation, and effectiveness is highest when used earlier in pregnancy. In a small percentage of cases, the process is incomplete and a follow-up procedure is needed.
Practical Tips for the Day
Clear your schedule for at least a full day after taking the misoprostol. Most people feel well enough to return to normal activities within one to two days, but the first 6 to 8 hours can be physically demanding. Stock up on overnight pads, ibuprofen, a heating pad, comfortable clothes, and easy meals beforehand. Having someone nearby for support, even if just available by phone, helps.
Your period will typically return four to six weeks after a medication abortion. Fertility can return almost immediately, so contraception is relevant as soon as you feel ready to be sexually active again, which most providers suggest waiting at least a week for to reduce infection risk.