A pill abortion (medication abortion) uses two different medications, taken one to two days apart, to end a pregnancy up to 10 weeks from the first day of your last menstrual period. The first pill stops the pregnancy from progressing, and the second causes the uterus to empty. The process is FDA-approved through 70 days of gestation and has been used by roughly 5.9 million people in the United States since it became available in 2000.
The Two Medications and What They Do
The process relies on two drugs that work in sequence. The first, mifepristone, blocks progesterone, the hormone that maintains the uterine lining and supports early pregnancy. Without progesterone’s signal, the lining begins to break down. Blood vessels supplying the lining are disrupted, and the uterus starts to contract on its own. Essentially, mifepristone removes the hormonal support the pregnancy depends on.
The second medication, misoprostol, is taken 24 to 48 hours later. It’s a synthetic version of a natural compound called prostaglandin, which softens and opens the cervix while triggering strong uterine contractions. Those contractions push the pregnancy tissue out of the uterus, similar to what happens during a miscarriage. Misoprostol can be taken by mouth (held in the cheeks until dissolved) or inserted vaginally.
Step-by-Step Timeline
On day one, you take one tablet of mifepristone by mouth. Some people experience light spotting or mild nausea afterward, but most feel relatively normal during this stage. The medication is working at a cellular level, but the main physical process hasn’t started yet.
Between 24 and 48 hours later, you take misoprostol. This is when the active part of the process begins. Within one to four hours of taking misoprostol, most people start to experience cramping and bleeding. The cramping can be intense, often stronger than a typical menstrual period, and comes in waves as the uterus contracts. You’ll pass blood clots and tissue, which is the pregnancy and uterine lining leaving the body. The heaviest bleeding and strongest cramps usually last several hours, though the entire experience varies from person to person.
Lighter bleeding and spotting can continue for days or even weeks afterward. An average range is 9 to 16 days of some bleeding, and it can occasionally last up to 30 days.
How Effective It Is
The mifepristone-plus-misoprostol regimen is highly effective. In the first 10 weeks of pregnancy, completion rates are in the range of 95% to 99%, meaning the vast majority of people will not need any further procedure. A small percentage will have an incomplete abortion, where some tissue remains and a follow-up procedure is needed to complete the process.
Effectiveness is slightly lower when misoprostol is used alone without mifepristone (around 97% in studied populations at later gestational ages), and timing between the two medications matters. Studies show that taking misoprostol 24 hours after mifepristone produces a completion rate of about 97%, while taking them simultaneously is nearly as effective at around 96%.
What It Physically Feels Like
The experience after taking misoprostol is the most physically demanding part. Cramping ranges from moderate to severe and typically peaks within the first few hours. Many people compare it to very strong period cramps. Over-the-counter pain relief like ibuprofen can help, and some providers prescribe stronger pain medication for the process.
Along with cramping and bleeding, you may experience nausea, vomiting, diarrhea, chills, or a low-grade fever. These side effects are caused by the misoprostol and usually resolve within a few hours. Seeing blood clots, sometimes large ones, is normal and expected. The heaviest part of the process is typically over within four to six hours, though lighter cramping and bleeding taper off gradually over the following days.
Confirming It Worked
About two weeks after the procedure, you’ll need to confirm that the abortion is complete. This is typically done with a low-sensitivity pregnancy test, which is designed to avoid picking up the small amounts of pregnancy hormone that can linger in your system for a few weeks even after a successful abortion. A standard drugstore pregnancy test taken too soon could give a misleading positive result.
Your provider will either give you the appropriate test to take at home or schedule a follow-up visit. If the test is positive, unclear, or you still have symptoms of pregnancy (breast tenderness, nausea), you’ll need further evaluation. In a small number of cases, a follow-up procedure is needed to remove remaining tissue.
Risks and Complications
Serious complications from medication abortion are uncommon. Out of the approximately 5.9 million people who used the regimen in the U.S. through the end of 2022, the FDA documented a total of about 4,200 adverse event reports across the entire 22-year period. That includes roughly 1,050 hospitalizations (not including deaths) and about 600 cases requiring blood transfusions.
The most common complication is heavy bleeding that doesn’t stop on its own. Some bleeding is completely normal, but soaking through two or more thick pads per hour for two or more consecutive hours is a sign that something is wrong. Infection is another risk, though it’s also rare. The FDA recorded about 418 infections over that same 22-year span, with 75 of those classified as severe.
Signs that need immediate medical attention include heavy sustained bleeding (as described above), fever lasting more than 24 hours, worsening abdominal pain days after the procedure, and foul-smelling vaginal discharge, which can indicate infection.
Who Can Use It
The FDA approves this regimen for pregnancies up to 70 days (10 weeks) from the first day of your last menstrual period. Originally approved in 2000 for use through seven weeks, the window was extended to 10 weeks in 2016. Beyond that point, other methods are used. You’ll need to confirm the pregnancy is intrauterine (inside the uterus), since the medications won’t treat an ectopic pregnancy, which is a medical emergency on its own.
People with certain conditions, such as bleeding disorders, chronic adrenal failure, or an IUD still in place, may not be candidates for medication abortion and would need to discuss alternatives with a provider. Availability also depends on your state’s laws, which vary significantly.