The abortion pill is actually two separate medications taken 24 to 48 hours apart. The first, mifepristone (200 mg), is swallowed as a regular pill. The second, misoprostol (800 mcg), is placed inside the cheeks and allowed to dissolve. The process is FDA-approved for pregnancies up to 10 weeks gestation and is effective about 95% of the time.
Step 1: Taking Mifepristone
Mifepristone is a single pill taken by mouth with water, just like any other oral medication. This is considered Day 1 of the process. The pill works by blocking progesterone, the hormone that sustains the pregnancy lining. Without progesterone, the lining begins to break down.
Most people feel little to nothing after taking mifepristone. Some experience light nausea or spotting, but significant bleeding at this stage is uncommon. You can go about your normal routine after taking it.
Step 2: Taking Misoprostol
Between 24 and 48 hours after mifepristone, you take four small tablets of misoprostol. These are not swallowed. Instead, you place them buccally, meaning you tuck them into the pouches between your cheeks and gums (two on each side). Let them dissolve for 30 minutes, then swallow whatever remains with water.
This is the medication that causes the uterus to contract and expel the pregnancy tissue. Plan to be at home when you take misoprostol, because cramping and bleeding typically start within 1 to 4 hours.
What to Expect Physically
After the misoprostol, you will experience cramping and heavy bleeding, heavier than a normal period. Most people pass the pregnancy tissue within 4 to 5 hours, though it can take longer. You may see large blood clots, which is normal during this process. The cramping and bleeding slow down noticeably once the tissue has passed.
Lighter bleeding and spotting can continue for days or even a few weeks afterward. Other common side effects include nausea, vomiting, diarrhea, chills, and mild fever in the first few hours after misoprostol. These typically resolve on their own.
How to Prepare
Having the right supplies on hand makes the process much more manageable. Stock up on thick maxi pads (not tampons, which shouldn’t be used during the process). Ibuprofen is the most commonly recommended over-the-counter pain reliever for the cramping. A heating pad or hot water bottle on the lower abdomen also helps considerably.
Keep water, snacks, and something to distract you nearby. Many people find it helpful to have someone with them for support, though it’s not medically required. Clear your schedule for the rest of the day after taking misoprostol. Most people feel well enough to return to normal activities within a day or two.
How to Know It Worked
Pregnancy symptoms like nausea and breast tenderness normally disappear within about 72 hours. The definitive confirmation is a low-sensitivity pregnancy test taken two weeks after the abortion. Testing sooner can produce a false positive because pregnancy hormones take time to leave the body.
If that two-week test is still positive, or if you continue to feel pregnant, contact your provider. In rare cases where the medication doesn’t fully work, a second dose of misoprostol or a brief in-clinic procedure may be needed.
Signs That Need Immediate Attention
Heavy bleeding is expected, but there are thresholds that signal a problem. Soaking more than two thick pads in a single hour is too much and requires emergency care. A fever lasting longer than 24 hours, especially with foul-smelling discharge, can indicate infection. Severe abdominal pain that doesn’t respond to ibuprofen, or no bleeding at all after taking misoprostol, are also reasons to seek help right away.
Who Should Not Use the Abortion Pill
The abortion pill is not safe for ectopic pregnancies, where the embryo implants outside the uterus, usually in a fallopian tube. Medication abortion will not treat an ectopic pregnancy and delaying proper treatment can be dangerous. An ultrasound or clinical evaluation before starting the process confirms that the pregnancy is in the uterus.
If you have an IUD in place, it needs to be removed before taking the medications. People with certain bleeding disorders, chronic adrenal conditions, or allergies to either medication are also not candidates. Your provider will screen for these before prescribing.