The abortion pill has a strong safety record. Approximately 7.5 million people in the United States have used it since its FDA approval in 2000, and serious complications are rare. It is FDA-approved for ending a pregnancy through 10 weeks of gestation and works effectively in about 95 to 99 percent of cases depending on timing.
What the Safety Data Shows
The FDA tracks adverse events reported by patients and providers who use mifepristone, the first of the two medications in the abortion pill regimen. Out of roughly 7.5 million users through the end of 2024, 36 deaths have been reported. That works out to about 0.0005 percent, or roughly 1 in 200,000. For context, a 2024 study published in JAMA Network Open found that carrying a pregnancy to term is approximately 44 to 70 times more likely to result in death than having an abortion, depending on the year analyzed and how causes of death are categorized.
Other serious but non-fatal complications are also uncommon. Across the full reporting period (2000 to 2024), about 1,056 people required a blood transfusion due to heavy bleeding, and around 422 experienced infections. Of those infections, 79 were classified as severe, meaning they required hospitalization for multiple days and intravenous antibiotics. The FDA notes that these reported events can’t always be definitively attributed to the medication itself, since other health factors and conditions may have contributed.
How the Abortion Pill Works
The abortion pill is actually two separate medications taken in sequence. The first, mifepristone, blocks progesterone, the hormone that maintains the uterine lining and supports early pregnancy. Without progesterone, the lining begins to break down. Mifepristone also triggers the body to produce natural prostaglandins, which are chemicals that cause the uterus to contract.
The second medication, misoprostol, is taken 24 to 48 hours later. It intensifies those uterine contractions and helps the body expel the pregnancy tissue. The experience is similar to a heavy, crampy period, though the intensity varies from person to person. Most people pass the pregnancy within a few hours of taking misoprostol.
Effectiveness by Gestational Week
The earlier in pregnancy you take the abortion pill, the more effective it tends to be. In clinical studies of the mifepristone-misoprostol regimen, success rates looked like this:
- Week 4: 99.3 percent
- Week 5: 98.8 percent
- Week 6: 98.1 percent
- Week 7: 98.3 percent
- Week 8: 95.7 percent
The overall success rate through about 8.5 weeks was 98.3 percent. In the small number of cases where the medication doesn’t fully work, a follow-up procedure is needed to complete the process. The FDA approves the regimen for use through 10 weeks (70 days from the first day of your last period).
Normal Side Effects vs. Warning Signs
Cramping and bleeding are not side effects of the abortion pill. They are how it works. Most people experience both within a few hours of taking misoprostol, and the bleeding is typically heavier than a normal period. Nausea, vomiting, diarrhea, and mild fever or chills are also common and usually resolve within a day.
There are specific warning signs that something may be wrong. Soaking through two or more pads per hour for two or more consecutive hours is considered abnormally heavy bleeding and could indicate that tissue has been retained in the uterus. A fever that persists beyond the first day, pain that keeps getting worse rather than gradually improving, or severe pain lasting several days also warrants medical attention. These complications are treatable, but they do require prompt care.
Who Should Not Take It
The abortion pill is not appropriate for everyone. Because mifepristone blocks progesterone and also interacts with the body’s stress hormone system, people with adrenal gland disorders should not use it. It’s also not safe for anyone with an ectopic pregnancy, where the fertilized egg has implanted outside the uterus (typically in a fallopian tube). An ectopic pregnancy requires different treatment, and taking the abortion pill would not resolve it.
People taking long-term blood-thinning medications or those with bleeding disorders face a higher risk of dangerous blood loss. An intrauterine device (IUD) needs to be removed before using the medication. Prescribers certified under the FDA’s program are required to be able to accurately date a pregnancy and rule out ectopic pregnancies before prescribing.
Impact on Future Fertility
A large body of research shows no connection between medication abortion and difficulty getting pregnant later. In one analysis, first-time mothers who had a prior abortion were actually less likely to have needed fertility treatment (about 2 percent) compared with women in their first pregnancy with no prior abortion (about 5 percent), suggesting that abortion does not cause secondary infertility.
The main theoretical risk to future fertility would be a serious uterine or fallopian tube infection, which could lead to scarring. But severe infections after abortion are rare, and the risk has dropped further now that preventive antibiotics are standard practice. There is no evidence that medication abortion increases the risk of ectopic pregnancy, miscarriage, or preterm birth in future pregnancies.
How It’s Prescribed and Dispensed
The abortion pill can only be prescribed by a healthcare provider who is certified through the FDA’s safety program. That provider must be able to date pregnancies accurately, diagnose ectopic pregnancies, and either perform or arrange for surgical care if a complication arises. Since 2023, the FDA no longer requires an in-person visit before prescribing, which means telehealth consultations are permitted. Certified retail and mail-order pharmacies can now dispense the medication directly, with tracked shipping required for any mailed prescriptions.
You will still need to sign a patient agreement form that outlines how the medications work, what to expect, and what symptoms should prompt emergency care. Your prescriber is required to review this with you and ensure you have access to emergency medical facilities if needed.