The two pills used in medication abortion are mifepristone and misoprostol. They are taken sequentially, usually 24 to 48 hours apart, and are FDA-approved for ending a pregnancy up to 10 weeks (70 days) of gestation. You may also hear the process called “medication abortion” or “medical abortion,” though the pills themselves go by specific drug and brand names.
Mifepristone: The First Pill
Mifepristone is the first pill taken in a medication abortion. It works by blocking progesterone, a hormone the body needs to sustain a pregnancy. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue. The brand name for mifepristone when used for abortion is Mifeprex, made by Danco Laboratories. Generic versions of mifepristone also exist.
This pill is taken by mouth as a single dose. On its own, mifepristone does not complete the abortion. It prepares the body for the second medication.
Misoprostol: The Second Pill
Misoprostol is the second pill, taken 24 to 48 hours after mifepristone. It causes the uterus to contract and expel the pregnancy, similar to what happens during a miscarriage. Misoprostol is placed inside the cheeks (buccally) and allowed to dissolve rather than swallowed whole. You may recognize its older brand name, Cytotec, though that was originally developed for stomach ulcers and is not specifically branded for abortion use.
In some cases, misoprostol is used on its own without mifepristone, though the two-pill regimen is more effective and is the FDA-approved standard.
How the Two-Pill Regimen Works Together
The combination works in two stages. Mifepristone stops the pregnancy from progressing, and misoprostol then triggers the body to complete the process. Most people begin feeling the effects shortly after taking the second pill. Bleeding and cramping typically start within one to four hours, followed by heavier cramping and bleeding with blood clots over the next several hours. A low-grade fever, chills, nausea, fatigue, dizziness, or diarrhea can also occur and generally resolve within a day.
The heaviest bleeding usually happens in the hours after the second pill, but period-like bleeding can continue for several days. Light to moderate bleeding may last for several weeks afterward. Severe bleeding, defined as soaking through more than two thick pads in an hour, warrants immediate medical attention, as do signs of infection like a fever lasting longer than 24 hours or foul-smelling discharge.
Other Names You Might Hear
The process goes by several names depending on who is talking about it. Healthcare providers typically use “medication abortion” or “medical abortion.” Informally, people call it “the abortion pill,” even though two separate medications are involved. The term “induced abortion” distinguishes it from a miscarriage, which medical professionals call a “spontaneous abortion.” You may also encounter the phrase “chemical abortion” in political or legislative contexts, though this is not a standard medical term.
Abortion Pills Are Not the Morning-After Pill
A common point of confusion is the difference between abortion pills and emergency contraception like Plan B or ella. These are entirely different medications that work in entirely different ways. Morning-after pills prevent pregnancy from occurring in the first place by delaying ovulation. They only work if you are not already pregnant and must be taken soon after unprotected sex. Mifepristone and misoprostol, by contrast, end an existing pregnancy. The two categories are not interchangeable, and taking emergency contraception will not cause an abortion.
How These Pills Are Dispensed
Mifepristone is not available at regular retail pharmacies like most prescriptions. Under the FDA’s safety program (called REMS), it can only be dispensed in clinics, medical offices, and hospitals by or under the supervision of a certified prescriber. This means you cannot simply pick it up at a drugstore counter. Some states have additional restrictions that affect access, including rules around telehealth prescriptions and mailing of the medication. Misoprostol, because it has other approved medical uses, is more widely available at pharmacies, but in the context of abortion it is typically provided alongside mifepristone through the same clinical channels.
What to Expect Physically
The physical experience is often compared to an early miscarriage. After taking misoprostol, cramping can range from moderate to severe, and passing blood clots is normal. Most people manage the process at home with over-the-counter pain relief, a heating pad, and rest. The acute phase, with the heaviest bleeding and cramping, typically resolves within several hours, though everyone’s experience varies.
Signs that something needs medical attention include no bleeding at all within 24 hours of taking misoprostol, severe bleeding that soaks more than two thick pads per hour, severe abdominal or back pain, fever lasting more than 24 hours with foul-smelling discharge, or continued symptoms of pregnancy. A follow-up visit or check-in with a provider is standard to confirm the abortion is complete. If your period has not returned within two months, that also warrants a call to your provider.