The abortion pill is actually two separate medications taken in sequence: mifepristone (brand name Mifeprex) and misoprostol. Together, they end an intrauterine pregnancy up to 10 weeks gestation, which is 70 days from the first day of your last menstrual period. The FDA first approved Mifeprex in September 2000, and a generic version of mifepristone became available in April 2019.
How the Two Pills Work
Mifepristone and misoprostol do two different jobs. Mifepristone goes first. It blocks progesterone, the hormone that maintains pregnancy by keeping the uterine lining intact. Without progesterone’s signal, the lining begins to break down, blood vessels in the uterine wall are disrupted, and the pregnancy can no longer sustain itself. Mifepristone also triggers mild uterine contractions on its own.
Misoprostol is taken 24 to 48 hours later. It causes strong uterine contractions that expel the pregnancy tissue from the uterus. It works by mimicking a natural hormone called prostaglandin, which signals the uterine muscles to contract. The combination of both medications is significantly more effective than either one alone.
How the Process Feels
After swallowing the first pill (mifepristone), most people don’t notice much. The real physical experience begins one to four hours after taking the second pill (misoprostol). Heavy cramping and bleeding with blood clots are normal over the next several hours. Some people also feel tired, nauseated, or dizzy, and may have diarrhea or a low-grade fever lasting about a day.
The heaviest bleeding typically lasts one to two days, then gradually lightens over two to three weeks. Period-like spotting can continue beyond that. For pain, ibuprofen and a heating pad are the standard approach. Taking a pain reliever about 30 minutes before the misoprostol can help get ahead of the cramping.
Effectiveness Rates
The two-pill regimen is highly effective. For pregnancies under 10 weeks, success rates are around 95%. A systematic review of pregnancies between 9 and 12 weeks found a 94.6% success rate. Even in a study of self-managed medication abortion between 9 and 22 weeks, 89.4% of participants completed the process with pills alone, without any procedural intervention.
Safety Profile
Medication abortion has one of the strongest safety records of any outpatient treatment. In a rigorous study tracking over 11,000 patients, only 0.31% experienced a major complication (defined as hospitalization, blood transfusion, or surgery). As of December 2022, 32 deaths had been reported out of roughly 5.9 million people who took mifepristone for medication abortion in the United States. That’s a mortality rate of 0.54 per 100,000 cases, which is lower than the mortality rate associated with childbirth.
Misoprostol Alone as an Alternative
When mifepristone is unavailable or inaccessible, misoprostol can be used on its own. It’s less effective, but it still works for most people. A large meta-analysis covering more than 16,000 patients found that misoprostol-only regimens had a failure rate of about 15%, dropping to around 11% when patients were able to take at least three doses. Ongoing pregnancy (where the pregnancy continued despite treatment) occurred in roughly 6% of cases. The safety profile remained strong: at most 0.2% of patients needed hospitalization or a transfusion.
This makes misoprostol alone a viable option in situations where mifepristone cannot be obtained, though the two-drug combination remains the standard of care.
How These Medications Are Dispensed
Mifepristone is regulated under a special FDA safety program, which means it can only be dispensed by certified prescribers or certified pharmacies. It is not stocked on regular pharmacy shelves the way most prescriptions are. Misoprostol, by contrast, is a widely available generic medication also used for other medical purposes, including preventing stomach ulcers. Your provider will typically supply both medications together or direct you to a certified pharmacy that can fill the prescription, and in many states telehealth consultations with mail delivery are an option.