What mifepristone does and how the process works
Mifepristone is a medication that ends an early pregnancy by blocking progesterone, a hormone the body needs to maintain pregnancy. It is used as the first step in a two-medication abortion process. The medication works by stopping the pregnancy from growing; a second medication called misoprostol, taken one to three days later, causes the uterus to contract and expel the pregnancy tissue.
The process typically takes a few hours to a few days from start to finish. Mifepristone is taken by mouth at a clinic, hospital, or telehealth visit. Misoprostol is usually taken at home, where you can be in a private, comfortable space. Bleeding and cramping begin within hours of taking misoprostol and can last for several hours or longer.
This method is most effective when used before 10 weeks of pregnancy, though some providers use it up to 11 weeks. The success rate is over 99 percent when both medications are taken as directed. If the pregnancy does not end, a surgical procedure may be needed.
Key Takeaways
- Mifepristone blocks progesterone and stops pregnancy growth; misoprostol, taken days later, causes cramping and bleeding to expel the pregnancy.
- The process happens mostly at home and takes a few hours to several days, with heaviest bleeding in the first few hours after misoprostol.
- Medication abortion is over 99 percent effective when both drugs are taken as directed before 10 weeks of pregnancy.
- You will need an ultrasound to confirm pregnancy age and rule out ectopic pregnancy before mifepristone can be prescribed.
- Bleeding and cramping are normal; contact your provider if you have signs of incomplete abortion, infection, or severe bleeding that soaks more than two pads per hour.
Before you take mifepristone: what your provider will check
Before prescribing mifepristone, your provider must confirm the pregnancy is in the uterus (not ectopic, or in the fallopian tube) and measure how far along you are. This requires an ultrasound, which can be done in person or, at some telehealth providers, by having you perform the scan yourself at home with a handheld device and guidance over video.
Your provider will also ask about your medical history. Mifepristone is not used if you have certain conditions: an IUD in place (it must be removed first), a bleeding disorder, or you take blood thinners. Severe liver or kidney disease, uncontrolled high blood pressure, or a severe heart condition may also prevent use. Allergies to mifepristone or misoprostol are rare but will be noted.
You will receive written instructions on how and when to take both medications, what to expect, and when to contact your provider. Some providers require an in-person visit; others offer the entire process by telehealth, with mifepristone mailed to you or picked up at a pharmacy.
How to take mifepristone and what happens next
Mifepristone is taken as a single 200-milligram tablet by mouth. You swallow it whole with water; it can be taken with or without food. Some providers have you take it at the clinic so they can observe you for a short time afterward. Others send you home with the tablet to take privately.
After taking mifepristone, you may feel nothing at all, or you may notice light spotting or mild cramping within hours. Some people have nausea, headache, or fatigue. These side effects are usually mild. You are not required to stay home or take time off work, though some people choose to.
Between one and three days after mifepristone, you take misoprostol. Your provider will tell you the exact timing. Misoprostol is taken as four 200-microgram tablets, either placed in your cheek pouch (buccal), under your tongue (sublingual), or swallowed. Buccal and sublingual routes are more effective than swallowing. You hold the tablets in place for 30 minutes, then swallow any remaining bits with water.
Bleeding, cramping, and what is normal during abortion
Cramping and bleeding begin within 30 minutes to a few hours of taking misoprostol. Cramping is usually moderate to severe and feels like strong menstrual cramps. Ibuprofen (up to 800 milligrams every six hours) and acetaminophen (up to 1,000 milligrams every six hours) both help; you can alternate them. A heating pad on your lower belly also eases pain. Some providers prescribe stronger pain medication if needed.
Bleeding is heaviest in the first few hours and typically includes clots. You may pass tissue that looks like a gestational sac or clots the size of a plum or larger. Bleeding usually slows after a few hours but can continue lightly for one to two weeks, similar to a period. Spotting may come and go for up to four weeks.
Signs that the abortion is complete include a drop in pregnancy symptoms (breast tenderness, nausea), the end of heavy bleeding within a few hours, and a negative pregnancy test after one to two weeks. Your provider may ask you to take a pregnancy test or have a follow-up ultrasound to confirm the pregnancy has ended.
When to contact your provider right away
Contact your provider when ready if you soak through two or more pads per hour for two hours in a row, or if you pass clots larger than a golf ball. These can be signs of incomplete abortion or heavy bleeding that needs treatment. Do not wait to see if it stops on its own.
Also contact your provider if you have signs of infection: fever of 100.4 degrees Fahrenheit or higher that lasts more than four hours, severe abdominal pain that does not ease with medication, foul-smelling vaginal discharge, or chills. Infection is rare but requires prompt care.
If you have chest pain, shortness of breath, or severe headache, call 911 or go to an emergency room. These are not typical side effects and need when ready evaluation. You can also reach out to your provider if you are unsure whether what you are experiencing is normal; they are familiar with the range of what happens during medication abortion.
What happens if the abortion does not complete
In fewer than 1 percent of cases, the pregnancy does not end after both medications are taken. This is called an incomplete abortion. Signs include ongoing pregnancy symptoms, a positive pregnancy test after two weeks, or an ultrasound showing pregnancy tissue still in the uterus.
If this happens, your provider will discuss options: taking misoprostol again, having a surgical abortion (aspiration), or, in rare cases where the pregnancy is still viable, continuing the pregnancy. The choice is yours. A second dose of misoprostol is successful in most cases where the first dose did not work.
Medication abortion versus surgical abortion: what differs
Medication abortion and surgical abortion (aspiration) both end pregnancy safely and effectively. Medication abortion happens mostly at home over several days, with cramping and bleeding you manage yourself. Surgical abortion is a procedure at a clinic or hospital that takes 5 to 10 minutes, with cramping during the procedure but usually less bleeding afterward.
Medication abortion requires two visits or telehealth calls (one to receive mifepristone, one to confirm completion) or one visit if you use telehealth throughout. Surgical abortion is usually one visit. Medication abortion costs less in many places. Both have success rates over 99 percent and similar risks of rare complications like infection or heavy bleeding.
Some people prefer medication abortion for privacy or control; others prefer surgical abortion because it is faster and they do not have to manage bleeding at home. Your provider can discuss which option fits your situation, health history, and preference.
Frequently Asked Questions
Can I take mifepristone if I have an IUD?
No. The IUD must be removed before you take mifepristone because the combination raises the risk of infection and incomplete abortion. Your provider can remove the IUD during the same visit where you would receive mifepristone, and then you can proceed with the medication abortion.
What if I change my mind after taking mifepristone but before taking misoprostol?
If you have not yet taken misoprostol, contact your provider when ready. In some cases, a medication called progesterone can be given to try to reverse the effect of mifepristone, though this is not always successful and is not available everywhere. Time is critical, so call your provider right away if you are uncertain.
Will medication abortion affect my ability to get pregnant in the future?
No. Medication abortion does not damage the uterus or affect fertility. You can become pregnant again as soon as your next cycle. If you do not want to become pregnant, start a birth control method right away; your provider can discuss options during your follow-up visit.
Can I drive myself home after taking mifepristone?
Yes, in most cases. Mifepristone does not cause drowsiness or impair driving. If your provider gives you pain medication or anti-nausea medication at the visit, ask whether it is safe to drive before you leave. For misoprostol at home, you do not need to drive anywhere.
What should I tell my employer or family about why I need time off?
You do not have to tell anyone. If you need to take time off work, you can say you have a medical appointment or personal matter without explaining further. If you do tell someone, that is your choice. Your medical information is private.