The Abortion Pill: How Mifepristone & Misoprostol Work, What to Expect

The abortion pill is the most widely used medication in reproductive health care, and has been used in more than 60% of all abortions in the United States since 2023. The abortion pill is two pills taken in a series, and has been proven safe and effective for decades when taken as directed by a health care provider. Here's what you need to know about how the abortion pill works, what the experience is like, the cost, side effects and when to seek medical attention.

We've sourced this guide from the Food and Drug Administration labeling, the American College of Obstetricians and Gynecologists, the World Health Organization (WHO) and research studies. The legality of abortion varies across U.S. states, so this guide will not cover the legal aspects. For state law, consult trusted sources such as AbortionFinder or your state's health department.

What is medication abortion?

Medication abortion is a way to end a pregnancy using prescription medication. It uses two prescription drugs: one (mifepristone) blocks the hormone progesterone that pregnancy relies on and the other (misoprostol) stimulates the uterus to contract and pass the pregnancy. Together the drugs terminate and expel the pregnancy, usually within 1-2 days.

Mifepristone was first approved by the FDA in 2000. In 2023, it's available through telehealth and be dispensed by mail-order and retail pharmacies certified to dispense medication when abortion is legal in the state. The two-pill regimen can be used up to 10 weeks (70 days) of pregnancy, counted from the first day of the last menstrual period.

Mifepristone and misoprostol are listed by the World Health Organization (WHO) as essential medicines, and clinical trials demonstrate the regimen is greater than 95% effective when taken according to instructions and within the approved time frame.

How does the abortion pill work?

The abortion pill is a two-step process to terminate a pregnancy. The first pill (mifepristone) stops progesterone, the hormone that maintains the pregnancy in the lining of the womb. Misoprostol (the second medication, taken 24-48 hours after mifepristone) makes the uterus contract and expel the pregnancy. The procedure takes 4-24 hours after misoprostol.

A systematic review in Obstetrics & Gynecology in 2022, which looked at over 30,000 patients, found this regime successfully terminated pregnancy in 97% of people at 9 weeks or less, and in fewer than 1 in 300 people had serious complications.

Mifepristone is taken in a clinic, by mail from a certified telehealth service or a certified pharmacy on prescription. Misoprostol is taken home and inserted in the cheek or vagina as directed by the clinician. A painkiller and antiemetic (anti-nausea) medication are generally prescribed with this medication.

Abortion pill timeline: what to expect

The abortion pill timeline runs from the first dose through follow-up, typically 1 to 2 weeks total. The table below shows what most people experience, based on FDA prescribing information and ACOG patient guidance.

Bleeding heavier than a normal period is expected, and passing clots up to the size of a lemon is normal. The cramping is often described as stronger than typical menstrual cramps and comes in waves. A heating pad, ibuprofen taken as prescribed, and rest help most people manage it.

A health companion app like August AI can help you log symptoms, bleeding, and pain levels day by day, and notice if anything falls outside the expected range so you know when to call your provider.

Abortion pill side effects

Abortion pill side effects include heavy bleeding, severe cramping, vomiting, diarrhoea, chills, fever, feeling sick, headache and fatigue. They are common and usually stop within a day of taking misoprostol. Side effects show the medicine is working, not that there's a problem.

Side effects usually disappear within 24 hours. Bleeding improves in 2-3 days and recovery is usually complete in 1-2 weeks. The FDA's adverse event reports and a 2020 analysis in the New England Journal of Medicine confirm that severe complications (requiring hospitalisation, blood transfusion or major infection) happen in less than 1 in 300 cases. This is safer than many low-risk surgeries, such as wisdom tooth extraction.

Results that require immediate medical care include passing two thick maxi pads an hour for two consecutive hours, a fever of 100.4°F or more that lasts over 24 hours after taking misoprostol, severe pain that does not improve with pain medication, or no bleeding within 24 hours of misoprostol.

Abortion pill cost in the U.S.

Abortion pill cost ranges from $0 to about $800 in the U.S., depending on insurance, state, and provider. Most clinics list a self-pay price between $300 and $600, while certified telehealth services often charge $150 to $300. Some insurance plans, including Medicaid in certain states, cover medication abortion in full.

Cost factors include:

• Whether you have health insurance and what your plan covers

• The state where you live (Medicaid coverage varies widely)

• Whether you use an in-person clinic or a telehealth service

• Whether the visit includes lab tests, an ultrasound, or follow-up care

Several nonprofit abortion funds help cover costs for people who can't afford the out-of-pocket price. The National Network of Abortion Funds maintains a directory of local funds.

Abortion pill online: telehealth access

Getting the abortion pill online has become more common since the FDA permanently lifted the in-person dispensing requirement in 2021 and certified retail pharmacies in 2023. In states where abortion remains legal, certified telehealth services can prescribe mifepristone and misoprostol after a video or text consultation, then ship the medication to your home or send the prescription to a certified local pharmacy.

A 2022 study in JAMA Internal Medicine of more than 3,700 telehealth medication abortions found effectiveness and safety equal to in-person care, with 95% of patients reporting they were satisfied with the experience.

State law determines whether telehealth abortion is available where you live. Verified directories like AbortionFinder and INeedAnA list providers serving each state and flag legal restrictions.

Abortion pill vs surgical procedure

The abortion pill vs surgical procedure decision often comes down to how far along the pregnancy is, personal preference, and access. Both are safe and effective when performed in their appropriate windows, according to ACOG clinical guidance.

Some people choose medication abortion because it feels more private and natural. Others choose a surgical procedure because it's faster and they want to be done in one visit. Neither option is "easier" overall. They're different experiences.

When to call your provider or go to the ER

Most people complete medication abortion safely without medical contact beyond their planned follow-up. Some symptoms need urgent attention.

Call your provider within 24 hours if you have:

• No bleeding at all within 24 hours of taking misoprostol

• Bleeding lighter than a normal period (could mean the pregnancy continued)

• Fever above 100.4°F lasting more than 24 hours after misoprostol

• Foul-smelling vaginal discharge

• Heavy bleeding lasting more than 2 days at peak

Go to the ER or call 911 for:

• Soaking through 2 or more thick maxi pads per hour for 2 hours in a row

• Severe abdominal pain not relieved by prescribed medication

• Fainting or severe dizziness

• Signs of an allergic reaction (hives, swelling, trouble breathing)

• Heavy bleeding with shoulder tip pain (a possible sign of ectopic pregnancy that wasn't caught earlier)

For symptoms that feel off but aren't clearly emergencies, August AI lets you describe what you're experiencing in plain language and helps you decide whether to wait, call your provider, or go to the ER. It saves the conversation so you can share it with your clinician later.

Key Takeaways

The abortion pill is a two-medication regimen (mifepristone followed by misoprostol) that safely ends an early pregnancy in 95 to 97% of cases when used within 10 weeks. The full process usually runs 4 to 24 hours after the second medication, with bleeding and cramps similar to a heavy period. Costs range from $0 with insurance or fund support to about $800 self-pay. Telehealth access has expanded since 2021 in states where abortion remains legal. 

Side effects are common but rarely serious, with complications affecting fewer than 1 in 300 people. Heavy bleeding that soaks through 2 pads per hour for 2 hours, fever lasting beyond 24 hours, or severe pain not relieved by medication need urgent care. Future fertility is not affected. State law determines access and timeline, so check verified directories before scheduling.