Since the Supreme Court overturned Roe v. Wade in June 2022, making it possible for states to ban abortion, there has been a heightened focus on medication abortion, often known as the “abortion pill.” Medication abortion was used for more than half of all abortions in the United States in 2020.
Medication abortion involves taking two medications—mifepristone and misoprostol—at specific times over a couple of days. These medications must be prescribed by an authorized health care provider.
State law bans or restrictions on surgical or procedural abortion may also apply to medication abortion. As the legal landscape of medication abortion is changing rapidly, individuals should consult their state law to determine the legality of medication abortion as it applies to them.
Below, we answer common questions about medication abortion.
How does medication abortion work?
For medication abortion, an individual takes mifepristone, followed by misoprostol up to 48 hours later.
Mifepristone is a medication that blocks progesterone activity in a female’s body. Progesterone is a critical hormone for supporting an early pregnancy. The second medication, misoprostol, causes contractions and expels the pregnancy tissue. It typically takes 12 to 24 hours to pass the tissue.
Mifepristone, in the above-described regimen with misoprostol, is currently approved by the U.S. Food and Drug Administration (FDA) to end a pregnancy through 10 weeks gestation (70 days or less since the first day of the last menstrual period).
What does medication abortion feel like?
After individuals take mifepristone, they likely will not feel anything. After taking the second pill, misoprostol, bleeding and cramps typically arise after a couple of hours. It may feel like a very crampy period with heavy bleeding or an early miscarriage. The further along the pregnancy is, the more discomfort individuals may experience. The cramping and bleeding may be accompanied by chills, nausea, and fever, which are side effects of misoprostol. If nausea, vomiting, fever, or diarrhea persists more than 24 hours after taking the second set of pills, individuals should call their doctor. These symptoms may be a sign of infection.
In most cases, the worst of the bleeding and cramping typically lasts up to 24 hours. It is common to feel tired for one to two days after taking misoprostol, but most people are able to go back to normal activities after the bleeding and cramping have stopped. If there is no bleeding within 24 hours of taking misoprostol, individuals should call their health care provider.
How do you know if the pregnancy has been terminated?
A person can confirm whether the medication abortion was successful by having an ultrasound or a blood test about a week after taking the medications. Because it takes time for pregnancy hormones to subside, an at-home, urine-based pregnancy test takes about a month after the medication abortion to show a negative result.
How early in the pregnancy can you have a medication abortion?
If abortion is permitted under state law, a medication abortion can be started as soon as pregnancy is confirmed. Individuals seeking medication abortion should visit their doctor or health care provider, who will take a medical history.
An ultrasound to confirm that the pregnancy is intrauterine, meaning in the uterus, may also be performed and is required in some states. Notably, a medication abortion will not treat an ectopic pregnancy, in which a fertilized egg implants outside the uterus; rather, prompt medical or surgical intervention for an ectopic pregnancy is necessary.
Individuals should check with their doctor or health care provider to determine whether an ultrasound is required or recommended.
How effective is a medication abortion?
Medication abortion is highly effective, although the risk of its failure does increase as the pregnancy progresses. People seeking this treatment are advised to discuss all options, as well as effectiveness rates and risks, with their medical provider.
If medication abortion does not terminate a pregnancy, a procedural (surgical) abortion* may be recommended.
Or, if the pregnancy is no longer continuing to develop but the tissue has not passed, an individual could decide, in consultation with their medical provider, to either have a procedural abortion or take additional misoprostol*.
As for effectiveness rates, when taken before 64 days of gestation, medication abortion is reported to terminate a pregnancy between 91.6% and 99.7% of the time, depending on how misoprostol is administered, the interval between the dose of mifepristone and misoprostol, and gestational age. Medication abortion is generally more effective earlier in the pregnancy. A second dose of misoprostol* may be prescribed and administered starting at 64 days of gestation to increase effectiveness.
* The procedures and/or steps mentioned above may be recommended by a medical provider only if it is legal in the state in which the person resides or is present. States differ on time periods in which abortion is a legal option and whether and the extent to which there are any exceptions.
What are the risks of medication abortion?
Medication abortion is considered a safe procedure. Complications are rare, but they can include, but are not limited to, pregnancy tissue being left in the uterus, blood clots in the uterus, bleeding too much or for too long, infection, or an ongoing pregnancy. These issues can often be addressed with medication or other treatments.
There is less than a 0.4% risk of serious complications, according to a 2013 review article published in Contraception. From 2000 to June 2022, there have been 28 deaths out of 5.6 million women who have taken mifepristone, according to the FDA. However, “these events can not with certainty be causally attributed to mifepristone” for various reasons, the FDA says.
Still, individuals should watch out for an allergic reaction to either medication (rash, hives, itching, swollen or blistered skin with or without a fever, wheezing, and trouble swallowing, among others), excessive bleeding (saturating two pads per hour for more than two hours), severe stomach pain, severe diarrhea, serious vaginal irritation, pelvic pain, and a fast heartbeat. Individuals experiencing these symptoms should consult with their doctor.
Outside of any rare or serious complications, medication abortion, according to studies, does not affect future pregnancies or overall health.
How does medication abortion affect the menstrual cycle?
It’s normal to have some vaginal bleeding and spotting for a few weeks after medication abortion. Typically, the menstrual period will return four to eight weeks later.
Individuals can have sex after a medication abortion as soon as they feel ready. Because it’s possible to remain pregnant after a medication abortion, a doctor should be consulted before using birth control pills or a device.
This article was medically reviewed by Yale Medicine obstetrician-gynecologist Tessa Madden, MD.
Information provided in Yale Medicine articles is for general informational purposes only. No content in this article should be used as a substitute for medical advice or medical care from your doctor or health care provider. No content in this article should be construed as advice on the legality of medical abortion in the state in which you are located. Always seek the individual advice of your doctor or health care provider with any questions you have regarding a medical condition.
Information in this article was accurate at the time of original publication. Because information about abortion medication is changing rapidly, we encourage you to review your state laws for the latest information and consult with your doctor or health care provider for medical advice relating to the use of medication abortion.