How to Have an Abortion with Mifepristone and Misoprostol

A medication abortion can be performed with Mifepristone and Misoprostol in succession or with Misoprostol alone. This page details information about the combination of Mifepristone and Misoprostol for an abortion with pills. If you can only access Misoprostol, please see this guide.

Before starting

Combining Mifepristone and Misoprostol is very effective (95%) to end a pregnancy that is 13 weeks or less.

Remember this information is useful for an abortion with pills in pregnancies that are 13 weeks or less counted from the first day of your last menstrual period.
If you are more than 13 weeks pregnant, the process is different and requires special care, so please reach out to our team for the right guidance and available options.

To confirm that this method is safe for you, we recommend reading the previous section about contraindications for using abortion pills. If you are not sure that this procedure is a good option for you, contact us.

Mifepristone and Misoprostol Dosage

For an abortion at less than 13 weeks of pregnancy you’ll need:
One 200 mg Mifepristone pill, and
At least four 200 mcg Misoprostol pills.

However, it’s better to have an extra dose of four misoprostol pills (an additional 800 mcg), equalling a total of eight misoprostol pills (1600 mcg), because you might need to take all of them to ensure the abortion is complete, especially if you are 9-13 weeks pregnant.

If you only have four misoprostol pills, you can still use them.

Good to know: 200 mg of mifepristone and 200 mcg of misoprostol are the most common dosages, but if the pills you have different dosages of mg and/or mcg, you will need to recalculate the total number of pills so you can use the correct amount of medication.

If you have any questions, please do not hesitate to contact us. We are here to support you throughout your abortion process.

How to take Mifepristone and Misoprostol for a safe abortion

Step 1: Take the mifepristone pill with water.

Swallow one 200 mg mifepristone pill with a glass of water.

If you throw up in the first 30 minutes after taking the mifepristone, it will most likely not work. In this instance, if you have an extra mifepristone pill, you’ll need to repeat Step 1.

Wait 24 to 48 hours.

Wait 24 to 48 hours before moving on to the next step. Choose any time within that range when you’ll have access to a bathroom and can stay in a safe, comfortable place for at least 12 (or ideally 24) hours as symptoms will start soon after taking misoprostol.

Step 2: Take 800 mg of ibuprofen.

Take a pain reliever like ibuprofen (800 mg) about 30 minutes before using the misoprostol. Acetaminophen or paracetamol (1000 mg) can be used; however, they may not work as well as ibuprofen.

This step is not required, but it is highly recommended. Ibuprofen will reduce the intensity of the cramps and help you manage the possible side effects of misoprostol.

Check the frequently asked questions page for recommendations on alternatives for pain management.

If you have anti-nausea medicine, you can take it now.

Wait 30 minutes.

Wait about 30 minutes after taking the pain reliever before using the misoprostol pills so it can start working. Ibuprofen can be used as needed throughout and after the procedure.

Step 3: Place 4 misoprostol pills under your tongue and hold them there for 30 minutes.

Place four misoprostol pills (200 mcg each) under your tongue. It is very important that the pills remain under your tongue for 30 minutes to allow them time to be absorbed into your system. You can swallow your saliva, but don’t eat or drink anything during these 30 minutes.

After 30 minutes, you can drink some water and swallow what’s left of the pills. Some brands of misoprostol dissolve easily, while others don’t. But don’t worry, whether they dissolve isn’t important. As long as you hold them under your tongue for 30 minutes, they’ll be absorbed and work just fine.

• If you vomit within the 30 minutes that the misoprostol pills are under your tongue, it is likely that they will not work. In this case, you’ll need to immediately repeat Step 3 with a new dose of four misoprostol pills.
• If you vomit after holding the pills under your tongue for 30 minutes, you don’t need to repeat Step 3 as the pills will have already been absorbed into your system.

Misoprostol is used differently from other medicines and can be taken in various ways for an abortion. These instructions will show you how to use it sublingually, by placing the pills under your tongue. Our team recommends this way because the instructions are easy to follow, and it leaves no visible trace of the pills. There are no tests that can detect the medicine in your body.

However, you might prefer a different option based on your situation. According to medical evidence, using misoprostol pills sublingually (under the tongue), buccally (between gum and cheek), or vaginally are equally effective. If you want to learn about other ways to use misoprostol, contact our counseling team for instructions or take a look at our frequently asked questions.

Step 4: Take a second dose of misoprostol if needed.

For pregnancies under 9 weeks:

If you are less than 9 weeks pregnant, you probably won’t need a second dose of misoprostol.

But, if 24 hours have passed since you first dose of the four misoprostol pills and

• you have not had any bleeding,
• the bleeding has been lighter than your regular menstrual period, or
• you’re worried you’re bleeding too little,

you can repeat Step 3 and use four more misoprostol pills the same way as before.

For pregnancies between 9 and 13 weeks:

If you are 9-13 weeks pregnant, it’s recommended that you take a second dose of misoprostol pills. This helps the medication work more effectively and increases the chances of a successful abortion.

Wait for four hours after your first dose of misoprostol, then place four more 200 mcg pills under your tongue. Keep the pills there for 30 minutes, and follow the instructions just like in Step 3.

What to expect after taking mifepristone and misoprostol

Mifepristone

After taking mifepristone, the majority of people will not experience any symptoms; therefore, you can continue with your everyday activities.

Some people experience light bleeding. Even if you bleed, it’s very important to complete all the steps, including taking the misoprostol pills to complete the abortion.

Misoprostol

When taking misoprostol, you will experience cramping and bleeding that could start as soon as 30 minutes after taking the pills, but it may take up to 24 hours. Most people start bleeding within about four to six hours.

Very strong cramping is normal as the uterus contracts to remove the pregnancy. For pain relief you can take ibuprofen, use a hot water bottle, massage between your navel and pubic bone, or sit on the toilet. For nausea, drink clear fluids and eat light meals or snacks.

Pain medication can be used throughout the process. Follow the instructions, do not exceed the recommended daily dosage, and avoid using regular aspirin as it increases the risk of bleeding.

The bleeding may be similar to or heavier than your menstrual period.

You can expect to pass blood clots and tissue, which can be different sizes depending on how far along the pregnancy was. In an early pregnancy, even small blood clots can indicate that the abortion has worked.

For a pregnancy of more than 10 weeks, you might see or feel the embryo or fetus when it passes. This is a natural part of the process, and it’s completely normal. If this happens, you can choose to wrap it in sanitary pads or dispose of it by flushing it down the toilet – whatever feels right for you.

This is all normal and means the medication is working. We’re available to support you if you need to talk.

The duration of heavy bleeding and intensity of the cramps varies from person to person. Each abortion experience is different.

It’s okay if the bleeding stops and starts, and it can continue until your next period, which often happens within four to six weeks.

Pregnancy symptoms

Both bleeding and pregnancy symptoms should gradually improve over the next few weeks. Most people will stop having pregnancy symptoms like nausea and frequent urination within a few days. Breast tenderness is often the last symptom to go away and can take up to 10 days to subside after using misoprostol. If your pregnancy symptoms start to decrease a few days after using the pills, it is a sign that the abortion worked.

Side effects of Mifepristone and Misoprostol

Most people don’t experience side effects after taking mifepristone, but some might feel nauseous or bleed lightly.

Misoprostol can cause

• diarrhea
• nausea
• vomiting
• dizziness
• stomachache
• headache
• fever, and
• chills

Warning signs: seeking help

It is important to pay attention to your body and how you feel throughout the entire process. Although not common, there are some warning signs that require immediate medical attention.

Get medical help right away if you:

• If you fill two or more pads (completely soaked front to back, side to side) in one hour or less and it lasts for two consecutive hours or more.
• If you have a fever of 38 degrees Celsius (100.4°F) that starts 24 hours after using the last dose of misoprostol and does not go down after taking ibuprofen (confirm with a thermometer).
• If you experience severe pain that does not get better after taking pain medication like ibuprofen.
• If you feel very sick or the color and/or smell of your blood is very different from your regular period – blood can smell unpleasant and be brown, dark, or bright red, but if you have foul-smelling discharge that’s another color, it may be an infection;
• If you experience redness, itchiness, or a swollen neck, face, or hands – it is likely that you are having an allergic reaction to the medication. You can use an antihistamine, but if you find it difficult to breathe then the allergic reaction is very serious and you need medical care immediately.

Remember, if you need to seek medical attention, you do not have to say that you used abortion pills to induce an abortion as the pills will not be detectable if you used them under your tongue.

Precautions and self-care after an abortion with pills

In the weeks following your abortion with pills, consider these tips and precautions:

• Use pads to see how much you are bleeding during the first few days of the abortion; but then, you can switch to tampons or a cup.
• You can return to your normal activities (exercise, work, etc.) as soon as you feel ready.
• You can have sex whenever you are ready; the most important thing is to listen to your body. Be aware that you can get pregnant again very shortly after an abortion – within as little as two weeks – even if you are still bleeding.
• If you want to do a pregnancy test after an abortion to make sure it was successful, do it after four to five weeks. Doing the test sooner may give a false positive result. If the test is still positive at five weeks or if you still have pregnancy symptoms, contact our team for further support.
• It’s normal to feel different emotions after a pregnancy ends. Some people feel better right away, and others need more time. If you need support, talking about your feelings with someone you trust can help.