How Does the Abortion Pill Work? Here’s How You Get It and Take It

A medical abortion is when you take pills to end a pregnancy. It has been an option for terminating early pregnancies since the FDA first approved mifepristone (Mifeprex) and misoprostol (Cytotec) for this use in 2000. 

Since ancient times, people have used medications and herbs to try to terminate unplanned and unwanted pregnancies. But before the “abortion pill,” the only way to reliably end a pregnancy was a surgical procedure. 

Since the late 1980s in Europe, and since 2000 in the U.S., it has been possible for women to terminate an early pregnancy by taking pills. But since the FDA first approved medical abortion, the regulations surrounding exactly how and where this can happen have changed — and they continue to change. Nevertheless, the “abortion pill” remains a safe and reliable way to terminate early pregnancies in countries all over the world.

What is the ‘abortion pill’?

The term “abortion pill” is a bit confusing, since there isn’t just one pill. A medical abortion is actually a series of prescription pills you take over the course of 2 days — first, mifepristone (Mifeprex), and then misoprostol (Cytotec). 

Other terms people use for these medications are: 

• Abortion pills

• Medication abortion

• RU-486

• At-home abortion

• Plan C

If it’s hard to get access to mifepristone where you live, you can have a medical abortion using misoprostol alone, but it isn’t FDA approved. And it doesn’t work as well as the mifepristone and misoprostol combination. But the World Health Organization (WHO) approves this option for medical abortion whenever mifepristone is not available.

How far along can you take the abortion pill?

In the U.S., the abortion pill combination of mifepristone and misoprostol is only FDA approved for pregnancies that are within 70 days (10 weeks) of your last menstrual period. Globally, the WHO recommends that women should be allowed to self-manage their abortions at home — from start to finish — with abortion pills for up to 12 weeks.

How is the ‘abortion pill’ different from Plan B?

The abortion pill is not the same as Plan B. Plan B is an emergency contraception pill, also known as “the morning after pill.” 

Here’s how they’re different:

• Emergency contraception (EC): This medication prevents a pregnancy. EC blocks fertilization, even if you have sperm and an egg inside you. If you’re already pregnant, EC will not cause an abortion, and it will not harm the fetus.  

• The abortion pill: These medications stop a pregnancy that’s already in progress and make the pregnancy come out of your body.

How does the ‘abortion pill’ work?

The medication mifepristone is the first step of a pill abortion. This stops progesterone, the main hormone that supports the developing pregnancy. This leads the pregnancy to detach from the uterus wall, then it stops growing. Mifepristone also causes the body to release prostaglandins, chemicals that start contractions in the uterus.  

The second step in the pill abortion is the medication misoprostol. This is a lab-made version of these prostaglandins, and it brings on stronger contractions that push the pregnancy out of your body. This can cause cramping and bleeding, similar to a heavy menstrual period or a miscarriage.

Here’s what a typical medical abortion schedule looks like:

• Day 1 — mifepristone: On the first day, you take a 200 mg pill of mifepristone by mouth. This medication blocks progesterone, a hormone your body needs to grow a pregnancy. 

• Day 2 or 3 — misoprostol: In this period, you take four 800 mcg pills of misoprostol, which dissolve in your cheek or vagina. This medication causes your body to push the pregnancy out of your uterus.

• Days 7 to 14 — follow-up: You need a follow-up visit to check that you’re no longer pregnant.

How effective is the abortion pill?

If you take both mifepristone and misoprostol, the abortion pill is very effective at ending a pregnancy that is less than 10 weeks. Overall, it ends a pregnancy more than 97% of the time. The earlier you take it in the pregnancy, the better it works. Pregnancies closer to 11 weeks may need a top-up dose of misoprostol to help complete the abortion.

The follow-up visit after 7 to 14 days is to make sure the abortion pill worked. If it hasn’t worked, then you may need a surgical abortion (procedure) to terminate the pregnancy. 

Can your gynecologist or primary care doctor give you the abortion pill?

They can, but they need to be a certified abortion provider. A certified abortion provider can be a  gynecologist, a primary care provider, or a certified provider in an abortion clinic. A full list of healthcare providers who can prescribe the abortion pill is available through the National Abortion Federation (NAF) or the Abortion Care Network.  

How and where to get the pill

Exactly how and where you can get abortion pills depends largely on which state you live in — and that state’s laws on abortion. 

Once you have been assessed by a certified abortion provider, you may get a prescription for mifepristone and misoprostol. Depending on where you live, that assessment may be in person or virtually, via a telehealth provider (more on this below). 

Next, you’ll need to fill that prescription to get the medications. That can be at a certified hospital, health clinic, pharmacy, or through a mail-order pharmacy. Since January 2023, all retail pharmacies can fill prescriptions for the abortion pill in states where medication abortions are legal.   

Many organizations are working hard to help people who need access to abortion and other reproductive care services: 

• Abortion Finder

• Abortion on Demand

• AidAccess

• ​​ineedana.com

• M+A Hotline

• Plan C

• Planned Parenthood

• Safe2Choose

• Women Help Women

• Women on Web

Can you get the ‘abortion pill’ without a doctor’s visit?

Depending on where you live, you may be able to get a medical abortion without an in-person visit to a provider’s office. 

If your state allows medical abortion prescriptions via telehealth, then you can get an abortion pill without an in-person visit. You might be able to get it delivered to you in the mail or get a prescription sent directly to you or a pharmacy. 

But this isn’t the case everywhere. Many states have laws restricting virtual abortion consultations. These overrule the FDA authorization for virtual abortion prescriptions. 

If this is the case where you live, then you’ll need a minimum of one in-person clinic visit with a certified abortion provider. And, in some states, you may need more in-person visits to supervise your abortion. There are some states in which medication abortions aren’t legally available at all.

Who can’t take the abortion pill?

Some people can’t have a medical abortion, no matter how early the pregnancy is. You should not take an abortion pill if: 

• You have an ectopic pregnancy (your pregnancy is outside of the uterus).

• You have a history of bleeding or clotting problems.

• You take blood thinners. 

• You’ve had an allergic reaction to abortion pills in the past.

• You’re taking long-term corticosteroids.

• You have adrenal gland problems.

• You have a type of porphyria (a genetic condition).

If you have an intrauterine device (IUD), you’ll need to get that removed before a medical abortion. 

In some states, there are parental involvement laws. This means that someone under the age of 18 or 17 who is pregnant needs to notify and/or get consent from one or both parents before getting an abortion. You may be able to get around this with a “judicial bypass,” but this can take time. And you may not have much time if you’re trying to get abortion pills by the tenth week of pregnancy. 

What to expect after a medical abortion

You’ll feel cramping and bleeding after taking mifepristone. This will get worse after taking the second medication — misoprostol. It’s a sign the abortion is working. The cramping and bleeding will get better after a few days and may take a few weeks to settle completely. 

You may also feel unwell for a few days after the abortion, with nausea, chills, and weakness. It’s normal to have a fever for a day after taking misoprostol. 

Here are signs that the abortion may not be going as planned:

• You have a fever for longer than a day.

• Your abdominal pain and cramping are not letting up.

• You develop other new symptoms.

Likewise, if you don’t bleed or cramp at all, then it’s possible the abortion hasn’t worked. 

Either way, don’t delay getting help if you feel something isn’t right. 

Are there long-term risks of a ‘pill abortion’?

There’s good evidence to show that medical abortions are safe and do not increase the risk of problems in the future — like infertility, preeclampsia, ectopic pregnancy, or breast cancer. The research also shows no link between having a pill abortion and an increased risk of mental health disorders, such as depression, anxiety, or post-traumatic stress disorder (PTSD). 

How much does a medical abortion cost?

A medical abortion may cost anywhere from $0 to $1,000, depending on where you live and whether your health insurance covers part or all of it. Call your health insurance provider to find out if your plan will cover any of the costs of a medical abortion.

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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