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

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

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’s 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 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 that 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 isn’t available.

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 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’ll 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’ll 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’ll need a follow-up visit to check that you’re no longer pregnant.

What side effects can you expect when you take the abortion pill?

It’s normal to feel a bit unwell for a few days after taking the abortion pill. You’ll likely have the following side effects, which are typically signs that the abortion is working:

• Cramping

• Bleeding

• Nausea

• Chills

• Weakness

• Low-grade fever (for less than 24 hours)

Signs that you may need to contact a healthcare professional because the abortion may not be going as planned, include:

• You don’t bleed or cramp at all.

• You have a high fever (greater than 100.9°F) or fever for longer than a day.

• Your abdominal pain and cramping aren’t letting up.

• You have foul-smelling vaginal discharge.

• You develop other new symptoms.

How effective is the abortion pill?

If you take both mifepristone and misoprostol, the abortion pill is very effective at ending a pregnancy that’s less than 10 weeks. Overall, it ends a pregnancy up to 98% of the time. The earlier you take it in the pregnancy, the better it works. Pregnancies that are closer to 11 weeks may need a top-up dose of misoprostol to help complete the abortion.

The follow-up visit is typically scheduled for 7 to 14 days after you took the medication. Its purpose 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. 

Where and how do I get the abortion 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’ve 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. This can be done 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. These include: 

• AbortionFinder

• Abortion on Demand

• Aid Access

• ​​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 shouldn’t 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).

• 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 who’s 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. 

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

There’s good evidence to show that medical abortions are safe and don’t increase the risk of problems — like infertility, preeclampsia, ectopic pregnancy, or breast cancer — in the future. 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.

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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:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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