Mifepristone vs. Misoprostol: What Each Pill Does

Mifepristone and misoprostol are the two FDA-approved medicines used in the abortion pill process. They work in different ways and are taken at different times, and together they are 93 to 98% effective at ending an early pregnancy.

Mifepristone is the first pill. It blocks a hormone called progesterone that the pregnancy needs to keep growing, so the pregnancy stops developing. You take mifepristone at the clinic during your appointment with the doctor.

Misoprostol is the second medicine. It makes the uterus cramp and empty, much like a miscarriage. You take it at home 24 to 48 hours after mifepristone, and this is the step where you will have cramping and bleeding as the pregnancy passes.

Mifepristone blocks progesterone, a hormone your body makes during pregnancy. Progesterone keeps the lining of the uterus thick and nourished so the pregnancy can grow. When mifepristone blocks it, the lining starts to break down and the pregnancy cannot continue.

You take mifepristone as one pill by mouth at the clinic. The doctor gives it to you at your appointment after an ultrasound confirms how far along you are. The pill is small and easy to swallow.

Most patients feel little from mifepristone by itself. Some have light spotting or mild nausea, but many feel normal, and the big changes come after you take misoprostol the next day. In the meantime, mifepristone is quietly getting your body ready for the second medicine.

Misoprostol makes the uterus cramp and push out the pregnancy tissue. It softens the cervix and sets off cramping, much like a heavy period or an early miscarriage. This is the active step of the abortion pill process.

You take misoprostol at home, 24 to 48 hours after mifepristone. The standard way is to place four tablets between your cheeks and gums (two on each side) and let them dissolve for 30 minutes, and if any pieces are left after that you can swallow them with water.

Cramping and bleeding usually start within 1 to 4 hours of taking misoprostol. The cramps can be strong, like intense period cramps, and the bleeding will be heavier than a normal period with some blood clots. Most patients pass the pregnancy within 4 to 5 hours, and the doctor will explain how to manage the pain before you leave the clinic.

The abortion pill process usually takes 2 to 3 days. Here is what happens at each step.

Day 1 (at the clinic): You take mifepristone by mouth at your appointment. The doctor does an ultrasound, goes over your health history, and explains the next steps. The visit takes about an hour, and you can drive yourself home and go about your day.

Day 2 or 3 (at home): You take misoprostol 24 to 48 hours after mifepristone. Plan to be home for at least 4 to 6 hours, with a bathroom close by, a heating pad, and ibuprofen for cramps. Most patients pass the pregnancy within 4 to 5 hours.

1 to 2 weeks later: You come back to the clinic for a follow-up visit to confirm the abortion is complete. This visit is included in the $380 cost, and if everything looks normal, no further treatment is needed.

After taking misoprostol you will have cramping and bleeding, and that is how the medicine works. The cramps may feel like strong period cramps, and the bleeding will be heavier than a typical period.

Most patients pass the pregnancy within 4 to 5 hours of taking misoprostol. You may see large blood clots, which is normal. The heaviest bleeding usually lasts 3 to 5 hours and then slowly eases, and lighter bleeding or spotting can continue for 1 to 3 weeks after.

Other common side effects include nausea, vomiting, diarrhea, chills, and a mild fever. These are temporary and usually go away within 24 hours. Ibuprofen (up to 800 mg every 6 to 8 hours) is recommended for cramps, and a heating pad on your lower belly can also help.

Contact the clinic if you soak through two or more thick pads in one hour for two or more hours in a row, have a fever above 100.4°F that lasts more than 24 hours, or have severe pain that ibuprofen does not relieve.

Using both medicines together works much better than using either one alone. Studies show the two-drug combination is 93 to 98% effective, compared to about 80 to 85% for misoprostol used by itself.

Each medicine has its own job. Mifepristone stops the pregnancy from growing by blocking progesterone, and misoprostol then makes the uterus cramp and empty. By the time you take misoprostol, mifepristone has already stopped the pregnancy, so the second medicine can finish the process faster and more fully.

The FDA approved this two-drug plan in 2000, and millions of patients in the United States and around the world have used it safely. It has been studied for over 25 years and has a strong safety record.

Call The Center for Women at (708) 450-4545 to schedule your appointment. Same-day, evening, and weekend appointments are available.

The clinic is at 10215 W. Roosevelt Rd. #101, Westchester, IL 60154. The doctor will walk you through the whole process at your visit, including how and when to take each medicine. The all-inclusive cost of $380 covers your appointment, ultrasound, both medicines, and follow-up visit.