Misoprostol glossary page — medication used in abortion pill regimen
Medication · Abortion pill
Misoprostol
/ ˌmɪs.oʊˈprɒs.tə.lɒl /
Cytotec
Miso
The second pill
Prostaglandin
Misoprostol is a medication used to cause the uterus to contract and end a pregnancy. It is most commonly used as the second step in a two-pill process (after mifepristone), but it can also be used on its own when mifepristone is not available. It has been used safely for decades around the world.
Drug type
Prostaglandin
Synthetic hormone analog
How far along
Up to 12 weeks
When used alone
In use since
1980s
Decades of safe use
Effectiveness
95–98%
With mifepristone
Standard dose
800 mcg
4 tablets of 200 mcg each
WHO listed
Essential medicine
Globally recognized
How does it work?
Misoprostol works by triggering contractions in the uterus. It binds to prostaglandin receptors in the uterine wall, causing the muscles to tighten and push out the pregnancy. It also softens and opens (dilates) the cervix to help the process along.
When used after mifepristone (which blocks the pregnancy hormone first), misoprostol is much more effective — the uterus is already primed and responds quickly.
Think of it this way: Mifepristone stops the pregnancy from progressing. Misoprostol then signals the uterus to complete the process. Together they work as a team — and that’s why the two-pill method is so effective.
How is it taken?
Misoprostol can be placed in two ways. Your provider or care instructions will tell you which method to use:
Most common
Buccal (in the cheeks)
Place 4 tablets between your cheek and gum — 2 on each side. Let them dissolve for 30 minutes, then swallow whatever remains with water.
Easy to use at home. No special preparation needed.
Also used
Sublingual (under the tongue)
Place 4 tablets under the tongue and let them dissolve for 30 minutes, then swallow the rest. Slightly more side effects but works equally well.
Often used in regions where buccal is not advised.
Alternative
Vaginal
Tablets are placed inside the vagina and left to dissolve. Fewer digestive side effects, but some people prefer not to use this method at home.
Just as effective as buccal when used correctly.
Tip
Timing matters
When taken after mifepristone, wait 24–48 hours before using misoprostol. This gap gives mifepristone time to work and increases overall effectiveness.
Do not take both pills at the same time.
What to expect — a timeline
Here’s what typically happens after you take misoprostol:
30 min – 2 hours after taking
Cramping begins. This is the medication starting to work. Cramping can be strong — similar to heavy period cramps or early labor. Take ibuprofen beforehand if possible.
1 – 4 hours
Heavy bleeding starts. You may pass clots or tissue — this is expected and means the medication is working. Some people also have nausea, diarrhea, or chills during this stage.
4 – 8 hours
The most intense cramping and bleeding typically passes. The pregnancy is usually expelled during this window. You may feel tired and emotionally drained — that’s completely normal.
Days 1 – 3
Lighter bleeding continues, similar to a period. Some spotting can last up to 2 weeks. Cramping should gradually reduce.
Around 2 weeks later
A follow-up is recommended — either a home pregnancy test or a telehealth check-in — to confirm the process is complete.
How effective is it?
95–98%
Mifepristone + Misoprostol at 10 weeks or earlier
~80–85%
Misoprostol used alone (single dose) — still a valid, WHO-approved method
~87%
Misoprostol alone with a repeat dose after 3 hours
2–5%
Incomplete process — may need additional medication or care
Mifepristone + Misoprostol vs. Misoprostol alone
Both are valid options. Here’s a quick comparison to help you understand the difference:
Mife + Miso (two-pill method)
- 95–98% effective
- Gold-standard method
- Recommended up to 10 weeks
- Two steps, 24–48 hrs apart
- Fewer incomplete cases
Misoprostol only
- ~80–87% effective
- WHO-approved method
- Used when mife unavailable
- One step (may repeat dose)
- More cramping & nausea
Safety & what to expect
Misoprostol is very well studied and considered safe. Most side effects are short-lived and are a sign the medication is working.
Normal side effects
- Strong cramping
- Heavy bleeding and clots
- Nausea or vomiting
- Diarrhea
- Chills or low fever
- Headache
- Tiredness
Seek medical care if you have
- Soaking 2+ pads/hour for 2+ hours
- Fever over 101°F for more than 24 hrs
- No bleeding within 24 hours of taking it
- Severe pain not eased by ibuprofen
- Signs of infection (bad odor, discharge)
- Feeling very weak or faint
Do not use misoprostol if you have:
- A confirmed or suspected ectopic pregnancy — this is a medical emergency that pills cannot treat
- An IUD in place (it must be removed first)
- A known allergy to misoprostol or other prostaglandins
- Severe adrenal or clotting disorders (talk to a provider)
A note on ectopic pregnancy: Misoprostol cannot treat an ectopic pregnancy (a pregnancy outside the uterus). If you have unexplained sharp pain on one side, shoulder pain, or heavy bleeding before taking any pills, please seek emergency care right away.
Misoprostol & access
Misoprostol is more widely available than mifepristone because it is also used for other medical conditions (like stomach ulcers). In many countries it can be purchased over the counter.
In the United States, access varies by state. In states where abortion is legal, it is often prescribed via telehealth and delivered by mail along with mifepristone as a combined kit.
Laws around abortion pill access change frequently. For the most current information in your state, visit Plan C (plancpills.org) or the Guttmacher Institute.
Legal status last reviewed: May 2025
Legal status last reviewed: May 2025
Common myths — cleared up
Myth: “Misoprostol is only an abortion medication.”
Fact: Misoprostol is used for many medical purposes — treating stomach ulcers, managing postpartum bleeding, and helping with labor induction. It has been approved in many countries for these uses for decades. This is also why it’s more widely available than mifepristone.
Myth: “You need to be in a clinic to take misoprostol.”
Fact: In states where abortion is legal, misoprostol (and mifepristone) can be prescribed through telehealth and taken safely at home. Many people complete a medication abortion entirely at home with support from a remote care team.
Myth: “If misoprostol alone is used, it must not be safe.”
Fact: Misoprostol alone is a WHO-approved method for medication abortion. It is used around the world — especially in countries where mifepristone is harder to access — and is considered safe and effective when taken correctly.
Myth: “Using misoprostol will affect future pregnancies.”
Fact: There is no evidence that misoprostol affects future fertility. Organizations including the WHO and ACOG confirm it does not increase the risk of miscarriage, preterm birth, or infertility in future pregnancies.
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Sources & further reading
WHO — Medical management of abortion, 2018. WHO Essential Medicines List — Mifepristone + Misoprostol. who.int
ACOG — Medication Abortion Up to 70 Days of Gestation — Practice Bulletin No. 225. acog.org
Plan C — State-by-state guide to accessing abortion pills. plancpills.org
Guttmacher Institute — Medication Abortion — State policy tracker and research. guttmacher.org
RCOG — Best Practice in Comprehensive Abortion Care. rcog.org.uk
Reproductive Health Access Project — Misoprostol Alone for Early Abortion. reproductiveaccess.org
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