Using the Abortion Pill (RU486)

What to Expect During a Medical Abortion


On June 24, 2022, the Supreme Court overturned Roe v. Wade—ending the constitutional right to abortion. Following that ruling, some states have enforced bans or severe restrictions on abortion. President Joe Biden has since signed an Executive Order to help protect some abortion access.

A medical abortion involves taking two different types of medicine: Mifeprex (mifepristone) and Cytotec (misoprostol). Mifepristone, also known as RU486 and "the abortion pill," is taken to induce a medical abortion, which is the termination of pregnancy using hormones instead of an interventional procedure. Misoprostol is taken 24 to 48 hours after mifepristone to pass the pregnancy.

Mifepristone has a Risk Evaluation and Mitigation Strategy (REMS) program and can only be obtained from certified prescribers in clinics, medical offices, and hospitals or from certified pharmacies in-store or through mail order, with a prescription from a certified prescriber.

Both medications can be taken at home, and the process of passing the pregnancy tissue can take between four and five hours. This type of abortion is between 87% and 98% effective.

Your healthcare provider will assess whether Mifeprex and misoprostol worked during your follow-up visit, which is seven to 14 days after you took Mifeprex.

Doctor explaining prescription medication to patient in clinic
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The abortion pill is approved by the United States Food and Drug Administration (FDA) for use in medical abortion up to 70 days after the last menstrual period. Mifepristone is not the same as the morning after pill, which can be taken to prevent a pregnancy within 72 hours after unprotected sex. Many people are confused between the two pills, but there are significant differences between them.

The First Appointment

During this visit, your healthcare provider will determine if you are pregnant using a pregnancy test and/or a pelvic exam. If you are pregnant, your healthcare provider may then determine the date of your pregnancy based on your last menstrual period or by using an ultrasound, which is considered more accurate. An ultrasound is not FDA-mandated for the administration of Mifeprex, so you may or may not have one.

Your Decision

You may meet with a healthcare provider, nurse, or counselor, who may ask you about whether you are aware of all of your options, explain your options regarding pregnancy and pregnancy termination and invite you to share any questions or concerns. Often, prior to your abortion, a medical professional will try to identify whether you have felt that you could be in danger, may be suffering from abuse, or feel coerced in any way.

Taking RU486

Once you have signed a consent to have a medical abortion, you will be given three pills (200 mg each) of the abortion pill to be taken by mouth while you are at the healthcare provider's office. The hormonal action of mifepristone works against progesterone, a pregnancy hormone, to make the fertilized egg unable to remain attached to the lining of the uterus. This step induces a medical abortion about 64 percent to 85 percent of the time.

Over the next few days, you may notice vaginal bleeding, blood clots, and discharge of tissue, and you may experience uterine cramping or discomfort.

In some clinics, you may be given the medication to take at home. If this is the case, you will be provided with detailed instructions for taking the pills, as well as instructions about when to call about side effects.

The Second Appointment

During your second visit, which should be no more than 48 hours after you have taken mifepristone, your healthcare provider will perform a physical examination, an ultrasound, a blood test, or a combination of these to see if your pregnancy has terminated.

If you are no longer pregnant, this is likely to be your last visit for your medical abortion. You will be advised to be in contact with your healthcare provider or clinic if you have questions or experience any symptoms that cause you to be concerned.

If you are still pregnant, you will be given a second medication—misoprostol—in the form of two pills to be taken orally or as a vaginal suppository. This is a hormonal treatment that causes uterine contractions and thinning of the uterine lining, which interferes with the pregnancy.

Misoprostol is typically taken at the healthcare provider’s office and should cause the pregnancy to end six hours to one week later. You may be given a prescription for an antibiotic as well, to prevent an infection.

Administration of mifepristone and misoprostol, if done according to schedule, induces medical abortion 92 percent to 98 percent of the time.

Effects of the Misoprostol

As the hormones take effect, inducing a medical abortion, you may experience cramping and bleeding. You should also expect to pass blood clots and clumps of tissue, which can begin several hours after taking the medication and may last up to a week afterward.

Your healthcare provider may recommend or prescribe pain medication to help you tolerate the uterine discomfort. You should not take any over-the-counter medications without checking with your healthcare provider first, as some medications, such as aspirin (acetylsalicylic acid) and Advil (ibuprofen), can cause bleeding. Your healthcare provider will also give you instructions and tell you what to do in case of complications. Some women may feel nausea during the few days after taking misoprostol, and you can ask your healthcare provider for a prescription if your nausea or vomiting is intolerable.

It is important to note that some clinics may permit you to take misoprostol on your own, at home, and will provide you with instructions on how to do so. This alternative depends on the policy of the medical facility; many mandate that you take the drug in the presence of a healthcare provider so you can be evaluated for side effects.

The Final Appointment

You must follow-up with a visit to your healthcare provider two weeks after taking misoprostol, if applicable. At this time, your healthcare provider will use either an ultrasound or a blood test to confirm that the pregnancy has ended and ensure that there are no other problems, such as hemorrhaging or infection.

If you are still pregnant after taking both pills, an abortion procedure to end your pregnancy will be suggested. At this stage, it is not recommended that you continue with the pregnancy, as the hormonal treatments you will have already taken are not safe for a fetus. According to the Mifeprex label, “Patients who have an ongoing pregnancy at this visit have a risk of fetal malformation resulting from the treatment. Surgical termination is recommended to manage medical abortion treatment failures.”

You may experience cramping, nausea, vomiting, and bleeding that can last eight to 10 days after having an abortion procedure.

In some instances, further hormone therapy may be recommended, depending on whether your healthcare provider feels that hormones to induce uterine contraction would be a more effective and safer option for you than an abortion procedure.

A Word From Verywell

If you are planning on having a medical abortion, you should know that most women do not experience any adverse effects from the process and that the medications terminate pregnancy more than 90 perfect of the time.

Abortion is obviously a controversial subject and a big decision. If you have determined that a medical abortion is right for you, it is important to proceed with it in a timely manner because of the optimal time window for the process.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Mifepristone label.

  2. Food and Drug Administration. Questions and answers on mifepristone for medical termination of pregnancy through ten weeks gestation.

  3. Planned Parenthood. The abortion pill.

  4. FDA. Mifeprex label.

  5. Chen MJ, Creinin MD. Mifepristone with buccal misoprostol for medical abortion: a systematic review. Obstet Gynecol. 2015 Jul;126(1):12-21. doi:10.1097/AOG.0000000000000897.

  6. Schaff, Eric A. et al. Mifepristone and misoprostol for early abortion when no gestational sac is present. Contraception, Volume 63, Issue 5, 251 - 254 doi:10.1016/s0010-7824(01)00200-1

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.