Written by Angeline Ti
Since mifepristone became available in the US, the regimen for a medication abortion has generally involved a dose of mifepristone followed by one or more doses of misoprostol. Following the decision from the Supreme Court in Dobbs vs Jackson Women’s Health Organization in the summer of 2022, the availability of mifepristone has already decreased in states that have restricted or ended access to legal abortion care, and a pending challenge to the Food and Drug Administration’s approval of mifepristone may further limit its availability across the country.
A medication abortion with misoprostol alone is a safe, effective, and reasonable alternative when mifepristone is unavailable or inaccessible. In general, for people up to 12 weeks gestational age who take three to four doses of 800 mcg of misoprostol every three hours, the rate of continuing pregnancy is less than 6% and the rate of complications is very low. Misoprostol is effective if taking sublingually, buccally or vaginally, however pill fragments can remain in the vagina for up to a few days after placement, which may be an important consideration for some. Misoprostol alone can still be safe and effective beyond 12 weeks, however there are additional considerations that may increase the risk of complications, such as cesarean-section history and the presence of identifiable fetal parts. An individual’s medical history, proximity to care and comfort level should determine the appropriate regimen and level of care. There are a variety of global health organizations, such as the World Health Organization or Ipas, who have protocols for the provision of misoprostol-only medication abortion up to 12 weeks and beyond.
At any gestational age, taking repeated doses of misprostol increases the risk of medication-related side effects, including cramping, nausea, diarrhea and low-grade fevers or chills. To help manage these symptoms, people can take over-the-counter medications such as ibuprofen or acetaminophen for pain, loperamide for diarrhea, and dimenhydrinate or meclizine for nausea. Non-pharmacologic measures such as lower abdominal heat may also be helpful.
Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.