What you need to know about mifepristone side effects and misoprostol side effects

Like any medication, there are symptoms and side effects that people commonly experience when taking mifepristone and misoprostol to end a pregnancy. Below, we’re covering key things to know about these abortion medications — and what you can expect while, and after, taking them.

What is medication abortion?

Medication is a safe and effective way to end a pregnancy. Mifepristone and misoprostol are the two FDA-approved medications used for medication abortion through 10 weeks (or 70 days gestation). The World Health Organization (WHO), though, has guidelines for safe use of abortion pills through 12 weeks of pregnancy. 

Misoprostol can also be used on its own for termination of pregnancy, but the combination of abortion pills is what’s typically prescribed by clinics in the U.S. Both medications are extremely safe and effective. In fact, when comparing their rate of severe adverse outcomes with Tylenol, Viagra, and childbirth, abortion pills are significantly lower risk. Taking abortion pills also doesn’t have a long-term impact on fertility, mental health, or other health outcomes. 

Research also shows that when medication abortion is prescribed through telemedicine, it’s just as safe and effective as getting the pills in person.

All about mifepristone

What is mifepristone?

Mifepristone was created to be used alongside misoprostol and approved by the FDA in 2000. In the U.S., mifepristone is often prescribed under the brand name Mifeprex.

How do you take mifepristone?

If you’re taking the combination regimen of mifepristone and misoprostol, you’ll start by taking one single dose of mifepristone (1 tablet) orally.

How does mifepristone work?

Mifepristone helps end a pregnancy by binding to the body’s progesterone receptors — cell proteins that attach to progesterone in the blood so the hormone can act on those cells. This blocks the production of progesterone, which is essential to maintain and grow a pregnancy.

What are common side effects of mifepristone?

According to the International Planned Parenthood Federation, side effects associated with mifepristone include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Dizziness
  • Tiredness
  • Tachycardia (fast heart rate)

Some people may also experience light bleeding.

All about misoprostol

What is misoprostol?

Misoprostol is a medication that was originally used to treat peptic ulcers — with a known side effect of intense uterine cramping and bleeding, which meant pregnant people were cautioned against using it. In the late 1980s, Brazilian people discovered the medication could also be used to safely and effectively end a pregnancy.

In the U.S., misoprostol is often prescribed under the brand name Cytotec.

How do you take misoprostol?

If you’re taking the combination regimen of mifepristone and misoprostol, you’ll take 800mcg of misoprostol 24-48 hours following a dose of mifepristone. This medication is most effective if taken buccally (absorbed through the cheek) or sublingually (absorbed under the tongue), but it can also be placed in the vagina (the recommended route if you need to take misoprostol sooner than 24 hours after mifepristone).

How does misoprostol work?

Misoprostol is a prostaglandin, which means it causes the uterus to cramp and empty out its contents — thereby ending a pregnancy.

What are common side effects of misoprostol?

The main symptoms of misoprostol are the heavy cramping and bleeding (often with clots) that signal the medication is working. The cramping and bleeding may be significantly more intense than a typical period.

According to the International Planned Parenthood Federation, other side effects associated with misoprostol include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fever
  • Dizziness
  • Headache
  • Chills
  • Rashes

How long do mifepristone and misoprostol side effects last?

Everyone’s bodies respond a little differently. Cramping may start about 2-4 hours after taking misoprostol and can last for about 3-5 hours. Bleeding may begin at that same time, but light bleeding can last on and off for 1-4 weeks.

For some people, most uncomfortable symptoms and side effects will decrease after about 24 hours. 

What can help with mifepristone and misoprostol side effects?

Taking over-the-counter ibuprofen (Tylenol if you’re allergic to ibuprofen) and using a heating pad can help with cramping. Alternating ibuprofen with Tylenol every 3-4 hours (without going past daily limits) may be even more effective than just ibuprofen alone. Some people may also take anti-nausea medication or Benadryl (which some may find also helps with nausea).

What kind of mifepristone and misoprostol side effects should be brought up with a healthcare professional?

Please reach out to a healthcare professional for medical attention if you experience any of the following serious side effects and/or signs of serious infection after taking abortion pills:

  • Heavy vaginal bleeding: This means completely soaking through two maxi pads in an hour two hours in a row.
  • Large blood clots: Blood clots that are larger than a lemon.
  • Changes in discharge: Foul-smelling, green, or yellow vaginal discharge.
  • Severe abdominal pain or cramps: Severe stomach pain or cramps that don’t go away with pain medication.
  • Fever: A fever above 100.4 degrees Fahrenheit that doesn’t go away after taking pain medication or lasts more than 24 hours.

If a Juniper Midwifery clinician was your prescribing healthcare provider, please reach out immediately for follow-up. 

Is there anyone who shouldn’t use medication abortion? What about drug interactions?

Medication abortion is a safe and effective option for most people in early pregnancy — even those with many medical conditions or those who are breastfeeding/nursing. That said, medication abortion is not recommended for people with any of the following:

  • Confirmed or suspected ectopic pregnancy (pregnancy outside of the uterus)
  • Intrauterine device (IUD) in place (IUD can be removed before taking the medication)
  • Current use of long-term systemic steroid therapy
  • Chronic failure of the adrenal glands
  • Known bleeding disorder or use of anticoagulant therapy
  • Inherited porphyria (a rare blood disease that can increase blood pressure and heart rate)
  • Intolerance or known allergic reaction to mifepristone or misoprostol

Telemedicine abortion (without blood testing or ultrasound imaging) is not recommended for people with a prior ectopic pregnancy, prior tubal sterilization, or other tubal surgery.

Need abortion care? Juniper Midwifery can help

If you’re currently less than 10 weeks pregnant and need to access abortion care in New York, New Jersey, Connecticut, California, or New Mexico, Juniper Midwifery can help.After completing an intake assessment, our clinicians will review your information (including health history and last menstrual period) to make sure medication abortion is right for you. Once your prescription is confirmed, it’ll take about 2-4 business days for your medication to arrive. (You can also expedite shipping for $25 when checking out for guaranteed 1-2 business day shipment). 

Juniper Midwifery patients who would also like a follow-up contraception consultation and prescription for birth control can get them for free in addition to abortion care.

For any of our patients who need additional support or medical advice, our clinicians are here for you. Please reach out whenever you need to. Organizations like the Reprocare Healthline, All-Options, Exhale Pro-Voice, and Connect & Breathe also provide free, anonymous, and nonjudgmental emotional support for people accessing abortion care.