As concerns grow over restricted access to mifepristone, many are turning their attention to medical abortions being performed with only misoprostol.  

While this option may appear simpler, cheaper, or more private, there’s a lot you need to know beforehand, like how a misoprostol-only abortion works and the risks it carries. 

Can you take misoprostol without mifepristone? 

How does the normal abortion pill process work? 

Normally, a medication abortion (the abortion pill) involves two drugs: mifepristone and misoprostol. 

Mifepristone works first by blocking the body’s natural production of progesterone, a hormone that allows a pregnancy to grow. Without progesterone, the pregnancy doesn’t continue.  

Then, 24 to 48 hours later, misoprostol is taken to soften the cervix and cause heavy bleeding, cramping, and contractions to expelling the pregnancy from the uterus. 

You can read more about mifepristone here and misoprostol in more depth here. 

How does a misoprostol-only abortion work? 

When misoprostol is taken without mifepristone, the first step of ending the pregnancy is skipped.  

To compensate, multiple doses of misoprostol are taken in an attempt to force the body to expel the pregnancy, but this approach is much less effective than using both mifepristone and misoprostol together. 

How effective is misoprostol alone for medication abortion?  

How misoprostol is taken – orally, vaginally, or sublingually (under the tongue) – affects how well it works. While under your tongue might be most effective, it is linked to more intense side effects. 

Studies show that when used alone, misoprostol fails up to 39% of the time. That means about 1 out of every 4 women may have an incomplete abortion or need surgery afterward. 

When taken together with mifepristone, misoprostol is up to 98% effective in completing an abortion up to 10 weeks of pregnancy. 

What to expect when taking misoprostol without mifepristone? 

Beyond its lower effectiveness, the experience itself can be physically and emotionally difficult. Many women aren’t fully prepared for what happens during the process, especially the possibility of seeing recognizable tissue or even the developing fetus, depending on how far along the pregnancy is.  

Because misoprostol doesn’t end the pregnancy first, there is also a risk that the fetus could still be alive when expelled. Studies show a 17% survival rate during a misoprostol-only abortion.  

If the abortion is incomplete and the pregnancy continues, misoprostol exposure can also lead to birth defects, putting the child at risk for serious health complications. 

Are there other risks or complications I should know of?  

Many women choose medical abortion because it seems like a more private, less invasive option than a surgical abortion. However, medical abortions have been linked to more complications and risks. 

Severe risks of taking misoprostol include:  

• Low blood pressure  
• Rapid heart rhythm 
• Heart attack  
• Tears in the cervix  
• Uterine rupture 
• Infection  
• Severe allergic reaction 

What should I know first? 

Before taking misoprostol, you should know the following answers about your health. 

1. How far along you are  

Taking the abortion pill past 10 weeks increases your risk of an incomplete abortion and complications.  

2. Whether you have an ectopic pregnancy 

Taking misoprostol without ruling out a non-viable pregnancy can mask the symptoms of a life-threatening ectopic pregnancy. 

An ectopic pregnancy cannot be treated or ended with any type of abortion pill, whether it’s mifepristone, misoprostol, or a combination of both. They must be treated by a doctor who can determine the safest way to treat this type of pregnancy complication. Ectopic pregnancies can be life threatening and need immediate care and treatment by a licensed physician for the best outcome and future reproductive health of the woman. 

3. If you have a condition which makes misoprostol dangerous

People with kidney disease, stomach ulcers, inflammatory bowel disease, heart or blood vessel problems, or dehydration should not take misoprostol, as it can worsen these conditions. 

4. What to expect and look out for with this drug 

Understanding what’s normal and when to seek medical help can make a crucial difference in your health and safety. 

A medical consultation and ultrasound with a licensed medical professional is crucial before taking misoprostol. Harmony Women’s Care offers free pregnancy consultations with no insurance required.