How do you take mifepristone and misoprostol together?

Opening Summary: Mifepristone and misoprostol are taken in sequence 24-48 hours apart to end a pregnancy up to 11 weeks. You take mifepristone first (usually at the clinic), which blocks progesterone and stops pregnancy development. Then you take misoprostol at home 24-48 hours later, which causes cramping and bleeding to expel the pregnancy.

Quick Facts: Mifepristone and Misoprostol

What Are Mifepristone and Misoprostol?

Mifepristone and misoprostol are two medications that work together to end a pregnancy. This combination is called medication abortion or “the abortion pill.”

Mifepristone (the first pill): Blocks progesterone, the hormone your body needs to continue a pregnancy. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue growing.

Misoprostol (the second pill): Causes your uterus to contract and cramp, pushing out the pregnancy tissue through your vagina. This is when the actual abortion happens.

Taking both medications is necessary for the abortion to work. Mifepristone alone won’t complete the abortion you must take misoprostol 24-48 hours later.

At Serenity Choice Health in Matteson, we provide both medications along with complete instructions, 24/7 support, and follow-up care. We serve patients from Chicago’s south suburbs and northwest Indiana, including Homewood, Tinley Park, Munster, IN, and Dyer, IN.

Learn more about medication abortion explained.

Step-by-Step: How to Take Mifepristone (First Pill)

When you take mifepristone: At your clinic appointment or immediately after leaving the clinic (within a few hours).

How to take it: Swallow one 200mg mifepristone tablet with water. That’s it one pill by mouth.

What happens after taking mifepristone:

Most people feel completely normal after taking mifepristone. You might experience:

• Light spotting or bleeding (about 20% of people)
• Mild cramping (uncommon)
• Nausea (rare)
• Or absolutely nothing at all

The pregnancy has stopped developing, but you won’t experience heavy bleeding or cramping yet. That happens after you take misoprostol.

What you can do after taking mifepristone:

• Go about your normal day
• Go to work or school
• Drive (you’re not impaired)
• Eat normally
• Take your regular medications
• Exercise lightly

What to avoid:

• Don’t take aspirin or blood thinners (ibuprofen is fine)
• Avoid alcohol in excess
• Don’t have vaginal intercourse

Important: You must take misoprostol 24-48 hours later for the abortion to work. Mifepristone alone will not complete the abortion.

Step-by-Step: How to Take Misoprostol (Second Pill)

When you take misoprostol: 24-48 hours after taking mifepristone. You can choose the exact timing within this window based on your schedule.

How many pills: Usually 4 tablets of 200mcg each (total 800mcg). Some protocols use 2-4 tablets depending on gestational age and provider preference.

Three ways to take misoprostol:

Method 1: Buccal (Most Common)

Place 2 tablets in each cheek pouch (between your gum and cheek) on both sides of your mouth. Let them dissolve for 30 minutes. The pills will get soft and chalky. After 30 minutes, swallow what remains with water.

Why buccal: This is the most effective method with the fewest side effects. The medication absorbs through your cheek tissues directly into your bloodstream.

Method 2: Sublingual

Place all 4 tablets under your tongue. Let them dissolve for 30 minutes. After 30 minutes, swallow what remains with water.

Why sublingual: Also very effective, though some people find the taste more unpleasant than buccal placement.

Method 3: Vaginal

Insert 4 tablets deep into your vagina with clean hands. You can lie down for 30 minutes after inserting them to keep them in place.

Why vaginal: Slightly less common now because buccal/sublingual work just as well and are more comfortable for most people. However, vaginal placement is an option if you can’t tolerate the taste.

At Serenity Choice Health, we typically recommend buccal placement because it’s effective, easy to do correctly, and causes fewer gastrointestinal side effects than sublingual.

Learn about abortion pills cost.

What to Expect After Taking Misoprostol

Cramping: Most people start feeling cramping 1-4 hours after taking misoprostol. The cramps feel similar to menstrual cramps but stronger often much stronger. Cramping is most intense during the 4-6 hours when you’re passing the pregnancy tissue.

Bleeding: Heavy bleeding starts around the same time as cramping (1-4 hours after misoprostol). You’ll pass blood clots some quite large, up to lemon-sized. You’ll also pass pregnancy tissue, which appears as white or gray material mixed with clots.

The heaviest bleeding typically lasts 4-6 hours. After that, bleeding decreases to something more like a moderate to heavy period. Light bleeding or spotting continues for 1-4 weeks.

Other symptoms you might experience:

• Nausea and vomiting
• Diarrhea
• Chills or feeling cold
• Low-grade fever (under 100.4°F)
• Headache
• Dizziness
• Fatigue

These are normal side effects of misoprostol and typically resolve within a few hours.

Read about how to know if the abortion pill worked.

Managing Pain and Symptoms at Home

Pain medication (start BEFORE cramping gets bad):

Ibuprofen (Advil, Motrin): Take 600-800mg every 6-8 hours. Start taking it right when you take misoprostol or when cramping begins. Ibuprofen works better than Tylenol for cramping pain.

Acetaminophen (Tylenol): Take 500-1000mg every 6 hours if you can’t take ibuprofen. You can alternate with ibuprofen for severe pain.

Do NOT take aspirin it increases bleeding.

Heat therapy:

• Heating pad on your lower abdomen or back
• Hot water bottle wrapped in a towel
• Warm (not hot) bath after the initial bleeding starts

Comfort measures:

• Rest in a comfortable position
• Stay hydrated (drink water, juice, tea)
• Eat light foods if you’re hungry (crackers, toast, soup)
• Have someone with you for support
• Watch TV, listen to music, or distract yourself
• Wear comfortable, loose clothing
• Keep a bathroom nearby

Managing nausea:

• Eat light, bland foods before taking misoprostol
• Ginger tea or ginger ale can help
• Avoid greasy or spicy foods
• Anti-nausea medication if prescribed

What to have ready:

• Ibuprofen (800mg worth)
• Maxi pads (not tampons)
• Heating pad
• Light snacks and water
• Clean towels
• Comfortable clothes
• Phone to contact clinic if needed

Learn about abortion pain management.

Timeline: Hour by Hour After Taking Misoprostol

Hour 0 (when you take misoprostol):

• Place pills in cheeks or under tongue
• Let dissolve for 30 minutes
• Take ibuprofen now
• Get comfortable

Hours 1-2:

• Cramping may start
• Light bleeding might begin
• Take more ibuprofen if needed
• Apply heating pad

Hours 3-6 (peak symptoms):

• Strong cramping (similar to labor contractions)
• Heavy bleeding with large clots
• Passing pregnancy tissue
• Possible nausea, chills, diarrhea
• This is the hardest part stay near bathroom
• Use heating pad, take pain medication

Hours 7-12:

• Cramping decreases significantly
• Bleeding still moderate but lessening
• Nausea and chills resolve
• You can rest and recover
• Worst is over

Day 2-7:

• Mild cramping
• Bleeding like moderate period
• Most people return to normal activities by day 2-3
• Continue using pads (no tampons yet)

Weeks 2-4:

• Light bleeding or spotting
• Minimal cramping
• First period usually returns in 4-6 weeks

Learn about when abortion pills don’t work.

Important Timing: When to Take Each Medication

Mifepristone timing: At your clinic appointment (day 1).

Misoprostol timing: 24-48 hours after mifepristone (day 2 or 3).

Why the 24-48 hour window?

This timing gives mifepristone time to block progesterone and prepare your uterus. Taking misoprostol too soon (less than 24 hours) reduces effectiveness. Taking it too late (more than 48 hours) is still effective but not ideal.

Choosing your misoprostol timing:

You can take misoprostol anytime within the 24-48 hour window. Plan for a time when you:

• Can be home for 6-8 hours
• Have privacy
• Don’t have work, childcare, or other obligations
• Can rest and recover
• Have support if you want it

Example timing:

• Mifepristone: Thursday at 2pm at clinic
• Misoprostol earliest: Friday at 2pm (24 hours later)
• Misoprostol latest: Saturday at 2pm (48 hours later)
• Most common: Friday evening or Saturday morning when you can rest all day

Can you take them at the same time?

No. Taking both medications simultaneously is less effective and causes more side effects. The 24-48 hour gap between medications is important for the abortion to work properly.

What If You Vomit After Taking the Pills?

If you vomit within 30 minutes of taking mifepristone:

Call the clinic. You may need to take another mifepristone pill because your body didn’t have time to absorb it.

If you vomit more than 30 minutes after mifepristone:

Don’t worry. The medication was absorbed already. The abortion will still work.

If you vomit while misoprostol pills are dissolving in your mouth:

If the pills were in your mouth for at least 30 minutes before vomiting, the medication was absorbed. You don’t need to take more pills.

If you vomit before 30 minutes with misoprostol:

Call the clinic. You might need to take additional misoprostol pills.

Tips to prevent vomiting:

• Take anti-nausea medication if prescribed
• Eat a light meal before taking misoprostol
• Avoid taking pills on completely empty stomach
• Stay hydrated
• Rest in a comfortable position

Signs the Medication Is Working

You’ll know the abortion is happening when:

• Heavy bleeding starts: Usually 1-4 hours after misoprostol
• Strong cramping: More intense than regular period cramps
• Passing large clots: Lemon-sized or larger blood clots
• Passing tissue: White or gray material mixed with blood
• Pregnancy symptoms decrease: Nausea, breast tenderness fade over next week

The abortion is probably complete when:

• Heavy bleeding and cramping have subsided (after 4-6 hours)
• You passed large clots and tissue
• Bleeding decreases to moderate amount
• Pregnancy symptoms are gone
• Pregnancy test is negative 2-3 weeks later

You’ll need follow-up care (1-2 weeks later) to confirm the abortion is complete. This can be:

• Clinic visit with ultrasound
• Home pregnancy test
• Telehealth appointment

Learn about abortion pill effectiveness chart.

Warning Signs: When to Call the Clinic

Call immediately if you experience:

Severe bleeding: Soaking through 2 or more maxi pads per hour for 2+ hours in a row. This is a medical emergency.

High fever: Temperature of 100.4°F (38°C) or higher, especially if it lasts more than 24 hours. This could indicate infection.

Severe pain: Abdominal pain that doesn’t improve with ibuprofen or gets worse instead of better.

Foul-smelling discharge: Vaginal discharge that smells very bad could indicate infection.

No bleeding: If you took misoprostol but haven’t had any bleeding within 24 hours, the medication may not have worked.

Continuing pregnancy symptoms: If nausea, breast tenderness, or other pregnancy symptoms continue or worsen after one week.

Feeling very ill: Weakness, dizziness, severe nausea/vomiting, or feeling like something is seriously wrong.

At Serenity Choice Health, we provide 24/7 nurse hotline access. You can call anytime day or night if you have concerns or questions after taking the medications.

Communities we serve:

• Harvey
• Dolton
• Park Forest
• Calumet City

What You Can and Cannot Do After Taking the Pills

You CAN:

• Shower (avoid baths until bleeding decreases)
• Take ibuprofen or Tylenol for pain
• Use heating pad
• Eat and drink normally
• Go to work/school after heavy bleeding stops (usually day 2-3)
• Light exercise after a few days

You CANNOT (for 1-2 weeks):

• Use tampons or menstrual cups (use pads only)
• Have vaginal intercourse
• Insert anything into vagina
• Swimming or baths (showers are fine)
• Very strenuous exercise

These restrictions prevent infection while your cervix is slightly open and your uterus is healing.

Can You Take Mifepristone and Misoprostol at Home?

Mifepristone: Some clinics allow you to take mifepristone at home after your consultation. Others have you take it at the clinic before leaving. Either way is fine mifepristone works the same whether taken at the clinic or at home.

Misoprostol: Always taken at home (or wherever you choose to be for 6-8 hours). You should be in a comfortable, private place where you can rest and manage symptoms.

Telemedicine abortion: Some providers offer telemedicine consultations where both medications are mailed to you. You take both at home following provider instructions. However, this may not be available if you’re in a state where abortion is banned.

At Serenity Choice Health, we typically have you take mifepristone at the clinic or immediately after, then provide misoprostol to take home 24-48 hours later.

Learn about is telemedicine abortion legal and telehealth abortion in Indiana.

Alternative Methods: Misoprostol Alone

Can you use misoprostol without mifepristone?

Yes, but it’s less effective. Misoprostol alone (without mifepristone first) has about 85% success rate compared to 95-98% when both medications are used together.

When misoprostol alone is used:

• When mifepristone isn’t available
• In countries where mifepristone is restricted
• If you can only access one medication

Misoprostol-only protocol:

If using misoprostol alone, the typical protocol is:

• 800mcg (4 tablets) placed buccally or vaginally
• Repeat dose 3 hours later
• Possibly repeat a third time 3 hours after that

This is more medication than when used with mifepristone and causes more side effects.

At Serenity Choice Health, we provide both medications for the highest success rate and best experience.

Storage and Handling of Medications

How to store mifepristone and misoprostol:

Before use:

• Store at room temperature
• Keep in original packaging until use
• Protect from moisture
• Keep away from children and pets
• Don’t refrigerate (room temperature is fine)

After taking mifepristone:

Store your misoprostol pills safely until you’re ready to take them 24-48 hours later.

Disposing of leftover pills:

If you have leftover pills (rare, but possible), don’t flush them. Instead:

• Remove from packaging
• Mix with coffee grounds or cat litter
• Place in sealed bag or container
• Throw in household trash

Traveling with medications:

If you need to travel between taking mifepristone and misoprostol:

• Keep pills in original packaging
• Store in carry-on bag (not checked luggage)
• Have prescription or clinic paperwork if possible
• Be aware of state laws where you’re traveling

Common Concerns and Questions

“Will it hurt?”

Yes, medication abortion involves cramping that ranges from moderate to severe. Most people describe it as worse than menstrual cramps. However, ibuprofen, heating pads, and rest make the pain manageable for most people.

“Will I see the pregnancy?”

Yes, you’ll see blood clots and pregnancy tissue. Early in pregnancy (under 6 weeks), the tissue may be too small to distinguish from blood clots. Later (8-11 weeks), you might see recognizable tissue. You can flush everything down the toilet you don’t need to examine or save anything.

“Can I be alone?”

You can be alone if you choose, but many people prefer having a support person with them. Having someone there for practical help (getting water, changing pads) and emotional support can make the experience easier.

“What if I change my mind after taking mifepristone?”

There is some evidence that mifepristone’s effects may be reversible if you take high-dose progesterone immediately. However, this “abortion pill reversal” is controversial, not well-studied, and may not work. If you’re unsure, don’t take mifepristone until you’re certain.

“Can I save the pills for later?”

No. These medications are prescribed for you specifically at this time in your pregnancy. Don’t save them, share them, or sell them. The dosing and timing are specific to your gestational age.

Learn about abortion pills in Indiana.

Frequently Asked Questions

How long do you wait between mifepristone and misoprostol?

Wait 24-48 hours between taking mifepristone and misoprostol. This timing is important for the abortion to work effectively. Taking misoprostol too soon (less than 24 hours) reduces effectiveness. You can choose any time within the 24-48 hour window based on your schedule and when you want to be home for 6-8 hours to manage symptoms.

Can you take mifepristone and misoprostol at the same time?

No, you should not take mifepristone and misoprostol at the same time. Taking them simultaneously is less effective and causes more side effects. The medications work in sequence: mifepristone blocks progesterone and prepares your uterus, then misoprostol 24-48 hours later causes contractions to expel the pregnancy. The sequential timing is important for the 95-98% success rate.

How do you take misoprostol pills: swallow or dissolve?

Dissolve misoprostol pills don’t swallow them whole. The most common method is buccal: place 2 tablets in each cheek between your gum and cheek, let them dissolve for 30 minutes, then swallow what remains with water. Alternatively, you can place all 4 tablets under your tongue (sublingual) or insert them vaginally. Dissolving allows the medication to absorb more effectively than swallowing whole pills.

What happens if you don’t take misoprostol after mifepristone?

If you only take mifepristone without taking misoprostol, the pregnancy will likely continue. Mifepristone alone stops pregnancy development temporarily, but without misoprostol to cause expulsion, many pregnancies will resume developing. Taking mifepristone without completing the protocol with misoprostol leaves you with an uncertain pregnancy status and requires follow-up care to determine if the pregnancy continued or not.

How long after taking misoprostol does bleeding start?

Bleeding typically starts 1-4 hours after taking misoprostol, though some people begin bleeding within 30 minutes and others don’t start until 6 hours later. The heaviest bleeding and cramping usually occur 4-6 hours after taking misoprostol. If you have no bleeding within 24 hours of taking misoprostol, contact your clinic—the medication may not have worked and you might need additional treatment.

Get Mifepristone and Misoprostol at Serenity Choice Health

At our Matteson, Illinois clinic, we provide medication abortion with complete instructions, 24/7 support, and compassionate care.

What we provide:

• Both mifepristone and misoprostol medications
• Clear, detailed instructions
• Pain management medication
• 24/7 nurse hotline for questions
• Follow-up care to confirm success
• Sliding scale fees based on income
• Insurance acceptance (including Illinois Medicaid)

Call us today to:

• Schedule your medication abortion appointment
• Ask questions about the process
• Discuss pain management options
• Verify insurance coverage
• Get same-day or next-day appointments

We serve:

• Chicago south suburbs
• Northwest Indiana (Munster, Dyer)
• Surrounding communities

Additional resources:

• Abortion pills vs surgical abortion
• What are the different abortion procedures
• How does an abortion actually work

You don’t have to go through medication abortion alone. We’re here to support you every step of the way.