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What is misoprostol?

Misoprostol is a medication typically used in combination with mifepristone to bring about an abortion during pregnancy. Learn more about how this drug is used, the side effects, and more.

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Misoprostol is the second medicine taken for a medication abortion. When used in combination with mifepristone, it’s up to 98% effective in ending a pregnancy in the first trimester.

What is misoprostol?

Misoprostol, also called Cytotec, has been used as an abortion medication since the late 1980s and early 1990s. At that time, misoprostol was approved only to treat peptic ulcers, but women in areas with restrictions to abortion access discovered the side effect of uterine cramping and vaginal bleeding.

In the United States, misoprostol became FDA-approved in 1996. And in 2000, the FDA approved mifepristone, which alongside misoprostol is also known as "the abortion pill."

How does misoprostol work?

Misoprostol causes the uterus (or womb) to contract, causing cramping and bleeding to empty the contents of the uterus, thus ending a pregnancy. When taken with the other medication often used for medication abortion treatment, mifepristone, it’s up to 98% effective in ending pregnancy in the first trimester. 

To use misoprostol, we recommend consulting with an abortion provider who can prescribe the medications and ensure the process is completed safely. For most patients, 24-48 hours after taking 200mg mifepristone, the medication which ends the pregnancy, you’ll take four 200mcg tablets of misoprostol (Hey Jane's clinical care team lets each patient know exactly how much misoprostol they should take).

Vaginal bleeding and cramping are expected. They mean the treatment is working. Misoprostol can also cause other side effects for about 24 hours after taking it. None of these side effects are dangerous, but they can be uncomfortable. 

What does misprostol do to the uterus?

Misoprostol causes uterine cramping and bleeding. Generally, you’ll experience vaginal bleeding within about 6-24 hours after taking the misoprostol, and heavy bleeding can last for a few hours.

Is misoprostol safe to use for an abortion?

Misoprostol is a safe and effective way to end an early pregnancy. A 2019 study found that only .2% of people who used misoprostol only in a first trimester abortion experienced a serious adverse event. And care with Hey Jane is even safer: A 2023 clinical white paper found that only .16% of Hey Jane patients experienced a serious adverse event while following our mifepristone-misoprostol protocol.

Additionally, a study published in 2024 found that telemedicine abortion care (through a provider like Hey Jane) is not only safe and effective, but it's just as safe and effective as receiving medication abortion care from an in-person clinic.

What are the side effects of misoprostol?

Misoprostol side effects include:

  • Nausea
  • Diarrhea
  • Vomiting
  • Upset stomach and abdominal pain 
  • Vaginal bleeding or spotting
  • Heavy, menstrual-like cramps
  • Fever
  • Chills/shivering

Side effects from misoprostol can happen, but they should go away in a few days. Over-the-counter pain medication, heating pads, and other comfort measures can help manage these symptoms if you do end up experiencing them. Let your provider know if your fever lasts more than 24 hours after taking misoprostol.

Does misoprostol cause cramping?

Yes, a side effect of misoprostol is cramping. That is because the medication causes the uterus to cramp and bleed in order to empty out—which, in turn, ends a pregnancy. Cramping varies from person to person, and can be very intense. It usually starts within a few hours of taking misoprostol. You can take ibuprofen (which is included for every Hey Jane patient) or, if you're allergic, Tylenol in order to feel more comfortable.

What are the most common side effects of misoprostol?

The most common side effects of misoprostol are gastrointestinal, mainly diarrhea and abdominal pain. In clinical trials, about 13% of people who took misoprostol (Cytotec) experienced diarrhea and 7% of people had abdominal pain. If you have an underlying inflammatory bowel disease, this might be something to watch out for. 

Helpful tip: You can reduce your chance of getting diarrhea by taking misoprostol after meals, at bedtime, and by stopping any magnesium-based antacids, like Maalox and Mylanta, while taking this medication.

What are the gynecological side effects of misoprostol?

Some people have also experienced vaginal bleeding, spotting, and menstrual-like cramping after taking misoprostol. It’s fine to use period products if you’re experiencing any spotting or bleeding.

What are other less common side effects of misoprostol?

There are a few other side effects that may be causally related to misoprostol, including nausea, flatulence, headache, indigestion, vomiting and constipation. During clinical trials, only 3.2% -1.1% of people reported these side effects, so they aren’t that common. The studies also found no significant difference between how often these symptoms occurred for people taking misoprostol vs. the placebo. 

When would you need to seek emergency care after taking misoprostol?

If any of these symptoms persist after about a week or increase in intensity, contact your health care provider or seek emergency care. 

Studies show that people are able to safely manage medication abortion treatment at home without a clinic visit, but your provider may request you follow up in-person based on their clinic policies and your health history.

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How do I get misoprostol?

Misoprostol should only be taken when prescribed by a medical provider. To buy misoprostol online, use a professional telehealth abortion provider. This will ensure your process is safe and effectively ends your pregnancy. You can also meet with an abortion provider in a clinic where they can administer the medications during the visit or give them to you to take at home.  

How to get an abortion at home

Laws around abortion telehealth services change frequently and differ state to state. You can learn more about state-by-state options here, and you can find providers near you here

Hey Jane provides telehealth medication abortion services and abortion pills online for people who are up to 10 weeks pregnant. Check that you are eligible for services here and begin our online intake 24/7 to speak with one of our licensed medical providers within 1 business day. If approved, we’ll send your medications to the address of your choice (as long it’s in one of the states where we’re operating) in an unmarked box to protect your privacy. They should arrive on your doorstep in about 1 to 5 days.

For more information, read reviews from past patients (or check out our patient stories featured in Cosmopolitan), and check out our Frequently Asked Questions page for answers to common questions.

Why Hey Jane cares

Hey Jane supports those seeking options for their pregnancy and aims to make patients feel informed about their choices. We offer loads of resources and provide accurate information about abortion and the process.

By offering telehealth abortion services and abortion pills online, we eliminate the need to find an in-person clinic—which can be difficult, especially as the number of abortion clinics declines and wait times increase. 

We also offer a range of ways to pay for our abortion services—we are the only fully virtual abortion clinic to accept insurance, and partner with abortion funds to provide financial assistance to those who can’t afford treatment. Plus, all Hey Jane patients have an automatic support network through The Lounge, our private peer-to-peer community forum available to patients past and present.

If you need care, Hey Jane is here for you.

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Written by

Sally Rashid, RN BSN

Sally Rashid is a Registered Nurse and writer living in Detroit, Michigan. She has worked in reproductive care for a decade as a doula, nurse, and advocate for abortion access. Sally was a 2020 winner of Yes, And Laughter Lab's competitive incubation program for her work as writer and co-creator of Darling, a dark comedy about an abortion clinic at constant risk of closure. On top of writing for the beauty and healthcare industries, Sally is an all-around creative lady who loves music, making connections, and chilling with her two cats.

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