Austin Women's Health Center Blog&Inspiration

What to Know About Misoprostol Only Abortions

March 15, 2023
woman taking misoprostol abortion pill

A lawsuit underway in Amarillo, Texas is currently challenging over two decades of the Food and Drug Administration’s (FDA) approval of an abortion medication, Mifepristone. At Austin Women’s Health Center, we offer medically-accurate information met with supportive pro-choice care. A misoprostol only abortion is a safe and effective option.

The Texas Abortion Pill Lawsuit

In Texas, abortion has been under attack since before the Supreme Court struck down constitutional rights to abortion in June 2022. More recently, a Texas lawsuit filed by anti-abortion groups aims to dismantle FDA-approval of Mifepristone, one of the two medications used in the most common regimen of abortion with pills. The lawsuit exists despite extensive scientific research that confirms the safety of Mifepristone.

Trump-appointed federal judge Matthew Kacsmaryk is expected to decide on the case soon. The lawsuit asks the court to declare the FDA’s approval of Mifepristone as unlawful. Kacsmaryk’s power is limited, but he could order the FDA to start a congressionally mandated process entailing public hearings, which could take months to years, according to a recent article by Slate.

Mifepristone has been approved by the FDA since 2000. Because this is a federal case however, the ruling could further restrict abortion access throughout the country by taking Mifepristone off the market. This outcome would also impact pregnancy loss treatment, as Mifepristone is used in miscarriage management.

Providers around the country are bracing to offer Misoprostol-only abortions in anticipation of the ruling. For self-managed abortion, Misoprostol alone has been used worldwide, and is a supported method by The World Health Organization (WHO), even though it’s not an FDA-approved method.

For a medical abortion or abortion with pills, the most common regimen is a combination of the drugs Mifepristone and Misoprostol. Abortion with pills accounts for more than half of all abortions in the US, according to 2020 data—this number is likely higher now. This regimen is up to 98% effective. Efficacy rates depend on how far along you are in a pregnancy, with the highest efficacy in an earlier pregnancy. WHO recommends using the end of the first trimester, or 12 weeks, as a cutoff point for abortion medication.

Mifepristone works by blocking the hormone progesterone, and Misoprostol works by causing the uterus to empty. For the most common regimen, you take Mifepristone, which stops the pregnancy from continuing. 24-48 hours later, you take Misoprostol, which causes the uterus to contract and empty. You take Misoprostol buccally or between your cheek and gum, sublingually or under your tongue, or vaginally.


Misoprostol Only Abortion

While Mifepristone taken alone is not effective at ending a pregnancy, the second abortion pill, Misoprostol, is safe and effective at ending a pregnancy. Abortion with both drugs is only slightly more effective than the Misoprostol alone method.

In a meta-analysis, Misoprostol alone had nearly an 80% success rate in first-trimester abortions. A recent study found that number to be higher, at 88% success in abortions up to 10 weeks without intervention and a low rate of severe adverse effects.

Misoprostol-alone abortions can take significantly longer to complete than a combination of Mifepristone and Misoprostol. At one week, approximately 14% of those using Misoprostol alone will have an ongoing pregnancy; this rate drops to 6% at two weeks, and by four weeks it’s approximately 0%. Most patients taking a combination of Mifepristone and Misoprostol will complete the process by one week.

RELATED: Medication Abortion vs. Surgical Abortion: Which is Best For Me?


What to Expect During a Misoprostol Only Abortion

For a self-managed Misoprostol abortion, three doses of the medication, containing four pills of 200 mcg each, are required. Before a Misoprostol only abortion, it’s recommended to know the contraindications, which include taking blood thinners, chronic adrenal failure, blood disorders, ectopic pregnancy, or an allergy to the drug.

Side effects for a Misoprostol-only abortion can last a few hours or days. They typically include:

– fever

– diarrhea

– nausea

– vomiting

– headache

– chills


Some warning signs to look out for during a self-managed abortion with Misoprostol are:

– heavy bleeding or soaking through more than two pads an hour 

– a fever of 100.4 F that does not improve with medication such as Ibuprofen and lasts more than 24 hours

– noticeable variations in blood, such as a different smell or color

– an allergic reaction such as difficulty breathing, redness, or itchiness

If you are concerned by side effects during a Misoprostol-only abortion, anonymous hotlines can offer advice and reassurance or let you know if further care is recommended.



The self-managed miscarriage and abortion hotline is a team of pro-abortion medical professionals that can be reached by phone or text at 1-833-246-2632. The hotline is available from 8 AM to 11 PM in all continental US time zones, and clinicians will respond within an hour. They will not ask your name when you call.

If you need further care, such as going to a hospital for complications, there is no way a provider can know if you took abortion pills—Misoprostol won’t show up on a blood or urine test. The only way a provider would know is if you decide to tell them or if you inserted Misoprostol vaginally and still have remnants of the pills. If you seek care for complications, you can try removing them before heading to care. Complications from abortion and miscarriage are the same, so a provider will likely assume that you’re experiencing a miscarriage.


We Offer Post-Abortion Counseling

At Austin Women’s Health Center, we offer pro-choice care. We provide patients post-abortion counseling to offer emotional support and to establish care for any complications that may arise after one week following your medication abortion. If we can’t provide care in-office, we will refer patients to the care they choose.