How Does the Abortion Pill Work?

About half of all abortions are medication abortions, meaning they’re done using the abortion pill, according to Guttmacher Institute. Over the past several months, the legality of the abortion pill (which actually refers to refers to two drugs, mifepristone and misoprostol) has been called into question. Although the medication was first approved by the Food and Drug Administration 23 years ago and five million people have since used it for pregnancy termination as of June 2021, access to the medication has remained inconsistent at best, especially following the overturn of Roe v. Wade in June 2022. However, in a major step toward increased abortion access, mifepristone pills are now set to be sold in select CVS and Walgreens pharmacies across the country, starting in just a few weeks.

In a statement released by the White House on March 1, President Joe Biden called the news “an important milestone in ensuring access to mifepristone, a drug that has been approved by the Food and Drug Administration as safe and effective for more than 20 years.” Although Biden encouraged all pharmacies to seek mifepristone certification, the rollout will begin in states where abortion is legal (and the pills will not be available by mail).

According to the Walgreens website, the retailer will start dispensing pills in New York, Pennsylvania, Massachusetts, California, and Illinois, while CVS will start with all its Massachusetts and Rhode Island pharmacies, per The New York Times. Both have plans to gradually expand to other states, so long as it remains safe for staff members. In the interest of safety, the chains will not publicly disclose the exact pharmacies dispensing the medication.

This news comes after a federal judge in Texas issued a ruling that threatened to invalidate the FDA’s previous approval of mifepristone back in April of 2023. “This does not just affect women in Texas,” President Joe Biden said in a statement at the time. “If it stands, it would prevent women in every state from accessing the medication, regardless of whether abortion is legal in a state.” The fact that pills will soon be available for pick-up like any other prescription shows how much progress has been made since then.

Still, with increased access to abortion pills, it’s essential to know how the medication works. For more information, we asked doctors to explain everything you need to know — including where you can get the abortion pill, and what obstacles to keep in mind.

How Does the Abortion Pill Work?

The abortion pill typically consists of two doses, each containing a different drug. The first dose is mifepristone, known in the US as Mifeprex, which was approved by the FDA in 2000. The exact laws around how and when it’s possible to obtain a medication abortion vary by state, but the FDA has approved mifepristone to be used through 10 weeks gestation. That’s 70 days or less since the first day of one’s last period, although the medical community has since supported its use up to 77 days, says Colleen P. McNicholas, MD, the chief medical officer at Planned Parenthood of the St. Louis Region.

Dr. McNicholas says mifepristone stops a pregnancy from progressing by blocking progesterone, one of the hormones that attach the pregnancy to the uterus. Misoprostol then causes the uterus to contract, resulting in cramping and bleeding after one to four hours that expels pregnancy tissue. According to Planned Parenthood’s national website, a person may also feel the following side effects:

Nausea and slight bleeding may occur after taking mifepristone, although it’s uncommon. Expelling the pregnancy tissue usually lasts four to five hours or longer, and the cramping may persist for a few days. Planned Parenthood notes that if you don’t have any bleeding within 24 hours of taking misoprostol, you should call your doctor.

You’ll have a follow-up appointment a week or two after the medication abortion. But Melissa Grant, COO of abortion and reproductive-health service provider Carafem, tells POPSUGAR that this checkup can sometimes happen virtually. After checking in about symptoms, providers may ask you to take a home pregnancy test to confirm a negative test result, for instance.

How Effective Is the Abortion Pill?

According to Planned Parenthood, if you are eight weeks pregnant or less, a medication abortion works about 94 to 98 percent of the time. For people who are between 10 to 11 weeks pregnant, it’s about 87 percent effective. If the abortion doesn’t work, you may need additional medication or an in-clinic procedure.

Complications from medication abortion are also rare but could include pregnancy tissue left in the uterus, infection, allergic reaction, blood clots in your uterus, and excessive bleeding. Call your doctor if you feel sick more than 24 hours after taking misoprostol.

Where Can You Get Abortion Pills?

Historically, mifepristone had to be ordered, prescribed, and dispensed by a qualified healthcare provider through a doctor’s office or clinic, such as Planned Parenthood or Carafem. Some doctors would give mifepristone to you in their office and write a prescription for misoprostol to be picked up at a certified pharmacy, or they might have misoprostol at their disposal and send you home with it. This made it so that patients were often required to take the pill in a qualified medical setting, such as a hospital or a health clinic.

The recent mifepristone news will now allow people to pick up their prescription more easily, and take the pills on their own time. The second pill, misoprostol, is taken 24 to 48 hours after the dose of mifepristone, and can be taken in the location of your choice — including your home. You can also stick to the office or clinic method if you feel more comfortable doing so.

It’s important to note that not all pharmacies, health clinics, and hospitals want to (or are able to) get certified to prescribe and administer abortion pills. One reason? They may fear retaliation directed at them by anti-abortion groups, reports The New England Journal of Medicine. While some reproductive health advocacy groups assert that both pills should be more readily available, not everyone agrees.

During the pandemic, a federal judge ruled in favor of an American Civil Liberties Union lawsuit that argued that patients should be able to be prescribed abortion pills via telehealth during the pandemic. It was lauded as a victory in the fight for abortion access, and many hoped it would spur lasting legislative change that would persist beyond the pandemic.

Instead, not even two years later, Roe v. Wade was overturned and abortion access became even worse. Ultimately, your state’s laws will impact whether and how you can access a medication abortion. If you’re seeking abortion pills, Grant suggests using the National Abortion Federation to find a list of accredited providers across the country. If your state isn’t listed, abortion may be illegal where you live. An organization like the National Network of Abortion Funds may be able to help you figure out your next steps.

How Much Does the Abortion Pill Cost?

The cost varies and also depends on several factors, such as the facility you go to, state law, tests you may need done before or after your medication abortion, and insurance coverage. However, Grant notes that the average cost nationwide for medication abortion through a private office is usually between $400 to $450. People who choose to purchase the pills virtually, she says, tend to pay a reduced cost.

Obstacles Remain For Medication Abortions

While drugstores that agree to certain rules — such as obtaining certification from the FDA — can provide the abortion pill, patients still need to obtain a prescription from their healthcare provider. Mifepristone isn’t available for over-the-counter use, it can’t be sent through mail, and some states still don’t allow for abortion pills of any kind. That’s not to mention the aforementioned fear of retaliation felt by pharmacists and staff, even in states where abortion is legal.

Better access to the abortion pill is good news, but Kirsten Moore, director of the Expanding Medication Abortion Access Project, reminds us that “millions of people still live in states where abortion care is banned entirely.” This may be a start, but everyone deserves access, and with abortion care still so up in the air, we can’t stop fighting now.

Alexis Jones is the senior health editor at POPSUGAR. Her areas of expertise include women’s health, mental health, racial and ethnic disparities in healthcare, diversity in wellness, and chronic conditions. Prior to joining POPSUGAR, she was the senior editor at Health magazine. Her other bylines can be found at Women’s Health, Prevention, Marie Claire, and more.

— Additional reporting by Melanie Whyte, Samantha Brodsky, and Chandler Plante