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Here’s how medication abortion works with just one drug that’s still fully available
Misoprostol is typically used as part of a two-drug protocol for a medication abortion. But it is also safe and effective when used alone, doctors say.
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Misoprostol is typically used as part of a two-drug protocol for a medication abortion. But it is also safe and effective when used alone, doctors say.
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A version of this story was originally published on April 10, 2023. It has been updated to reflect news that mifepristone must be prescribed in person as of Friday, May 1, 2026.
On Friday, a panel of federal appeals court judges changed rules for a medicine called mifepristone. For more than two decades, mifepristone has been used with another drug, misoprostol, for most medication abortions in the U.S.
The Food and Drug Administration, under President Joe Biden, relaxed prescribing rules for mifepristone. That allowed doctors to prescribe the two-drug regimen over the phone or online. The medicines could be mailed or picked up at pharmacies and taken at home to end pregnancy up to 10 weeks of gestation.
Friday’s court order said that the FDA has to go back to its earlier in-person prescribing rules for mifepristone. The order immediately applies to the whole country.
The makers of mifepristone have appealed to the Supreme Court asking for a quick change back to the Biden-era rules, as the case continues. In an earlier case involving mifepristone, the high court did just that. Something similar may happen again — or not.
In the meantime, the standard two-drug medication regimen is still available for in-person patients in states that allow abortion. And telemedicine abortions may continue in those states using only the other drug, misoprostol.
Misoprostol has been on the market longer and was first approved to treat gastric ulcers. It is also used for IUD insertion and to treat hemorrhage.
Here’s what to know about how misoprostol-only abortions work, how safe they are and how patients may be able to access them.
How does the single-drug protocol differ from the standard of care which uses two drugs?
Most medication abortions in the U.S. have used both mifepristone and misoprostol because patients experience fewer side effects when the medications are combined. A regimen involving both medications is also used for miscarriages.
But misoprostol alone can be used effectively for abortions — and is commonly prescribed in some countries. A grassroots effort among women in Brazil, Argentina and other South American countries in the late 1980s and early 1990s spread word that the medicine originally on the market as an ulcer treatment could be used to end unwanted pregnancies.
“This regimen is still incredibly safe and effective,” says Dr. Kristyn Brandi, a New Jersey family planning specialist and spokesperson for the American College of Obstetricians and Gynecologists.
With the two-drug regimen, patients first take mifepristone — which blocks the hormone progesterone — to end the pregnancy. Patients then take misoprostol 24-48 hours later, which causes the uterus to expel the pregnancy tissue. Patients experience bleeding and cramping, and usually pass the pregnancy within 4-6 hours after taking the misoprostol.
In a misoprostol-alone abortion, patients start the process with misoprostol, using the same amount as is used in the two-drug regimen. Three hours later, they take misoprostol again, causing the uterus to contract. They repeat this for three to four doses until the pregnancy passes, which usually takes between 9-12 hours.
Is the misoprostol-alone regime safe? What can patients expect to experience?
There’s lots of research that shows the misoprostol-only protocol is as safe as the two-medication protocol – but it does tend to cause more side effects.
Even though the two-drug protocol is still preferred when possible, there’s ample evidence that misoprostol alone is a very effective alternative, according to the Society of Family Planning, an abortion research organization.
Multiple organizations, like the American College of Obstetricians and Gynecologists and the World Health Organization, say the one-medication protocol is an acceptable choice, particularly when mifepristone isn’t available.
Patients using misoprostol alone, however, tend to experience more nausea, vomiting, and diarrhea, and a longer duration of cramping and bleeding. That’s why it’s usually the second choice regimen.
The misoprostol-only protocol is actually faster than the two-medication protocol, which takes about 30 hours total since patients take the second drug at least 24-hours after the first. In the misoprostol-alone regimen, the process usually only takes 9-12 hours, but patients typically experience cramping and bleeding for longer.
When might a patient need to seek further medical help for a medication abortion?
With either regimen, the reasons to seek follow up care are the same.
If patients experience heavy or prolonged bleeding — spotting that persists for over 2 weeks, for example, or bleeding so heavy they soak through more than two pads an hour for over two hours — they might need a procedure to complete the abortion.
A prolonged fever above 100.4 degrees Fahrenheit is also a reason to seek medical care. While low-grade fevers and chills are an expected side effect of misoprostol and aren’t life threatening, if a fever persists for more than 24 hours after taking misoprostol, it could be a sign of infection.
Also, if a patient does not experience any bleeding or cramping, the medication may not have worked to end the pregnancy, and she might need more misoprostol or a procedure to have a complete abortion.
How far along into the pregnancy does medication abortion work?
The Food and Drug Administration has approved the two-drug regimen to end pregnancies up to 10 weeks gestational age; the World Health Organization endorses it up to 12 weeks. After that, they’re less likely to be effective and may cause more bleeding and cramping.
For misoprostol-only abortion, it’s less clear cut. There’s some data showing that the regimen can be effective in ending pregnancies up to 22 weeks. That’s according to one study that looked at patients having self-managed abortions, without the direct involvement of a doctor in countries that have had restrictive abortion laws.
But in U.S. states where second trimester abortion is allowed, Brandi says, doctors will typically recommend a procedural abortion in a hospital rather than a medication-based abortion to end pregnancies after 12 weeks. That’s because second trimester misoprostol-only abortions can involve more bleeding and prolonged cramping. Doctors would probably only recommend misoprostol-alone in the second trimester in states where patients don’t have other legal options.
How do patients get prescriptions for medication abortions? Would they be able to get them for the one-drug regimen?
In states where abortion is legal in the first trimester, patients can speak to a health care provider and get a prescription for medication abortion via telehealth abortion companies, in-person at clinics that provide abortion like Planned Parenthood, and at many general OB/GYN and family medicine clinics.
When mifepristone’s legality was in question before, many providers indicated they would start prescribing misoprostol alone.
Dr. Jamie Phifer, the medical director of Abortion on Demand, said at that time that her team would continue to provide mifepristone and misoprostol combination abortions to their patients unless it becomes illegal.
“But we’re ready,” she added. “We can make the switch [to misoprostol-only protocols] within hours.”
In fact, misoprostol is easier to access than mifepristone because of its additional uses, so it’s stocked in almost all pharmacies and hospitals.
Are patients able to get the medication in states where abortion is banned?
Patients in states that have banned or heavily restricted abortion have been able to access telehealth medication abortion, and this is at the heart of the case Louisiana brought against the FDA.
No medication abortions are available legally in states that have banned abortion. But some organizations have been helping women in those states access pills. Abortionfinder.org keeps an up-to-date list of services that help people access abortion, and includes state-by-state legal information.
The Miscarriage and Abortion Hotline offers free consultations with clinicians if a patient has follow-up questions about a medication abortion, even if she had the abortion in a state where it’s illegal.
Some organizations have flouted the law openly to provide abortion medications in all 50 states.
Aid Access, for example, is based in the Netherlands and will mail mifepristone and misoprostol to patients in states where abortion is banned. Pills sent from abroad are not subject to FDA approval and safety regulations.
Mara Gordon is a family physician in Camden, New Jersey, and NPR’s Real Talk With A Doc columnist. She’s on Instagram at @MaraGordonMD.
The crowd went wild when the three Gámez-Cuéllar brothers and their father took the stage on Sunday night.
It was no ordinary concert. Two months ago, the brothers and their father, all musicians, were being held in federal immigration detention centers. Now, dressed in black mariachi suits, they were opening for the country music star Kacey Musgraves in New Braunfels, Texas.
Just before they went on, the family uttered a prayer of thanks. “Thank you, Father, for giving us this great opportunity,” Antonio Yesayahu Gámez-Cuéllar, 18, addressed God, as he stood next to his 15-year-old brother, Caleb Gámez-Cuéllar; their 12-year-old brother, Joshua Gámez-Cuéllar; and their father, Luis Antonio Gámez. “We ask you, Father, to protect us and bathe us in your light.”
In early March, the Gámez-Cuéllar family became snarled in President Trump’s mass deportation campaign. Their detention by U.S. Immigration and Customs Enforcement agents drew widespread and bipartisan outcries that led to the family’s release from an immigration facility in Dilley, Texas. The oldest sibling, Antonio, was released from a separate detention center near the border.
Shortly after the family was released, Ms. Musgraves extended an invitation to the brothers on Instagram: “great so come on the road with me.”
Antonio and Caleb, along with their younger brother, Joshua, all renowned mariachi players from McAllen, Texas, jumped at the opportunity to open three shows for Ms. Musgraves with their father. The performances on her Middle of Nowhere tour began Sunday and will continue for two more days at Gruene Hall in New Braunfels, northeast of San Antonio. The venue is a whitewashed building that resembles a small church and considers itself the oldest continuously operating dance hall in Texas.
“We were honored to be invited,” their mother, Emma Guadalupe Cuéllar López, said. At the concert, Antonio belted out a Spanish-language rendition of Frank Sinatra’s “My Way” to applause and cheers.
Moments earlier, he whistled Michael Jackson’s song “Thriller,” as he helped his younger brother Joshua adjust his bright red moño charro, a mariachi tie. Their father kissed Joshua’s forehead as encouragement.
“It is wild to believe that we went from being in such a dark place to opening a show for one of country’s biggest stars,” Antonio said.
Last June, Representative Monica De La Cruz, Republican of Texas, invited the brothers to perform at the U.S. Capitol with their bandmates and then visit the White House. Antonio was crowned the best mariachi trumpeter in Texas earlier this year.
For the last three years, the family lived a version of the American dream, in a part of the country where mariachi music is central to public education and border culture.
The Gámez-Cuéllar family entered the United States in 2023 at the border crossing in Brownsville, Texas, on an asylum claim and settled in nearby McAllen. Mr. Gámez, the father, said his family had fled San Luis Potosí, Mexico, where cartel members had kidnapped him.
Their immigration status remains in limbo, pending future court dates, he said.
The family members said they had followed the law by attending every court date and had a check-in with ICE officials in January. Initially, they said, they were told to return in June, but then the family received an unexpected call from ICE saying that they needed to check in on Feb. 25. They were swiftly detained.
In interviews before the show, family members described being held in deplorable conditions at the Dilley Immigration Processing Center, a sprawling jail fashioned out of trailers that serves as the country’s largest family immigration detention site.
Mr. Gámez said he tried not to think about the moment his oldest son was handcuffed and transferred to another detention center near the border, “like if he was a criminal,” he said. “It was very painful.”
“We are happy to be together again, far from there,” Ms. Cuéllar Lopez added.
The detention center in Dilley, where most of the family was held, was shuttered by President Joseph R. Biden Jr. in 2024 and reopened by President Trump last year. The center has since become an often-criticized symbol of the crackdown on immigrant families. It was where Liam Conejo Ramos, the 5-year-old boy detained by federal agents in Minnesota, was held with his father until a similar outcry led to their release.
After they performed four songs, the family members returned to their green room and collapsed on the couches. Mr. Gàmez said he was happy with their numbers. “It was a great experience,” he said.
They hope it’s not the last one. On a recent day in April, the Gámez-Cuéllar family said the brothers were focused on the future. Antonio, who is graduating from high school this year, plans to attend the University of Texas Rio Grande Valley and join its mariachi team. His brothers intend to keep playing for their school bands.
“Mariachi music will be in our future,” Antonio said.
Gasoline prices are displayed at a Mobil gas station on April 29 in Portland, Ore.
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Gas prices in the U.S. have gone up more than 30 cents a gallon in the last week and are slated to continue rising as the Strait of Hormuz remains closed amid the Iran war.
The cost for regular gas as of Sunday is an average $4.446 — a week ago it was $4.099, according to AAA’s fuel site. U.S. gas prices were an average $2.98 on Feb. 26 — two days before the war in Iran began — and a year ago, the average price of gas was $3.171, according to data from AAA.
Gas prices in the U.S. are the highest they have been since late July 2022, said the automotive group.
President Trump has promised that when the war in Iran ends, that gas prices will “drop like a rock.” It is unclear when the war will end, but even when it does and the Strait of Hormuz is reopened, gas prices could still remain high, according to experts.
And prices could go up higher the longer the strait, which is a crucial route for oil and natural gas trade, stays closed, said Kevin Book, co-founder of ClearView Energy Partners, a research firm.
“When inventories are low and you can’t get oil out of the ground or out of the strait, you should expect prices to keep rising at least until demand capitulates and starts to contract,” Book told NPR’s Ayesha Rascoe on Weekend Edition on Sunday. “So, we may be weeks or even months, depending on how long the strait stays closed, from the peak of prices from this crisis.”
Book added that it could take months for ships trapped in the Strait of Hormuz to get through, damaged facilities to be repaired, and inventories to be replenished before gas prices return to what is considered normal. And even if gas prices were to fall fast and quickly, Book predicted that the reason would “probably be a bad one, not a good one.”
“It would probably be recession, undercutting demand, knocking the knees out from under the market,” he said.
Between the weeks of March 20 and April 24, the Department of Energy released 17.5 million barrels of crude oil from the U.S. Strategic Petroleum Reserve in an effort to curb high fuel prices stemming from the war, according to data from the U.S. Energy Information Administration.
Seven countries within the OPEC+ group on Sunday announced they agreed to increase production by 188,000 barrels per day starting in June as a commitment to “market stability.”
Higher prices at the gas pump are also impacting Americans’ wallets amid a weakened U.S. dollar. The U.S. dollar depreciated about 10% from early January 2025 to the end of April 2026 — with losses in the first half of 2025 being the biggest since 1973, according to an analysis by Morgan Stanley.
A weakened dollar could make it more expensive for Americans to travel abroad and increase the price of imported goods — while American exporters could see a financial boost, according to financial analysts.
Todd Blanche, the acting attorney general, on Sunday sought to contrast the Justice Department’s indictment of the former F.B.I. director James B. Comey over a social media post with other instances in which people have shared the same message, saying that the department had gathered additional evidence during an 11-month investigation.
Mr. Comey was indicted last week over a photo that he posted on Instagram in May 2025 of seashells on a beach that spelled out “86 47,” which the department characterized as a threat to the president. The charge was the second attempt by the Justice Department under President Trump to prosecute Mr. Comey and the department’s latest effort to pursue charges against the president’s perceived enemies.
Asked on NBC’s “Meet The Press” whether others who displayed the same numbers, or bought or sold T-shirts with the same message, would face the same prosecution, Mr. Blanche said no.
The “86 47” message, Mr. Blanche said, is “posted constantly — that phrase is used constantly.” He added, “Every one of those statements do not result in indictments.” What makes Mr. Comey’s case different, he argued, is other evidence collected, which he said he could not describe.
“Of course the seashells are part of that case,” said Mr. Blanche, who acknowledged that proving Mr. Comey’s intent would be crucial to his prosecution. “You prove intent with witnesses; you prove intent with documents,” he said, adding that there was “a body of evidence” that led to Mr. Comey’s indictment. The three-page indictment, secured on Tuesday, was focused only on the seashell post.
Mr. Comey has insisted he is innocent and will fight the charges. He has said he did not associate the phrase “86” with violence, and pointed to its origins in the restaurant business, where it has for decades been used to refer to removing something from the menu or throwing out an unruly customer.
Senator Adam B. Schiff, Democrat of California, appeared later on the show and said there was only one thing that distinguished Mr. Comey’s case from other examples of people using the phrase: “the fact that James Comey is a political opponent of the president; it’s the fact that the president has called on him for prosecution; it’s the fact that Todd Blanche wants to keep his job.”
Mr. Schiff called the charges against Mr. Comey “deeply illegitimate” and said he expected the case to be thrown out of court before it ever gets to a jury.
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