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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.
At least about two dozen people have died amid the perilous climate crisis-driven heatwave that has scorched swaths of the US with record temperatures.
As a huge heat dome sits over the county’s eastern half, extreme heat gripped millions of people in the days leading up to the US’s semiquincentennial on Saturday – and beyond it. More than 20 states experienced have reported stifling temperatures more than 100F (38C), marring celebrations. And more than 140 million people remained under active heat alerts across the US on Sunday.
Officials in New Jersey believe the extreme heat was a factor in the deaths of 22 people across 10 counties there, mostly in central and northern parts of the state. Many of the individuals were found in homes with no air conditioning, outside their residences, on the street and in parked cars, according to officials.
The first of those deaths occurred on Thursday, and the ages of the deceased in question mostly range from their mid-30s to their 80s. Preliminary findings cause investigators to believe the deaths are heat-related, though the chief state medical examiner for New Jersey would later determine the exact cause of death for each.
“This is not a typical summer heatwave,” the New Jersey department of public health said in a statement. “This type of heat can quickly become life-threatening to humans and to animals of all ages.”
The National Weather Service (NWS) has said cool air from the north in the coming days is going to lower some of the most extreme temperatures in the region, including New Jersey. The Fifa World Cup final is scheduled to be held in the New Jersey city of East Rutherford on 19 July.
Elsewhere, a heat-related death was reported in Cook county, Illinois, Natalia Derevyanny, a government spokesperson, told NBC News. The cause of that death was recorded as organic cardiovascular disease – with heat stress as a contributing factor.
Hinds county in Mississippi reported the death of 74-year-old Mitchell Ray Cooley due to heat exposure on Thursday, state officials said. Cooley had been reported missing, and his body was found the next day behind a gas station, the county coroner said in a statement.
“Mr Cooley suffered from a medical condition that impaired his judgment,” the coroner’s office said. “Based on the investigative findings, scene examination, and subsequent evaluation, the cause of death has been determined to be weather-related heat exposure. At this time, there is no indication of foul play.”
Meanwhile, on 27 June, Martha Irene Van Egmond, 83, died in Bolton, Mississippi, after falling in her garden. When her husband, Rick, tried to help her up, he fell too. The couple were unable to get up and spent hours in the heat.
Rick Van Egmond said he and his wife called out for help, and eventually two men from a nearby apartment complex came – but it was too late for Martha. She died surrounded by flowers, doing what she loved, he said to local news outlet WAPT.
Jeramiah Howard, Hinds county’s chief death investigator, attributed her death to the heat combined with her age, WAPT reported.
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As Donald Trump spoke during rain-dampened celebrations in Washington DC on Saturday, emergency services there had treated 51 people with heat-related issues as of 8pm ET, with 12 taken to nearby hospitals, according to local emergency response officials.
Other events scheduled for Saturday – including the Independence Day parade in DC – were cancelled amid the blistering heat. Among other weather-related disruptions, Trump’s so-called Great American State Fair on the National Mall also temporarily closed down on Friday after reports that 44 visitors had been treated for heat-related illnesses.
The worst of the heat started moving out of the US’s north-east and midwest regions by Sunday, shifting farther south into the mid-Atlantic and south-eastern parts of the country.
But scientists warn that heatwaves with extreme temperatures are indications that the world must lower the greenhouse gas pollution driving the global climate crisis.
The NWS is urging the public to avoid heat sickness by drinking plenty of fluids as well as staying out of the sun and in air-conditioned environments. Officials have also asked people to check on relatives and neighbors.
Rep. Nancy Pelosi, D-Calif., and her husband Paul arrive at the funeral services for Clive Davis at Central Synagogue in New York, Monday, June 29, 2026.
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LOS ANGELES — The husband of former House Speaker Nancy Pelosi was involved in a hit-and-run in California that left a parked car with “major” damage authorities said Saturday, and he could face misdemeanor charges.
Paul Pelosi was driving his brown convertible Friday in Yountville, a town in the heart of wine country, when he struck a legally parked car on the side of the road, briefly stopped and then drove away, the Napa County Sheriff’s Office said in a statement. No injuries were reported.
A witness saw the collision and called 911. Shortly afterward sheriff’s deputies found Pelosi with damage to the front of his car on a road roughly a quarter of a mile away. He reportedly told officers he knew he hit something but was not sure when or what caused the damage.
Pelosi, 86, did not have any alcohol in his system, according to the statement. The sheriff’s office referred him to the Department of Motor Vehicles for a process to determine whether he may continue to drive — something that officials say is common for older drivers.
Pelosi was not arrested, and because no one was injured, the sheriff’s office recommended a misdemeanor charge for fleeing the scene of an accident.
A staffer for Nancy Pelosi did not immediately respond to an email seeking comment.
Paul Pelosi pleaded guilty in 2022 to misdemeanor charges of driving under the influence in Napa County and was sentenced to five days in jail and three years of probation. However, he served only two days in jail and received good conduct credit for two other days, leaving just one day to serve in a work program at the courthouse.
As part of his probation, Pelosi was required to attend a three-month drinking driver class and install an ignition interlock device, which forces drivers to provide a breath sample to prove sobriety before the engine will start. He also was ordered to pay about $5,000 in victim restitution for medical bills and lost wages, along with nearly $2,000 in fines.
That same year he was attacked and severely beaten with a hammer at the couple’s San Francisco home.
WASHINGTON (7News) — The thousands of people attending the Great American State Fair and other areas around the National Mall are being ordered to evacuate as stormy weather approaches.
The National Weather Service previously announced a Severe Thunderstorm Warning in the District. Officials are asking attendees to seek shelter.
SEE ALSO: Historic Fourth of July fireworks to light up National Mall: How to watch live
The DC Homeland Security & Emergency Management released a list of places where the crowds can go to get out of the weather:
Federal Buildings:
- Ronald Reagan Building – 100 Pennsylvania Ave NW
- Dept. of Commerce – 1401 Constitution Ave NW
- Dept. of Agriculture – 1400 Independence Dr SW
- Dept. of Education – 400 Maryland Ave SW
- Internal Revenue Service – 1111 Constitution Ave NW
- Voice of America – 330 Independence Ave SW
- Thomas Jefferson Memorial – 16 E Basin Dr SW
Museums:
- National Museum of American History – 1300 Constitution Ave NW
- National Museum of Natural History – 1000 Constitution Ave NW
- National Museum of African American History and Culture – 1400 Constitution Ave NW
Freedom 250 organizers released this statement:
“The safety of our guests, performers, and staff is our top priority. Due to approaching severe storms, Freedom 250, United States Secret Service, United States Park Police, National Park Service, the Federal Emergency Management Agency, and all public safety partners are asking all guests to evacuate event grounds and seek temporary shelter in a nearby building. Available shelter locations include the Department of Commerce, Department of Education, Department of Agriculture, Internal Revenue Service, VOA Building, Thomas Jefferson Memorial, National Museum of American History, National Museum of Natural History, the African American Museum, and the Ronald Reagan Building. Please remain calm, follow the directions of law enforcement and event staff, and stay tuned to Freedom 250’s official channels for updates. Freedom 250 will share updates on programming and doors reopening — please stay close to our official channels for updates.”
The Secret Service said they have suspended screening on the National Mall.
“Security screening on the National Mall has been suspended due to dangerous storms,” the Secret Service said. “If you are already on the grounds, follow directions from officers and event staff and move to shelter immediately. Do not shelter under trees.”
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Metro riders are also asked to seek shelter. Commuters should expect heavy crowds at stations near the National Mall and are asked to consider using L’Enfant Plaza, Metro Center, Archives, Federal Triangle or Federal Center SW stations to avoid congestion.
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