How late into pregnancy is the abortion pill effective?

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In 2000, the FDA initially approved mifepristone for use with misoprostol to end a pregnancy up to 49 days gestation, or the seventh week of pregnancy. Gestation is the number of days since the first day of a person’s last menstrual period.

Then, in 2016, after reviewing further data and information submitted by the drug manufacturer, the FDA approved mifepristone to end a pregnancy up to 70 days gestation, or 10 weeks.

The FDA states that a person should not take mifepristone if it has been more than 70 days since their last period began. However, according to the American College of Obstetricians and Gynecologists (ACOG), evidence supports using the medication for more advanced gestations.

Other leading health organizations have similar views to the ACOG:

• The Guttmacher Institute says doctors use medical abortion safely off-label at later gestation.
• The World Health Organization (WHO) says that the abortion pill is safe up to 12 weeks of pregnancy.
• The Royal College of Obstetricians and Gynaecologists (RCOG) in the United Kingdom specifies that people can use abortion medication in the second trimester up to 24 weeks of pregnancy.

While the ACOG agrees that the abortion pill is effective for a medical abortion during the second trimester, it notes that it carries a higher risk of complications. These can include an incomplete abortion requiring dilation and evacuation (D&E), also known as a surgical abortion.

Medical abortion comprises two pills: mifepristone and misoprostol. It is essential that a person takes both medications in the correct order.

The first medication someone takes to end a pregnancy is mifepristone, which blocks the hormone progesterone, which plays a vital role in maintaining the early stages of pregnancy. When mifepristone blocks progesterone, it causes the uterus lining to thin, preventing the embryo from remaining implanted.

The second medication, misoprostol, causes the cervix to soften and dilate. The uterus will then contract and empty its contents through the vagina. People will experience abdominal cramping and vaginal bleeding.

The FDA recommends the following regimen for medical abortions:

• Day 1: Take 200 milligrams of mifepristone by mouth.
• After 24–48 hours: Insert 800 micrograms of misoprostol in the mouth between the cheek and gum to absorb.
• After 7–14 days: Follow up with a healthcare professional to evaluate bleeding, uterine size, and signs of infection.

The pregnancy typically ends around 2–24 hours after taking mifepristone and misoprostol. A person can expect bleeding and cramping that will be heavier than that of a menstrual period.

The abortion pill is effective at ending pregnancy up to 12 weeks gestation around 95–99% of the time. However, its efficacy reduces the longer a pregnancy lasts.

Sometimes, a medical abortion may not be fully effective, and the pregnancy may not pass from the uterus. If this happens, a healthcare professional will discuss the next steps with the individual. They can choose to wait and see if cramping and bleeding begin, undergo a surgical procedure to empty the uterus, or take another dose of misoprostol.

The FDA recommends the abortion pill up until 10 weeks gestation. However, as this article mentions above, other health organizations have different guidance. A person’s healthcare professional can advise them on whether or not a medical abortion is the right choice for them.

If a person is further on in their pregnancy, they could have a surgical abortion, depending on the laws in their state.

Surgical abortion may involve either vacuum aspiration or D&E. A person can usually get vacuum aspiration until week 13 of pregnancy and D&E after that.

Learn more about what to expect during a surgical abortion and abortion aftercare.

There are many restrictions on access to abortion, including abortion pills, since the Supreme Court overturned Roe v. Wade on June 24, 2022. Access to abortion care may depend on where a person lives.

The FDA no longer requires healthcare professionals to dispense the medication in person, so some healthcare providers and pharmacies may mail the abortion pill depending on state law.

People may be able to access medical abortion by mail via the following resources:

• Hey Jane
• Plan C
• Carafem
• Aid Access
• Just The Pill
• Choix
• Abortion On Our Own Terms

The National Abortion Federation has a resource called Abortion Finder to help people locate in-person and virtual abortion providers. The advocacy group Planned Parenthood also has a database for abortion services.

Below are answers to common questions regarding the abortion pill.

Is it the same as plan B?

Plan B is not the same as the abortion pill. Also known as the morning-after pill, Plan B is an emergency contraception that prevents pregnancy soon after sex without a barrier method.

It works by stopping the release of an egg from the ovary, preventing fertilization of the egg and sperm. However, if implantation has already occurred, Plan B will not terminate a pregnancy.

Where can I get the abortion pill?

Accessibility to the abortion pill will depend on where a person lives. Abortion Finder has a State-by-State Guide to help people locate abortion support.

Is it safe?

Doctors consider the abortion pill to be safe.

Around 2% of abortions have complications, which may include:

• incomplete abortion
• infection
• heavy vaginal bleeding
• pain

The abortion pill consists of two medications called mifepristone and misoprostol. These medications halt pregnancy growth and cause cramping and bleeding to end the pregnancy.

According to the FDA, people can use abortion pills to end pregnancies up to 10 weeks gestation. Beyond 10 weeks, doctors recommend people have a surgical abortion.

Access to the abortion pill differs depending on where a person lives and the laws in their state. In some states, people can access a medical abortion by mail through certified medical prescribers and pharmacies.