What is Misoprostol

Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. It  is taken by mouth when used to prevent gastric ulcers in persons taking NSAIDs.

More information on how to self-manage an abortion with pills

1. What medications can be used safely for an abortion with pills?

Abortion with pills involves two medications: mifepristone and misoprostol. They can be used together — or misoprostol can be used alone — to empty the uterus safely and effectively by starting a process similar to a miscarriage. When misoprostol is used alone, it is slightly less effective but still very safe. This method is very common because mifepristone is not available in many places.

2. What is the difference between mifepristone and misoprostol?

Mifepristone blocks the activity of progesterone (a hormone needed to maintain a pregnancy) in the uterus and softens the cervix so the pregnancy comes out more easily. Misoprostol makes the uterus contract and push out the pregnancy. This is similar to what happens when a person has a miscarriage.

When both medications are available, mifepristone is taken first, and then misoprostol is taken 1–2 days later. Mifepristone is always swallowed. Misoprostol is put in the mouth to dissolve, either in between the cheek and gum or under the tongue. Note: You don’t need to take misoprostol vaginally, and no one ever needs to insert it for you.

Mifepristone is only available in a limited number of countries around the world. Check here to see if it is available in your country: www.medab.org. Mifepristone is often packaged together with misoprostol and sold as a combined product just for abortion.

Misoprostol is more widely available around the world, less expensive than mifepristone, and easier to buy from pharmacies and medicine sellers. In addition to being used to induce an abortion, misoprostol is also used to treat ulcers and to prevent or treat heavy bleeding after childbirth, therefore it is generally easier to purchase without a prescription.

Misoprostol is the medication’s clinical name, but it is sold internationally under many different trade names, such as Cytotec, Misoclear, Misotac, Kontrac, and Isovent. You can find a full list of names here: www.womenonwaves.org.

3. What do abortion pills look like?

Both mifepristone and misoprostol are sold in tablet or pill form. Misoprostol pills usually, but not always, have a unique six-sided shape. Mifepristone is usually a round, white pill. If someone is selling these medications in capsule form, they are not legitimate. (A capsule is a shell or container, usually made of gelatin, that contains a medication.)

4. What does mifepristone combined with misoprostol look like?

Where mifepristone is available, it is usually sold packaged together with misoprostol as a “combi-pack.” Combi-packs are rarely counterfeit and should look something like this.

5. What is a “blister pack” and why is it important?

A “blister pack” is a way of packaging medicines where individual pills are sealed in a “bubble” between two layers of material. The most common materials used for blister packs are cardboard, plastic and aluminum.

Misoprostol becomes less effective when the pills are exposed to heat and moisture. For that reason, misoprostol must be sealed in double-aluminum blister packs (aluminum on top and bottom), rather than cardboard or plastic. You are unlikely to find legitimate or effective misoprostol that is being kept in cardboard, plastic or as loose pills in a bottle.

A double-aluminum blister pack should look something like this. Be sure the aluminum is not opened on any side until you are ready to use the pills.

6. How much do the pills cost?

The cost of misoprostol varies around the world. But misoprostol is widely available, so it’s generally not very expensive. Manufacturers sell the pills to pharmacies for very little cost — less than $0.05 USD (5 cents) per pill. The highest sales price found in a recent study was $2 USD per pill.

Misoprostol is usually an affordable option for someone seeking an abortion. Of course, some pharmacists or medicine sellers may take advantage of people seeking misoprostol and try to charge too much for the pills. You can ask people you trust if they know how much the pills should cost where you live, or you can search the internet for local cost information. But remember: Misoprostol should not be expensive.

Pre-packaged combi-packs of mifepristone and misoprostol are only available in a limited number of countries (less than 30), and they are less likely to be sold without a prescription. If you live in a low- or middle-income country where combi-packs are available, the prices are likely controlled, and a combi-pack should cost less than $20 USD.

7. How many pills do I need to buy?

If you have access to both mifepristone and misoprostol, you will need 1 mifepristone pill of 200mg and at least 4 misoprostol pills of 200mcg each. If you are 10–12 weeks pregnant, you may need to take 1 or 2 extra doses (4 or 8 extra pills) of misoprostol to finish the abortion process. If you have access to misoprostol only, you will need at least 12 misoprostol pills of 200mcg each if you are less than 13 weeks pregnant.

8. How can I know if the pills are real and not counterfeit?

Even if you ask for abortion pills by name, such as misoprostol or mifepristone, some medicine sellers may try to sell you counterfeit pills that won’t work and may delay you from having an abortion. Safe, effective abortion pills should be:

• The color white
• Pills or tablets, NOT capsules
• Packaged in an undamaged, double-aluminum blister pack, ideally
• Sold to you by a pharmacy or medicine seller you trust
• Not expired (an expiration date should be on the package)

9.  Can I buy abortion pills without a prescription?

Mifepristone and misoprostol can be obtained from a health provider, from pharmacies and medicine sellers, and from the internet. Depending on what country you live in, a prescription may be required to buy mifepristone and misoprostol from a local pharmacy or medicine seller. But the two medications are often sold without a prescription. Misoprostol is typically much easier to buy because it is also used to treat ulcers and to prevent or stop heavy bleeding after childbirth. Mifepristone and misoprostol “combi-packs” and misoprostol alone can be bought from online pharmacies and organizations that support people to self-manage their abortions (see the list in question #10).

10. Where can I find more information on abortion with pills?

Reliable, evidence-based information on how to safely self-manage an abortion with pills can be found on the websites of these organizations:

• Safe2Choose: www.safe2choose.org
• Women Help Women: www.womenhelp.org
• Women on Web: www.womenonweb.org

There are also these reliable mobile apps available in the Apple App Store and Google Play Store:

• Euki — Sexual health info & tracking. You can download it in the Apple app store and Google Play store.
• Safe Abortion (SA) — Hesperian Health Guides. You can download it in the Apple app store and Google Play store.