What to Know About Abortion and Miscarriages With or Without Mifepristone

You may have seen the headlines: A Texas lawsuit may someday affect access to a medication called mifepristone. Mifepristone is used in abortion care and miscarriage care.

I’m an ob-gyn who’s trained in the full scope of pregnancy care, including pregnancy loss and abortion care. That means I have prescribed mifepristone to countless patients. I’ve seen firsthand how safe and effective it is.

Here, I’ll explain what mifepristone is and what’s happening with the lawsuit. I’ll also walk through the options if you ever need to have an abortion or manage a miscarriage without mifepristone.

Long story short: There would still be safe options available.

First, what is mifepristone?

Mifepristone is a medication used for both abortion care and miscarriage care. Mifepristone helps stop a pregnancy from growing. It also helps prepare the body to empty the uterus. It does this by softening the cervix and helping the lining of the uterus break down.

Mifepristone is the first step in a two-step process. After you take mifepristone, you take another medication called misoprostol. Misoprostol causes cramping and bleeding, which empties the uterus.

Misoprostol works best when taken after mifepristone, but it can also be used on its own.

What happened with mifepristone? Why was there a lawsuit?

Mifepristone was approved by the U.S. Food and Drug Administration (FDA) for abortion care more than 20 years ago. It is very safe and commonly used. More than half of abortions in the U.S. are now done with this medication.

In April 2023, a federal judge in Texas decided that mifepristone should be taken off the market. Then an appeals court said mifepristone should stay on the market, but with new restrictions.

These decisions are not based in science or medical facts. They are based on a lawsuit from groups trying to limit access to abortion care.

The Supreme Court has stepped in and said that for now, mifepristone should remain available with no new restrictions. The lawsuit will continue to be reviewed by judges. It’s possible that access to mifepristone will continue to change while the lawsuit makes its way through the courts.

Does this change anything about the safety of mifepristone?

No, nothing about the safety of mifepristone has changed. The Texas judge and appeals court ignored decades of data showing mifepristone is safe. If you have taken mifepristone before, you made a safe decision supported by doctors, research, and real-world results.

What are the options for abortion care and miscarriage care without mifepristone?

If mifepristone is ever not available, there would still be safe options available. These two options can be used for an abortion or a miscarriage:

• Taking misoprostol by itself. This is already how many miscarriages are managed. This is usually effective, but there is a chance that the uterus may not fully empty and a procedure may be needed. Also, this option may result in more bleeding than taking mifepristone and misoprostol together.

• Having a procedure. The most common procedures used for abortion care and miscarriage care are vacuum aspiration or dilation and curettage (called D&C or suction curettage). In these procedures, a small tool is inserted through the cervix and into the uterus to remove the tissue. This is the fastest, most reliable treatment.

With miscarriage, you have another option: letting the pregnancy tissue pass on its own. This generally happens within 2 weeks of a miscarriage, but it can take as long as 8 weeks. Sometimes, the body doesn’t pass all the tissue and treatment is still needed. (Read more about treatment after a miscarriage.)

How do I get misoprostol?

You need a prescription from a health care professional to get misoprostol in the U.S.

Some states may let you use telehealth (talking with a doctor by phone or video) or a website to have the pills mailed to you. But as always, laws that restrict access to abortion care may limit your options. Read more about abortion care and access.

Doctors like me are here for you.

We health care professionals want to give you the best treatment possible. We hope that mifepristone will always be available, but the other options are still incredibly safe.

No matter what judges say, we will keep doing all we can to provide good health care for the people who need it. That will always be the same.

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to health care. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. It is not legal advice. It should not replace the advice of a lawyer. ACOG does not endorse the products or services of any person or organization. Links to resources do not imply ACOG’s endorsement of the resource. The content in linked resources may change without notice. No one associated with ACOG will be liable for any loss, damage, or claim related to the information on this webpage. The use of this information is voluntary. Clinicians should be familiar with and comply with any federal, state, and local restrictions on abortion, including medication abortion. Read ACOG’s complete disclaimer.