What pills are used to remove a miscarriage?: An Overview of Medical Management

October 12, 2025 •

4 min read

According to the American Academy of Family Physicians, medication management for early pregnancy loss is highly effective and widely used in clinical practice. This guide provides a comprehensive overview of what pills are used to remove a miscarriage, detailing the medical process, effectiveness, and what to expect during this difficult time.

Quick Summary

Medical management for early pregnancy loss primarily involves using a combination of the medications mifepristone and misoprostol, or sometimes misoprostol alone, to help expel remaining pregnancy tissue from the uterus. The process, which is a safe alternative to surgery, can induce bleeding and cramping similar to a heavy period, with specific expectations and follow-up care required.

Key Points

Combined Regimen is Most Effective: The most successful medical management for early miscarriage involves a two-step process using mifepristone and misoprostol.
Mifepristone Prepares the Uterus: The first pill, mifepristone, blocks progesterone and helps to break down the uterine lining to prepare for tissue expulsion.
Misoprostol Induces Cramping and Bleeding: The second medication, misoprostol, causes uterine contractions to expel the tissue and results in cramping, bleeding, and potential nausea.
Expect Heavy Bleeding and Cramping: The most significant physical symptoms occur after taking misoprostol, mimicking a heavy period or early labor.
Follow-Up is Critical: A follow-up appointment is necessary to confirm that the miscarriage is complete and to monitor for any complications, which can be done via ultrasound, blood tests, or at-home pregnancy tests.
Alternative Options Exist: For those who prefer not to use medication, expectant management (wait and see) or surgical management (uterine aspiration/D&C) are other safe and effective choices.
Risks are Rare but Possible: Though overall very safe, medical management carries a small risk of heavy bleeding, infection, or an incomplete miscarriage.
Seek Immediate Medical Attention for Severe Symptoms: It is crucial to contact a healthcare provider immediately for excessive bleeding (soaking more than two maxi pads an hour for two hours) or signs of infection.

For many experiencing early pregnancy loss, medical management with medication offers a safe and effective alternative to a surgical procedure or expectant management, which involves waiting for the miscarriage to happen naturally. This method gives patients more control over the timing and setting of the process. The primary medications used are mifepristone and misoprostol, which work in a coordinated manner to complete the miscarriage.

The Role of Mifepristone and Misoprostol

Mifepristone (Mifeprex)

Mifepristone is a medication that plays a key role in the combined treatment approach. It is an antiprogestational steroid that works by blocking the action of progesterone, a hormone necessary for a pregnancy to continue. By blocking progesterone, mifepristone helps to stop the growth of the pregnancy and prepares the uterus to expel the tissue by causing the uterine lining to break down. It is taken orally as the first step in the medical management process.

Misoprostol (Cytotec)

Misoprostol is a prostaglandin E1 analogue that is typically taken 24 to 48 hours after mifepristone. Its purpose is to induce uterine contractions and cause the cervix to soften and dilate, aiding in the expulsion of the pregnancy tissue from the uterus. Misoprostol can be administered in several ways, including buccally (dissolving in the cheek pouch) or vaginally. Many patients experience the onset of cramping and bleeding within a few hours of taking misoprostol.

Comparison of Treatment Regimens

The effectiveness and side effect profile can differ between using the combined regimen and using misoprostol alone. International and U.S. guidelines, including recommendations from the American College of Obstetricians and Gynecologists (ACOG), support the superior efficacy of the combination of mifepristone and misoprostol.


Feature	Combined Regimen (Mifepristone + Misoprostol)	Misoprostol-Only Regimen
Effectiveness	Generally higher; reported success rates of 90% or more for early pregnancy loss.	Lower compared to the combined regimen, with success rates typically ranging from 67% to 80% for early pregnancy loss.
Procedure Duration	Often results in a faster and more predictable process for passing the pregnancy tissue.	May take longer for the tissue to pass and is associated with a higher rate of incomplete miscarriage.
Need for Follow-Up	A follow-up to confirm completion is necessary, but the risk of needing a further procedure is lower.	Requires a higher likelihood of needing a repeat dose or a follow-up surgical procedure to complete the miscarriage.
Side Effects	Patients may experience side effects after taking misoprostol, but the overall experience is often better tolerated than misoprostol alone.	Increased incidence of gastrointestinal side effects like diarrhea, fever, and chills is more common.

What to Expect During Medical Management

The experience of a medically managed miscarriage varies, but there are common symptoms and phases to anticipate:

After Mifepristone: Most patients feel no immediate effects from the first pill, though some may experience minor spotting.
After Misoprostol: The most intense symptoms typically begin within 2 to 24 hours of taking misoprostol.
- Cramping and Pain: You will likely experience cramping, which can range from mild to severe, similar to intense period pain or early labor. Pain medication like ibuprofen can help manage the discomfort.
- Bleeding: Bleeding will be heavier than a normal menstrual period and may involve passing blood clots and tissue. This heavy bleeding phase typically lasts several hours. Total bleeding and spotting can continue for one to two weeks or even longer.
- Other Side Effects: It is common to experience nausea, vomiting, diarrhea, chills, and a low-grade fever due to the misoprostol.

Following-Up and Potential Complications

Importance of Follow-Up Care

Follow-up care is a crucial part of the medical management process to ensure the miscarriage is complete and to monitor for any complications. This can involve a combination of the following:

A follow-up appointment: Usually scheduled 7 to 14 days after taking mifepristone.
Ultrasound or hCG testing: A doctor may use an ultrasound or blood tests to confirm the uterus is empty and that pregnancy hormones are declining.
At-home pregnancy test: A follow-up pregnancy test may be recommended several weeks after the process.

Rare Complications

While medical management is very safe, a small risk of complications exists. These may include:

Incomplete Miscarriage: Some pregnancy tissue may remain in the uterus, requiring a repeat dose of misoprostol or a surgical procedure.
Heavy Bleeding (Hemorrhage): Although heavy bleeding is expected, rarely, it can become excessive, requiring emergency medical attention. Excessive bleeding is defined as soaking through more than two large sanitary pads per hour for two consecutive hours.
Infection: Signs of infection include a fever lasting more than 24 hours after taking misoprostol, severe abdominal pain, or a foul-smelling discharge.

Alternatives to Medical Management

For those who do not wish to or are unable to use medication, other options for miscarriage management are available:

Expectant Management (Wait and See): This involves allowing the miscarriage to progress naturally without intervention. The success rate varies depending on the type of miscarriage, and while effective, it can take several weeks.
Surgical Management (Uterine Aspiration): A procedure, often called D&C (Dilation and Curettage), is performed to remove the pregnancy tissue from the uterus. This is a fast and highly effective option but involves a surgical procedure.

Conclusion

The use of medication, primarily mifepristone and misoprostol, is a common and safe approach for managing early miscarriage, offering an effective alternative to surgical intervention or simply waiting for the process to complete naturally. The combined regimen of mifepristone followed by misoprostol is generally the most effective method, leading to higher success rates compared to using misoprostol alone. A clear understanding of what to expect, from potential side effects to the necessity of follow-up care, is vital. Discussing all management options with a healthcare provider is essential for making an informed decision that aligns with individual medical needs and preferences.

Frequently Asked Questions

Most people experience bleeding and cramping within 2 to 24 hours after taking misoprostol. For many, the most intense symptoms begin within a few hours.

A medical provider will schedule a follow-up appointment, typically 7 to 14 days later, to confirm the miscarriage is complete. This is done through a combination of checking symptoms, an ultrasound, or monitoring pregnancy hormone (hCG) levels.

In cases of an incomplete miscarriage, a repeat dose of misoprostol may be prescribed, or a surgical procedure like uterine aspiration may be recommended to remove any remaining tissue.

Over-the-counter pain relievers such as ibuprofen or acetaminophen are often recommended to manage cramping. Stronger painkillers may also be prescribed by your doctor.

After the heaviest bleeding phase, which lasts several hours, you can expect lighter bleeding or spotting to continue for one to two weeks, and sometimes longer.

You can ovulate and become pregnant again soon after a miscarriage, even before your first menstrual period returns. It is recommended to discuss your future pregnancy plans with your doctor.

Yes, medical management of miscarriage is a very safe and common procedure. Serious complications are rare, and medical professionals will provide guidelines for monitoring and when to seek emergency care.