Mifepristone and Misoprostol for Miscarriage
If you've been told you've had a miscarriage and offered medical management, your midwife or doctor may mention mifepristone and misoprostol. These are the two medicines used to help your body pass the pregnancy when it hasn't happened on its own. Knowing what each tablet does and what the process actually feels like can make a frightening moment feel a little more manageable.
How the two medicines work
Medical management uses two different drugs, taken a day or two apart, to help your body complete a miscarriage that has already been confirmed on a scan.
- Mifepristone is usually taken first, as a single tablet. It blocks the hormone progesterone, which softens the cervix and prepares the uterus to respond to the second medicine.
- Misoprostol follows, typically 24–48 hours later. This is what causes the uterus to contract and the pregnancy tissue to pass. It may be taken as tablets swallowed, dissolved under the tongue, or inserted vaginally, depending on your unit's protocol.
- Some hospitals give misoprostol alone, without mifepristone first — your team will explain which regimen they're using and why.
- You'll usually be given this medicine to take at home, with clear instructions on pain relief, what bleeding to expect, and when to call for help.
What to expect during the process
Cramping tends to begin within a few hours of the misoprostol dose and can feel like a strong period, sometimes more intense. Bleeding is usually heavier than a normal period and may include clots or visible tissue — this is expected and is a sign the process is working. Most of the tissue passes within a day or two, though some bleeding and spotting can continue for one to three weeks afterwards, gradually tapering off. You'll be given pain relief to take at home, usually paracetamol alongside a stronger option if needed, and a hot water bottle can help with cramping too. Most women manage the whole process at home, with a follow-up plan already agreed with your Early Pregnancy Unit (EPU).
When to seek urgent help
Contact your EPU, maternity unit, or NHS 111 straight away if you soak through more than two sanitary pads an hour for two hours in a row, pass large clots repeatedly, develop a fever, feel faint or very unwell, or have pain that isn't controlled by the recommended painkillers. These can be signs of heavy bleeding or infection that need prompt assessment. A follow-up scan or pregnancy test is usually arranged a couple of weeks later to confirm the miscarriage is complete — hold onto that appointment details even while you're at home.
Frequently Asked Questions
Is medical management of miscarriage painful?
Most women describe the cramping as similar to a strong period, particularly in the hours after taking misoprostol. You'll be offered pain relief, including paracetamol and, if needed, a stronger painkiller, and many women find they can manage comfortably at home with these alongside rest and a hot water bottle.
How long does the whole process take?
Cramping and bleeding typically start within hours of the misoprostol dose, with most tissue passing over one to two days. Lighter bleeding and spotting can then continue for one to three weeks as your body finishes the process, similar to a heavier, longer period.
What if the medicine doesn't work?
Occasionally the tablets don't complete the miscarriage fully, and some tissue remains. If bleeding doesn't start, is much lighter than expected, or a follow-up scan shows retained tissue, your team may offer a repeat dose of misoprostol or discuss surgical management (ERPC) instead. This isn't a sign anything was done wrong — it's simply how some bodies respond, and your care team will guide you through the next step.
This article is for informational purposes only and does not constitute medical advice.
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