If you’ve been prescribed misoprostol (often called “miso”) to manage a miscarriage, you may feel anxious about what will happen. Misoprostol is a medication that helps the uterus empty, and it’s one of the most common and effective options for managing miscarriage.
This guide explains how misoprostol works, what to expect physically and emotionally, and when to call your doctor.
What Is Misoprostol?
Misoprostol is a medication that causes the uterus to contract.
It’s used worldwide for miscarriage management, abortion care, and to prevent postpartum hemorrhage.
In miscarriage care, it is used for missed, incomplete, and early pregnancy loss, not viable pregnancies.
How Is It Taken?
Misoprostol can be given orally, under the tongue, or vaginally.
NICE NG126 and ACOG Practice Bulletin recommends 800 mcg misoprostol vaginally or orally, often with prior 200 mg mifepristone.
Sometimes it’s given alone, and sometimes in combination with another medication, mifepristone. Mifepristone + Misoprostol combination is more effective than misoprostol alone.
What to Expect Physically
Bleeding and cramping usually begin within a few hours of taking misoprostol.
Bleeding may be heavier than a normal period and often includes passing clots and tissue.
Cramping can be intense; many describe it as stronger than period pain.
Heavy bleeding typically lasts 24–48 hours, followed by lighter bleeding or spotting for 1–2 weeks.
Mild fever/chills in the first 24 hrs can be a side effect, but persistent fever >38℃ beyond 24 hrs may indicate infection.
How Effective Is It?
Effectiveness depends on gestational age and whether misoprostol is used alone or with mifepristone.
If it doesn’t fully work, a repeat dose or a surgical procedure (D&C) may be needed.
When to Call Your Doctor
Seek medical attention if you experience:
Soaking two or more pads per hour for several hours
Severe abdominal pain unrelieved by medication
Foul-smelling discharge
Fever above 38°C (100.4°F) lasting more than 24 hours
Bleeding that continues beyond 2–3 weeks without improvement
If you feel dizzy, faint, or develop shoulder pain with heavy bleeding, seek emergency care immediately.
The Emotional Side of Misoprostol
For some, taking misoprostol feels empowering — the ability to complete the miscarriage at home in a private, familiar space. For others, it can feel traumatic — experiencing the process physically rather than having it completed surgically. Both responses are valid.
“It was the heaviest period of my life. I knew it was working, but it was also so hard emotionally.”
Some women find it helpful to speak with others who have used misoprostol. If you feel comfortable reaching out to friends, you might be able to hear about another person's experience if it would be helpful.
Key Takeaways
Misoprostol is a safe, effective option for managing miscarriage.
Expect heavy bleeding and strong cramping for the first 24–48 hours, followed by lighter bleeding.
Most people recover within 1–2 weeks, but call your doctor if you have heavy, prolonged, or unusual symptoms.
The emotional impact of using misoprostol is real — give yourself permission to seek support.
✨ We’re building Sibyl to walk with you through every stage of miscarriage care — including what to expect when using medications like misoprostol. If you’d like to help shape Sibyl, sign up for our beta: https://www.sibyl.care/signup
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