Period pills are the same medication as abortion pills—whether that’s using the mifepristone + misoprostol combo or misoprostol on its own. The main difference is not knowing if you’re pregnant or not. Period pills embrace uncertainty.

The medications (we call them mife and miso for short) are so safe that you can take them without taking a pregnancy test. If you are pregnant, the pills will cause an abortion. And if you aren't pregnant, the pills will start your period. When people take them within a week or two of a missed period, they will likely have bleeding similar to their regular period or slightly heavier.

“Period pills” or “menstrual regulation” is a practice used in many countries early in potential pregnancy when someone has missed their period. We think that a shift in language and framing, like using “menstrual regulation” was helpful in countries where abortion has long been banned. In Bangladesh, for example, menstrual regulation is legal and widely available through government supported clinics, even though abortion is illegal (yes! These are still the exact same pills!). In some places, “bringing down a period,” is culturally and legally more accepted than ending a confirmed pregnancy – even if the results are exactly the same: not being pregnant.

Let’s get into the history a little bit..

Before pregnancy tests, most people didn’t know right away if they were pregnant—they relied on a missed period as the first sign, but often didn’t know for sure until the “quickening,” around 14–20 weeks, when fetal movement could be felt. Throughout history and into the U.S. colonial era, if someone’s period was late, midwives would often try different methods to “bring down” a menstrual period. But how we thought about pregnancy started to change in the 1920s, when scientists discovered the pregnancy hormone hCG, which is what tests detect. Then, in the 1970s, at-home pregnancy tests became available, which allowed people to know a lot earlier (learn more about the history of the pregnancy test).

But pregnancy isn’t always black and white—it’s not like one day you’re not pregnant and the next you fully are. Early pregnancy is more of a process, starting with small hormonal changes. This is where period pills come in—they create space for a different way of thinking. Instead of needing to confirm a pregnancy, some people use these medications at the first sign of a missed period, without taking a test. For a long time, doctors required a positive pregnancy test before prescribing mifepristone or misoprostol, but we now know these medications are safe and can be used even earlier.

Now abortion pills have a really cool beginning in our opinion. Misoprostol (also known as Cytotec) was first made in the 1970s by a U.S. pharmaceutical company to treat stomach problems and ulcers. The bottle warned not to use it if you were pregnant, but in Brazil (where abortion was illegal), activists believed it could help women avoid unwanted pregnancies. And it worked! In the late 80’s, misoprostol began to be used widely for abortions across Latin America through activist networks where they shared safe ways to use it.

Misoprostol works by softening and dilating the cervix (the opening to the uterus) and causing the uterus to contract. These contractions are similar—though usually more intense—to cramps during a period. So, when there is a pregnancy in the uterus, misoprostol causes the uterus to expel it (which is exactly how a miscarriage happens, too). When there isn’t a pregnancy, the misoprostol can cause the uterine lining to shed, which triggers a period.

Image by Arwen Donahue, originally shared by We Testify.

Mifepristone (RU-486) on the other hand, was developed in 1980 by French scientists to specifically block the pregnancy hormone progesterone and end early pregnancies. In the late 1980’s and early 1990’s, clinical studies showed that using mifepristone followed by misoprostol was more effective than mifepristone alone. And in the 2000s this protocol was the standard of care globally.

Image by Arwen Donahue, originally shared by We Testify.

Mifepristone and misoprostol have been proven to be safe for people using them and effective for ending pregnancies. Normal side effects of the pills are cramping, bleeding and nausea whether you are pregnant or not and there are no long term health effects to taking these medications.

So now that we have a better understanding of the badass roots and the activists who helped shape abortion care today, why period pills?

Abortion has become more and more regulated in the U.S., and some states have banned doctors from performing them completely. The idea of "period pills" or "menstrual regulation" isn’t widely used here, mostly because abortion is still technically accessible—whether it’s at a clinic in protected states or sent by mail—so, people still have options. In countries like Bangladesh, though, menstrual regulation is legal even though abortion is banned. The U.S. doesn’t have specific laws about menstrual regulation (yet). And while most abortion bans here say the pregnant person can’t be criminally charged, self managing an abortion can still have legal risks. Taking these pills earlier can offer a way for people to avoid having to navigate the laws, logistics, expenses and stress of abortion access, especially in states where it’s banned.

That said, there is growing interest in this approach among people in the U.S. Between 2015 and 2017, the Gynuity Health Project surveyed people to understand why they might be interested in period pills. 70% of the participants who stated they would be unhappy if they found out they were pregnant expressed interest in taking period pills. Their reasons were to prevent and avoid being pregnant, as well as the potential emotional stress of finding out they were pregnant. 

If your period is late, it’s okay to not want to confirm a pregnancy.

There are many providers who will send you pills—no positive pregnancy test required. You can find a list of these providers on The Period Pills Project website.

Most of these providers will allow you to order pills in advance (sometimes referred to as “advanced provision") to make it even easier to take if you miss a period and don’t want to take a pregnancy test.

How to take period pills:

Follow the protocol outlined by the M+A Hotline.

If you follow the instructions and your period is late because you’re pregnant, these pills are 85-99% effective. You can find more information on how to be sure they worked or steps to take if you’re worried they didn’t in our guide on taking abortion pills before 6 weeks.

Here’s our take..

Our bodies are more beautiful and complex than words can perfectly describe or what any law should control. What matters most is that you get to decide if and when you carry a pregnancy and the more tools you have available to help you do that, the better.

And the lines get blurry with the words we use to describe pregnancy prevention. A miscarriage is a spontaneous abortion. An IUD is both preventative birth control and can be used as an emergency contraceptive. Ella is another type of emergency contraceptive pill, and new studies suggest it could be even more effective when used with misoprostol. And then there are abortion pills—which can be used for abortion, menstrual regulation, or even as a kind of emergency contraception if they are taken early enough.

You get to decide what your experience is called and what it means to you. With the safe and trusted options of mifepristone and misoprostol, you also get to choose when it makes the most sense for you—whether that’s after confirming a pregnancy or before, simply at the sign of a missed period. Ineedana.com is here to help you get the care you need—however you frame it, and whatever name you give it 💜

When we’re expansive in how we talk about abortion, we don’t just expand access, we expand safety and dignity for everyone.