Inclusion Criteria:  Pregnancy ≤ 63 days gestational age by ultrasound seeking termination of pregnancy Pregnancy visible on ultrasound Speaks English or Spanish Willing and able to return for follow-up appointment  Exclusion Criteria:  People with gestations > 63 days gestational age Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass Pregnancy of unknown location IUD or contraceptive implant in place History of allergy to letrozole or misoprostol Unable to return for clinic-based follow-up Currently breastfeeding Twin or multiple pregnancy History of liver disease or abnormal liver function