Objectives: Due to their accessibility and relative anonymity, pharmacies are especially attractive to people seeking care for stigmatizing health issues, such as STIs, family planning and abortion or menstrual regulation (MR). MR is the evacuation of the uterus of a woman at risk of being pregnant to ensure a state of non-pregnancy and is sanctioned by the government of Bangladesh. Despite the lack of reliable data, anecdotal evidence suggests women may be using medications they obtain from medicine sellers and/or pharmacies to induce MR or abortion. The extent to which this practice is taking place in Bangladesh is unknown as is the extent to which medicine sellers are aware of the safe and effective regimens. We investigated the availability and provision knowledge and practices of misoprostol and other abortifacient drugs in pharmacies and medicine shops in Dhaka and Gazipur Districts. Methods: This 9 month cross-sectional study included 3 consecutive components: 1) mapping and listing of all pharmacies in the 2 study areas; 2) conducting a knowledge and practices survey among pharmacies randomly selected from the mapping list; and 3) simulated client visits using 4 different role-playing scenarios in all selected pharmacies. Results: Survey respondents (n = 331) had a mean age of 34 years; 73% had college education or higher and 28% had no formal training for selling medicine. Almost all had heard of MR. When asked about methods used for MR, 96% of respondents reported the use of pills, and 93% reported surgical methods; 65% knew the legal limit for MR. 98% of respondents reported that clients are asking them for methods for pregnancy termination. 20% of pharmacies did not recommend any drug for MR; 35% recommended misoprostol only and 36% recommended misoprostol with another drug. No respondent described using an effective regimen for MR. In the simulated client visits, 94% of the sellers did not provide or refer the client for post-MR family planning. Conclusions: There is growing concern about the ineffective provision of misoprostol for MR through pharmacies in Bangladesh. This study suggests that pharmacy provision of misoprostol for MR is common. It also shows that pharmacists are providing ineffective drugs and regimens for MR. These study findings suggest that targeted resources and training for medicine sellers are required to improve the quality of MR in Bangladesh.