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Medical abortion: The abortion pill up to 9 weeks

Click here to download The abortion pill up to 9 weeks section from the bpas guide 

What is the abortion pill?
The abortion pill is a medicine that ends a pregnancy. The medical name for the abortion pill is mifepristone. It works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.

The abortion pill is followed by another medicine called misoprostol which makes the womb contract, causing cramping and bleeding similar to a miscarriage. 

First appointment
A bpas healthcare professional will give you the abortion pill (mifepristone) to swallow when you are in the clinic.

If your blood group is Rhesus-negative you will have an Anti-D injection.

You may then leave the clinic. Most women are able to carry on their usual lives at home or work, but you may have some bleeding and period-like pains.

It is unlikely that the abortion will happen after taking the first pill. However, this can happen occasionally. If you think you may have miscarried after taking the first pill it is likely we will do another ultrasound scan at your next visit.

You may have nausea or vomiting. If you vomit within one and a half hours of taking the pill, please inform the clinic as soon as possible, as the tablet may not have been absorbed.

Second appointment
You will return to the clinic anywhere from 6 hours up to 3 days later. At this visit, misoprostol tablets are placed in the vagina. You can place the tablets yourself or have a healthcare professional place them. You can put these tablets in while lying down, squatting, or standing with one leg up - whatever is most comfortable for you. Try to insert them as high up into your vagina as possible. Don’t worry too much about the exact position of the tablets in the vagina; it is not important for them to be in a specific place to be effective.

You will be given some antibiotics to take, pain medicine with instructions for use and advice on how to care for yourself.

Aftercare Line is also available to you at anytime, 7 days a week on 0800 247 1122

The misoprostol tablets will cause you to have cramps and bleed heavily. This usually starts about 2 hours after using the misoprostol, but may start sooner. Bleeding and cramping usually last a few hours. You may see large blood clots or tissue at the time of the abortion and you will probably need pain medicine. There is more information on pain control below.

Most women pass the pregnancy within 4 or 5 hours after taking the misoprostol. For others it can be quicker or take longer. Almost all women miscarry within a few days. It’s different for every woman.

Here are some comments from women who have had the abortion pill:
It felt like really bad period cramps. It was bearable and the pain did pass. I used a hot water bottle which really helped.”
“The abortion pill wasn’t as easy as I thought. The pain was quite intense for me.”

It’s normal to have some bleeding or spotting for up to 4 weeks after the abortion. You should use sanitary pads as it makes it easier to keep track of your bleeding.

Follow-up appointment
The abortion pill is very effective, but it is still very important to have a follow-up appointment to make sure it has worked. Misoprostol may cause serious birth defects if the pregnancy continues. If the abortion pill does not work for you, we would recommend a surgical abortion to end the pregnancy.

Your follow-up appointment may be 1-2 weeks later in person or 3 weeks later by phone. You will also receive a pregnancy test with instructions on how to use it. If you cannot return for a check up in person, do the test 3 weeks after the treatment. If the test is positive you must immediately call the bpas clinic, the number is at the front of your bpas guide, or call 0800 247 1122

A positive test may mean the treatment has not worked.

Side effects
For most women, medical abortion is like an early miscarriage. It is normal for you to have bleeding and cramping. You might also:

  • feel dizzy
  • feel nauseous or vomit
  • have a headache
  • have diarrhoea
  • have temporary flushes or sweats

 

You may feel more at ease if you have someone with you during the abortion.

Important!
Serious complications may have warning signs. Contact the bpas clinic or Aftercare Line straight away if you have:
 

  • heavy bleeding that soaks through 2 sanitary pads an hour, for  2 hours or more in a row
  • abdominal pain or discomfort that is not helped by medication, rest, a hot water bottle, or a heating pad
  • a fever of 38°C or higher
  • an unpleasant smelling discharge from your vagina
  • signs that you are still pregnant
  • no bleeding 24 hours after using misoprostol

 

You should start to feel better each day after the abortion. Feeling sick, having abdominal discomfort, diarrhoea, nausea, vomiting or weakness more than 24 hours after taking misoprostol could be a sign of a serious complication. Do not wait for your follow-up appointment to contact bpas, please call 0800 247 1122

Breastfeeding during medical abortion
If you are breastfeeding at the time of your abortion, please be aware that mifepristone will pass into the breast milk. Studies so far do not show that this causes any problem for the infant. However, if you want to be cautious you can suspend breastfeeding for 2 days after taking the abortion pill.

A little bit of misoprostol will be present in breast milk after you take it. If you are breastfeeding, the misoprostol may rarely cause your infant to have diarrhoea. To reduce any risk you can choose to wait 6 hours between using the misoprostol and breastfeeding.

Please let us know if you are breastfeeding so we can work out the best plan together.

Pain control
After a medical abortion, most women will have strong cramping, similar to period pains. There are many ways to lessen the pain:
 

  • wear comfortable clothes
  • stay in a familiar and relaxing place
  • apply a heating pad or hot water bottle to your lower stomach
  • use pain medicine like ibuprofen, paracetamol and codeine

 

How to get pain medicine
You can buy ibuprofen tablets in either 200mg or 400mg strengths and paracetamol 500mg tablets at your local pharmacy. A bpas healthcare professional will also offer you codeine 30mg, prescribed by one of our doctors, to take home.

Codeine 30mg is only available with a prescription. Some products that you can buy at the pharmacy have lower doses of codeine combined with either ibuprofen or paracetamol. However, they will not give you the same amount of pain relief as the codeine we provide.

How to use these medicines
Ibuprofen and paracetamol are for mild to moderate pain. Codeine is for moderate to severe pain.

You can start with ibuprofen and paracetamol, adding codeine when you need stronger pain relief. Or, you can just start with codeine. It’s up to you. You can also alternate the medicines depending on how you feel.

What dose you should take and how often you can take it

Please remember, there are 2 strengths of ibuprofen tablets. Follow the directions that are correct for the strength that you buy:

Ibuprofen (200mg): take 3 or 4 tablets by mouth every 8 hours as needed. Do not take more than 12 tablets in 24 hours.
Or
Ibuprofen (400mg): take 1 or 2 tablets by mouth every 8 hours as needed. Do not take more than 6 tablets in 24 hours.

As well as ibuprofen you can also take:
Paracetamol (500mg): take 2 tablets by mouth every 4 hours as needed. Do not take more than 8 tablets in 24 hours.

Codeine (30mg): take 1 or 2 tablets by mouth every 4 hours as needed. Do not take more than 8 tablets in 24 hours.

Please note:
Do not drive or operate machinery when taking codeine. If you have tried these options, but still have pain, please call the clinic or the bpas Aftercare Line on 0800 247 1122

Risks and complications of the abortion pill before 9 weeks 
Significant, unavoidable or frequently occurring risks:
These are usually easy to treat and rarely have any long-term health effects.
Unpredictable time to complete the procedure (variable)
Side effects of drugs such as nausea, vomiting, diarrhoea,  headache, dizziness, fever/chills (common)
Retained products of conception - where the pregnancy has   been successfully ended but some of the pregnancy tissue is left   behind in the womb (1 in 100)
Infection (1 in 2,000 may be higher)
Unpredictable, irregular or prolonged bleeding after the  abortion (variable)
Pain during the procedure (common)

These may require transfer to hospital or surgical procedures, and may have serious long-term health effects.
Psychological problems (variable)
Continuing pregnancy (1 in 100 - may be higher if medication used 6 to 8 hours apart)
Haemorrhage - very heavy bleeding (1 in 800)
Undiagnosed ectopic pregnancy (1 in 7,000)
Death (less than 1 in 100,000)

Extra procedures which may be necessary
Surgical abortion or uterine aspiration
Blood transfusion
Laparoscopy or laparotomy - operation to look inside the  abdomen
Hysterectomy - surgical removal of the womb (1 in 15,000)