For pregnancies under 9 weeks' gestation you may take the mifepristone and misoprostol at the same time, or you may leave the clinic after taking the mifepristone and return 1-3 days later to take the misoprostol. Your healthcare professional will discuss your particular options with you - there are different potential risks involved with each option. Taking both medicines at the same time is convenient for many women but causes more side effects and is less effective than when the medicines are taken at least one day apart. It is important that you understand the differences between your options - so please read the table below and talk to your healthcare professional about what is best for you.
Options table for medical abortion up to 9 weeks of Pregnancy
If you are more than 9 weeks' pregnant, you will leave the clinic after taking mifepristone and return 1-2 days later to take the misoprostol. Most women do not have bleeding or pain until they take the misoprostol.
However, if you think you miscarried between visits please tell us. We will do an ultrasound scan to decide if any further treatment is needed.
You may have nausea or vomiting after taking the mifepristone. If you vomit within 1 hour of taking the pill, please inform the clinic as soon as possible, as you may need to take the pill again.
The second medicine is Misoprostol tablets which 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. You will then leave the clinic to complete the abortion at home. You may feel more at ease if you have someone with you for this process.
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 will probably need pain relief at this stage. For more information on pain control please see the 'Pain control' section below.
You may see large blood clots or tissue at the time of the abortion. The tissue will be larger and more recognisable at higher gestations. Under 8 weeks, you are only likely to see the sac within which the early pregnancy is developing. A 10 week fetus is about the size of a large grape and you may recognise its shape. If you are worried about what you may see when the abortion happens, please discuss this with your healthcare professional.
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 normal to have some bleeding or spotting for up to 4 weeks after the abortion - use sanitary pads to make it easier to keep track of your bleeding.
If you have not started to bleed within 24 hours of taking the misoprostol contact your BPAS clinic or our Aftercare line on 0300 333 68 28 (+44 1789 508 210).
VIDEO: The abortion pill up to 10 weeks
If you live in Wales and your treatment is at BPAS Cardiff, Llandudno or Powys
If you normally live in Wales and have your treatment in a Welsh clinic, you may be allowed to take misosprostol (the second medicine) at home rather than at the clinic. If you are given misoprostol to take at home, you should take the tablets as directed, 24-48 hours after you took Mifepristone (the first medicine) at the clinic.
You will be given a pack of 6X 200mg misoprostol tablets along with a leaflet with supporting information which explains how to take this medication.
- EITHER insert 4 tablets high in the vagina
- OR place 4 tablets in your mouth between the upper cheek and gum (2 each side) and allow the tablets to dissolve for 30 minutes. Any undissolved tablets may then be swallowed with water.
- IF bleeding does not start after 4 hours you should repeat this process with the remaining 2 tablets
- Contact the BPAS clinic where you were treated or the telephone helpline 0300 33 6828 if you have any questions.
Do not throw away leftover tablets - if you have any, please return them to the BPAS clinic which supplied them or take them to a local pharmacy or GP surgery for disposal. It is not safe to dispose of medicines in household waste or via wastewater.
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
Risks and complications
Breastfeeding during medical abortion
If you are breastfeeding at the time of your abortion, please be aware that a small amount of both mifepristone and misoprostol will pass into the breast milk. Studies so far do not show that this causes any problems or adverse effects for breast fed infants. Breast feeding may continue uninterrupted but if you wish to suspend breast feeding during treatment, please talk to your healthcare professional to work out a plan.
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, or codeine
How to get pain medicine
You can buy ibuprofen tablets in either 200mg or 400mg strengths 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 is for mild to moderate pain. Codeine is for moderate to severe pain.
You can start with ibuprofen, 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.
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:
Codeine (30mg): take 1 or 2 tablets by mouth every 4 hours as needed. Do not take more than 8 tablets in 24 hours. For women aged 12-18 years of age, take 1 or 2 tablets by mouth every 6 hours as needed. Do not take more than 8 tablets in 24 hours. Codeine will not be given to anyone under the age of 12 years.
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 0300 333 68 28 (or +44 1789 508 210).
Client EMA experience
I recieved the treatment on Saturday morning at 11am and by 12.30pm I was already experiencing some twinges and cramps. These got progressively worse, so much so that by 1pm I was in pyjamas and in bed with a hot water bottle and a film. I took ibuprofen at this stage as although bleeding and cramping started properly about 2.5 hours into the treatment, it wasn't awful pain, just like strong and lingering period cramps. Then around 3 hours into the treatment I felt nauseous, I went very pale, quite shaky and cold, and the pain increased to very strong, dull aches that felt lots like very strong period pain. In no way did I feel like I needed to call out in pain or was out of control in anyway, it was all ok with codeine and a hot water bottle. I curled up in bed and watched my film to take my mind off it. 4.5 hours in (after 1 hour of very strong cramping and heavier bleeding) I needed the loo and as I sat down I felt something hot and jelly like fall out very fast. I didn't look but I assume it was the pregnancy as I instantly stopped shaking, had colour in my cheeks and felt and overwhelming sense of relief. Afterwards the cramping reduced somewhat and was completely manageable with a hot water bottle, ibuprofen and codeine occasionally. That evening I felt fine with no cramps at all and bleeding was heavy but not unlike a heavy period. The next day I was up and about as normal, bleeding just like a period and no cramping at all. All in all a very positive experience and I am eternally grateful to all the staff at Plymouth BPAS for your wonderful understanding and care