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Medical abortion:

The Abortion pill up to 10 weeks

Click here to find out about 'Pills by Post' early medical abortion

Early medical abortion is the routine treatment method for pregnancy of up to 10 weeks, unless it is not suitable or safe for the client to complete an abortion at home.  For pregnancies under 10 weeks gestation if the client cannot have pills by post they may collect their medications from the clinic and use them at home. 

You will be given pain medicine with instructions for use and advice on how to care for yourself. You will complete the abortion at home. 

Treatment

Medical abortion: The abortion pill up to 10 weeks

About medical abortion: the abortion pill

Medical abortion involves taking 2 medicines, mifepristone and misoprostol. The first medicine, Mifepristone, ends the pregnancy. It works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.

The second medicine, misoprostol, makes the womb contract causing cramping, bleeding and loss of the pregnancy similar to a miscarriage. 

The timing when you administer your medication is important:

  • You will swallow the first medicine (mifepristone) with water
  • you will take the second medicine (misoprostol) 1 to 2 days later
  • 3 to 4 hours after the first dose of misoprostol, you will take another dose
  • You will then pass the pregnancy at home 

Step 1 – Mifepristone

Swallow the mifepristone tablet with water - at 10 weeks gestation this is done at clinic.  At less than 10 weeks gestation you may take the tablet home. 

You may have nausea or vomiting after taking mifepristone. If you vomit within 1 hour of taking it, please inform the clinic as soon as possible as you may need to take the pill again. Most women do not have pain or bleeding until they take misoprostol.  Bleeding can occur after taking mifepristone, but it is usually light.  If bleeding does happen you should still use the misoprostol (second medication).  

Step 2 – Misoprostol

Misoprostol tablets are placed in the vagina or between the cheek and gum - at 10 weeks gestation the first dose of 4 tablets is done in the clinic and you will be give another 2 tablets to administer at home 3 to 4 hours after the first dose.  At less than 10 weeks gestation you can administer both doses of misoprostol at home.  See below for more detail.

Misoprostol (the second medication) causes strong, painful cramps and heavy bleeding.

Bleeding and cramping usually start 1 to 2 hours after using the tablets but may occur sooner. Bleeding and pain are often greatest when the pregnancy is being expelled. Most women pass the pregnancy within 4 hours - timings vary, but it is OK if this happens sooner or later. Almost all women miscarry within a few days.

You may be given codeine to help you manage the pain, and can also use pain relief from supermarkets and pharmacies too. Please refer to the ‘Pain control’ section on this page, for information about managing your pain.

Instructions for using misoprostol (second medication)

You will use 6 misoprostol tablets. 

  1. Use the first 4 tablets by either placing them into your vagina or in your mouth between your cheek and gum
  2. then 3 to 4 hours later use the remaining 2 tablets in your vagina or between your cheek and gum

Into the vagina

Insert 4 tablets as high as possible in the vagina.  The exact position of the tablets is not important provided they do not fall out.  You can put the tablets in while lying down, squatting, or standing with one leg up - whatever is most comfortable. Insert the 2 remaining tablets 3 to 4 hours later.

EMA misoprostol vaginal insertion

OR

Into the mouth between cheek and gum

Place 4 tablets into the mouth between the upper cheek and gum (2 on each side) and allow the tablets to dissolve for 30 minutes.  If the tablets have not completely dissolved within 30 minutes, you may swallow what is left with water.  Repeat with the remaining 2 tablets 3 to 4 hours later.

EMA misoprostol place tablets in mouth

Some clients describe the taste of misoprostol as unpleasant and the texture chalky. Placing the tablets between the cheek and gum is associated with higher rates of nausea, vomiting and diarrhoea.

Contact the BPAS clinic where you were treated or the telephone helpline 0300 33 6828 if you have any questions.

You should not have any leftover tablets - but if you do, please do not throw them away, please return them to BPAS or take them to a local pharmacy or GP surgery for safe disposal.  Leftover misoprostol tablets are not sufficient to cause and abortion and it would be illegal to use them for this purpose.  If you think you have a new or continuing pregnancy following your treatment, you should telephone for further advice.

Passing the pregnancy (and bleeding)

Use sanitary towels to monitor your bleeding during early medical/abortion pill treatment.

The amount and type of bleeding can vary for each person and each abortion.  It is normal to experience light, moderate, or heavy bleeding during a medical abortion (see figure below). Not everyone will pass blood clots during a medical abortion, but for those who do, the clots should be no larger than a lemon. It is NOT normal to have no bleeding/scant bleeding or flooding (see figure below) therefore you should telephone BPAS on 0300 333 68 28 for advice if:

  • 24 hours after taking the misoprostol, you do not bleed at all, have spotting/only see blood on a tissue when wiping (see Scant image 1)
  • You experience heavy bleeding soaking 2 maxi size sanitary pads for 2 hours in a row (see heavy image 4)

Call 999 if you experience extremely heavy bleeding (see Flooding image 5) and feel unwell

Misoprostol (the second medication), causes strong painful cramps and heavy bleeding. Bleeding and cramping usually start 2 to 4 hours after using misoprostol, but sometimes may take up to a few days for this to happen. 

Bleeding and pain are often greatest when the pregnancy is being expelled. Most women pass the pregnancy within 4 hours - timings vary, but it is OK if this happens sooner or later. Almost all women miscarry within a few days. You will be given codeine to help you manage the pain, and you can also use pain relief from supermarkets and pharmacies too.  Please refer to the 'Pain control' section below, for information about managing your pain.

When you pass the pregnancy, the tissue is larger and more recognisable at higher gestations, but in most cases, the fetus cannot be seen without magnification.  Under 8 weeks, you may see the pregnancy sac which is white and fluffy with brown-red tissue surrounding it. A 10 week fetus is about the size of an olive and you may recognise its shape. 

Once the pregnancy passes, the amount of bleeding should noticeably reduce. Most women have light bleeding for about two weeks, but you may have spotting up to your next period.  Sometimes you may have a short episode of pain with a gush of blood or a clot several weeks after the abortion - contact us if this continues.  

Side effects

For most women, early medical abortion is likely an early miscarriage. It is normal to have bleeding and cramping. You might also:

  • feel dizzy
  • feel nauseous, vomit and/or have diarrhoea (more likely when misoprostol is placed between the mouth and gum)
  • have a headache
  • have temporary flushes or sweats

If symptoms continue after 24 hours of taking the second medication (misoprostol), please get in contact.

Risks and complications

Significant unavoidable or frequently occurring risks

These are usually easy to treat and rarely have any long-term health effects.

  • If you are treated without an ultrasound scan to date your pregnancy, the gestation o f your pregnancy may be later than realised (1 in 1000).  This can mean the abortion treatment fails, or there is more pain and bleeding, you may see a recognisable fetus, or in extreme circumstances a live birth (1 in 10,000)
  • Unpredictable time to complete the procedure (variable)
  • Side effects of drugs such as nausea, vomiting, diarrhoea, headache, dizziness, fever/chills (1 in 10)
  • Retained products of conception – where the pregnancy is no longer growing, but some of the pregnancy tissue is left behind in the womb (2 in 100)
  • Infection of the womb or fallopian tube (2 in 1,000)
  • Unpredictable, irregular or prolonged bleeding after the abortion. Light bleeding can continue to next period.
  • Lower abdominal pain and cramping (experienced by all).  Pain can be severe requiring strong painkillers.
  • Continuing pregnancy (less that up to 1 in 100)
  • Haemorrhage – very heavy bleeding (2 in 1000)
  • Undiagnosed ectopic pregnancy (2 in 1000)
  • Psychological problems (variable)

Extra procedures that may be necessary

  • Surgical abortion or uterine aspiration (2 in 100)
  • Blood transfusion (2 in 1000)
  • Laparoscopy or laparotomy – operation to look inside the abdomen (3 in 100,000)
  • Hysterectomy – surgical removal of the womb (2 in 100,000)
  • Invenous antibiotics (2 in 10,000)
  • Salpingectomy (removal of fallopian tube) or salpingostomy (unblocking of fallopian tube) 1 in 10,000)

Death is very rarely linked to abortion treatment – less than 1 in 100,000 for all abortions. 

Can I continue breastfeeding during medical abortion?

Both mifepristone and misoprostol pass into the breast milk but the amounts are small and should not cause adverse effects in breastfed infants. Breastfeeding may continue uninterrupted following meifepristone and misoprostol. Stop breastfeeding if you take codeine - express and discard milk during use and for one feed after the last dose.

Pain control

During an early medical abortion, most women will have a 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 a pain medicine like ibuprofen and codeine

How to get pain medicine

You can buy ibuprofen tablets in 200mg or 400mg strengths and your pack may also contain codeine in 15mg or 30mg strengths. Codeine is not suitable for anyone under 12 years of age.

How to use these medicines

Ibuprofen is for mild to moderate pain. Codeine is for moderate to severe pain. Paracetamol can be used for mild to moderate pain by those who cannot take ibuprofen.

You can start with ibuprofen (or paracetamol) adding codeine when you need stronger pain relief. Or you can just start with codeine. Or alternate the medicines depending on how you feel.

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

Ibuprofen: Do not take more than 2.4g (2400mg) in 24 hours. Take 600mg to 800mg by mouth every 8 hours as needed.

Paracetamol 500mg: Do not take more than 8 tablets in 24 hours. You can take up to 2 tablets by mouth every 4 to 6 hours as needed.

Codeine 30mg: Do not take more than 8 tablets in 24 hours. Take 1 or 2 tablets by mouth every 4 hours as needed. If you are aged between 12 and 18 years, take 1 or 2 tablets by mouth every 6 hours as needed.

Codeine 15mg: Do not take more than 16 tablets in 24 hours. Take 2 or 4 tablets by mouth every 4 hours as needed. If you are aged between 12 and 18 years, take 2 or 4 tablets by mouth every 6 hours as needed.

Please note: Do not drive or operate machinery whilst taking codeine.

If you have tried these options, but still have pain, please call the Aftercare Line on 0300 333 68 28 (or +44 1789 508 210) for advice.

After treatment

Follow-up instructions

The abortion pill is very effective and usually uncomplicated, but it is important to make sure it has worked. Having some cramping and bleeding does not guarantee that your treatment was successful. Misoprostol may cause serious birth defects if the pregnancy continues. If the abortion pill does not work for you, you should contact us to discuss your options.

  • You will NOT be contacted by BPAS to find out if your treatment has worked
  • You need to complete the ‘self-assessment checklist’ below to ensure your treatment has worked and that you are no longer pregnant
  • 3 weeks after starting your treatment, you should use the pregnancy test we sent you, with the first urine you pass when you wake up in the morning (see below).

Click here for video instructions

Self-assessment checklist

I understand that BPAS cannot guarantee a healthy pregnancy if the treatment fails

I will contact BPAS if I experience any of the following signs that my treatment has not worked:

  • I did not bleed within 24 hours of taking misoprostol tablets
  • I had less than 4 days of bleeding
  • By the end of week 1, I still ‘feel’ pregnant or have symptoms of pregnancy such as sore breasts, sickness, tummy growing, etc.
  • 3 weeks after treatment, I performed the BPAS urine pregnancy test (using the first urine passed when I woke) and the test was positive, invalid, or I was not sure of the result
  • My next period has not come by 4 weeks after treatment (even if the pregnancy test was negative)

Telephone BPAS immediately on 0300 333 68 28 (or +44 1789 508 210) if you experience any signs listed above.

Pregnancy test instructions

The pregnancy test we sent with your medication should be used 3 weeks after you swallow the first medication (mifepristone). The pregnancy test should be performed using the first urine you pass after waking in the morning.

This is a diagram of your pregnancy test

  • Remove all packaging
  • Remove the cap from the test
  • As you urinate, hold the absorbent tip of the test in the urine stream or collect some urine in a clean pot and dip the tip into the urine for 5 to 10 seconds

  • Wait 5 to 10 minutes
  • Read the pregnancy test

Client EMA experience

"I received 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."

Important!

Contact your treatment clinic or our Aftercare Line immediately on 0300 333 68 28 (or +44 1789 508 210) if:

  • It is more than 24 hours since you took your misoprostol, and you still feel sick, have abdominal discomfort, diarrhoea, nausea, vomiting or weakness
  • heavy vaginal bleeding and have soaked through 2 or more large maxi pads an hour, for the last 2 hours
  • you have no bleeding 24 hours after using misoprostol
  • you have abdominal pain or discomfort that is not helped by medication, rest, a hot water bottle, or a heating pad
  • you have a fever of 38°C or higher
  • you have an unpleasant-smelling discharge from your vagina
  • you have signs that suggest you are still pregnant at the end of week 1 following treatment

Telephone 999 for an ambulance if you have experienced any of the following in the last 24 hours after your treatment:

  • loss of consciousness
  • severe allergic reaction
  • acute confused state
  • concern for a heart attack or stroke
  • chest pain
  • slurred speech
  • breathing difficulties
  • fits that aren't stopping