You will be given some antibiotics to take, pain medicine with instructions for use and advice on how to care for yourself. You will complete the abortion at home, whether you use the misoprostol in the clinic or at home. You may feel more at ease if you have someone with you for this process
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. However, if you think you may have miscarried between taking the mifepristone and misoprostol please contact us for advice.
Use sanitary towels to monitor your bleeding during early medical/abortion pill treatment.
Misoprostol (the second medication), causes strong painful cramps and heavy bleeding. Bleeding and cramping usually starts 1 to 2 hours after using misoprostol. Bleeding and pain are often the 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.
You may bleed heavily - possibly more than a period, and see large blood clots (as big as a lemon), or other tissue when you pass the pregnancy. The tissue is larger and more recognisable at higher gestations.
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. If you are worried about what you may see when the abortion happens, please discuss this with your healthcare professional.
Once the pregnancy passes the amount of bleeding and cramping should noticeably reduce. It is likely you will feel cramping on and off for a week or so and this should be easily managed with ibuprofen or paracetamol. After the pregnancy passes most women will have light bleeding for about two weeks, but you can have spotting up to your next period. 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.
If you have not started to bleed within 24 hours of taking the misoprostol contact your BPAS clinic.
Instructions for using misoprostol
You can either use misoprostol in the clinic or take it home. If you take it home, you will receive 6 tablets.
Place 4 tablets either in your vagina or in your mouth between your cheek and gum
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. If you do not feel comfortable doing this, a healthcare professional at the clinic can help you.
In the mouth - between cheek and gum
Place 4 tablets in your 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
If you have taken tablets home you will have 2 remaining misoprostol tablets. If you have not had any bleeding, or only a little bleeding 4 hours after the first dose of misoprostol use the additional 2 tablets either in the vagina or between your cheeks and gum.
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 - please return them to BPAS or take them to a local pharmacy or GP surgery for safe disposal.
For most women, medical abortion is like an early miscarriage. It is normal to have bleeding and cramping. You might also:
- feel dizzy
- feel nauseous or vomit and/or have diarrhoea (more likely when misoprostol is placed between cheek and gum)
- have a headache
- have temporary flushes or sweats
These symptoms may come and go throughout your treatment but if they continue after 24 hours of taking the second medication (misoprostol), please contact the clinic.
Risks and complications
Breastfeeding during medical abortion
If you are breastfeeding at the time of your abortion, be aware that a small amount of both mifepristone and misoprostol will pass into the breast milk. However, the amounts are small and not expected to cause any 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.
During an early 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
There are 2 strengths of ibuprofen tablets - follow the directions that apply for the strength 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. If you are 12-18 years of age, you may take 1 or 2 tablets by mouth every 6 hours as needed, but should not take more than 8 tablets in 24 hours. Codeine will not be given to anyone under the age of 12.
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).
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 the treatment is successful. Misoprostol may cause serious birth defects if the pregnancy continues. If the abortion pill does not work for you, you will be advised on either a surgical abortion or more medication to end the pregnancy.
If you are up to 9 weeks' pregnant you can take a pregnancy test home 2 weeks after treatment and complete the ‘self-assessment’ instructions to ensure the treatment has worked. You may return to the clinic 1-2 weeks after treatment for a scan to confirm the abortion is complete, if you choose.
If you are between 9 and 10 weeks, you will return 1-2 weeks after treatment for a scan to confirm the abortion is complete.
If you are up to 9 weeks pregnant you will be asked to complete a self-assessment agreement during your appointment. Click here to view a copy of the agreement.
We will give you a pregnancy test to take two weeks after your treatment. If your pregnancy test is positive, you need to telephone the clinic where you attended for your treatment when they are next open. The telephone number is in the front of your 'My BPAS guide' and your discharge letter. If you do not have the clinic number, telephone 03457 304030 to request the clinic number and opening hours.
Click here for instructions on how to use a 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