Abortion Pill Treatment during COVID-19 

 

Early Medical Abortion is the routine treatment option for pregnancies up to 10 weeks gestation, unless this is not safe or suitable for you. 

Medical abortion: The abortion pill up to 10 weeks

Medical assessment

You will have your consultation and medical assessment over the telephone and have opted for treatment with medical abortion. You will need to come into the clinic to take the first medication and then will complete your treatment at home.

Consent

We will explain the known risks and complications of your treatment during your telephone assessment. The risks and complications of this treatment are presented below.

Risks and complications of the abortion pill

Treatment

About medical abortion  

The abortion pill involves taking two 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.

How to take mifepristone and misoprostol

The timing when you administer your medication is important.

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

Step 1 (at the clinic) Mifepristone 

Swallow the mifepristone tablet with water.

You may have nausea or vomiting after swallowing the mifepristone. If you do vomit you should still use the misoprostol as outlined in step 2 below. contact us if you have any concerns.

Most women do not have bleeding or pain until they take the second medication (misoprostol). Bleeding can occur after taking mifepristone but it is usually light. If bleeding does happen you should still use the misoprostol (second medication). Contact us if you have any concerns.

Step 2 (at home) Misoprostol

Misoprostol tablets are placed in the vagina or between the cheek and gum - see below for more detail.

Misoprostol causes strong, painful cramps and heavy bleeding.

Bleeding and cramping usually start 1 to 2 hours after using the tablets. 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 be given 6  tablets of misoprostol to take home

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

Into the vagina

Insert 4 tablets as high as possible in the vagina; the exact location is not important only that they do not fall out. You can do this while laying down, squatting or standing with one leg up - whatever is most comfortable for you.  Insert the remaining 2 tablets 3 to 4 hours later.

EMA misprostol 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 by 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.

Passing the pregnancy (and bleeding)

Use Sanitary towels to monitor your bleeding during 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

Bleeding and cramping usually start 2-4 hours after taking misoprostol but sometimes it can take up to a few days for this to happen.

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. 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 these symptoms continue after 24 hours of taking the second medicine, please get in contact with us.

Pregnancy remains

You will pass the pregnancy at home or another place of your choosing. You can decide how to dispose of the pregnancy remains. They can be flushed down the lavatory or wrapped in tissue, placed in a small plastic bag and put in the dustbin. 

If you have any other questions about the disposal of the pregnancy remains, please see pregnancy remains for more information.

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 you may also be given codeine in 15mg or 30mg strengths.

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. Or alternate the medicines depending on how you feel.

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

Always follow the instructions that accompany the pain medication that you purchase, and take special care not to exceed the recommended daily doses.

There are 2 strengths of ibuprofen tablets. Follow the directions that are correct for the strength that you buy.

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 when 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 passed when you woke up in the morning. (see below)

Self-assessment checklist

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

Recovery

Our Aftercare Line is open 24 hours a day, 7 days a week. If you have any questions or are unsure about anything, please call 0300 333 68 28 (or +44 1789 508 210) for help.

What to expect after treatment 

Recovery after an uncomplicated abortion usually happens fairly quickly, but it is different for every woman. There are some things to expect, which are normal, and other signs and symptoms that are not. It’s important that you know about both.

Most women recover quickly after an abortion. How much pain and bleeding you experience afterwards can vary.

Feelings

After an abortion, most women feel relieved, but some may also feel sad or guilty.

If you feel you need to talk to someone, you can call us on 03457 30 40 30 (or +44 1789 508 211) to make an appointment for post-abortion counselling. This is a free service for women who have had treatment at BPAS.

Physical symptoms as your body recovers

Symptoms of nausea, vomiting and tiredness usually stop within 3 days of an abortion. Sore breasts may last 7 to 10 days. Take ibuprofen or paracetamol, if necessary for the pain.

Important/unexpected or unusual symptoms

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

  • you have heavy vaginal bleeding and have soaked through 2 or more large maxi pads an hour, for the last 2 hours
  • it is more than 24 hours since you took your misoprostol, and you still feel sick, have abdominal discomfort, diarrhoea, nausea, vomiting or weakness
  • 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
  • if treated without a scan (or your scan only showed a gestation sac and no yolk sac)
    • no or minimal bleeding 24 hours after using misoprostol
    • lower abdominal pain worse on one side
    • lightheadedness, dizziness or feeling faint
    • shoulder tip pain
  • if you were treated following a scan showing a pregnancy in your uterus and you have no or minimal bleeding 5 to 7 days after using misoprostol
  • if you have a positive pregnancy test or other sign listed on the self-assessment checklist

Telephone 999 for an ambulance if you experience any of the following:

  • 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
  • you experience extremely heavy bleeding and feel unwell

More information

Other questions you may have

Does having an abortion increase my chance of getting breast cancer?

No, there is no proven association with breast cancer and abortion.

Can I continue breastfeeding during medical abortion?

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

Will having an abortion cause problems with future pregnancies?

If your abortion is uncomplicated there should be no issues with future pregnancies as a result of the abortion.  There are no proven associations between abortion and future infertility, ectopic pregnancy or placenta praevia.  Having an abortion may be associated with future pregnancies ending before the due date. This risk appears to increase when someone has had more than one abortion.

How will I feel afterwards?

Every woman is different so they feel, experience and cope in a way individual to them. There is no evidence to suggest that you will experience any mental health issues as a result of an abortion. However, if you have a history of mental health problems you may still have those problems whether you choose to have the abortion or not.

What about travel after treatment?

Travel is not ideal in the first 24 hours after using misoprostol. You may experience symptoms whilst in transit. You will need to know how to access emergency services in case of a complication.

What about contraception and STI Screening?

Routine STI screening is recommended for all women having an abortion. Online STI testing is available here. If you have symptoms of sexually transmitted infection you must see your GP or GUM clinic for treatment before attending your BPAS appointment.  

During this exceptional time we cannot offer our usual choice of contraception.  We can only offer Progesterone only Pills following early medical abortion at BPAS during the Covid-19 outbreak.  Ordinarily, almost all methods of contraception could be started on the same day as a medical abortion or the day after. If you choose intrauterine contraception (IUD or coil) this can be inserted as soon as the abortion is complete.

 

To locate your nearest NHS contraception or service or STI clinic visit the following websites:

England www.nhs.uk/service-search

Northern Ireland www.informingchoicesni.org 

Scotland www.sexualhealthscotland.co.uk/get-help/sexual-health-service-finder

Wales www.nhsdirect.wales.nhs.uk/LocalServices

Feedback and complaints

When your treatment is complete, if you wish to provide any feedback about the service your recieved , please email clientservices@bpas.org alternatively you may be given a postal feedback form at the clinic.

There may be times you want to feedback formally or raise a complaint with us. Find out more about BPAS complaints and feedback here.