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.
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.
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.
The timing when you administer your medication is important.
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.
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.
You will be given 6 tablets of misoprostol to take home
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.
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.
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.
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:
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.
For most women, early medical abortion is likely an early miscarriage. It is normal to have bleeding and cramping. You might also:
If these symptoms continue after 24 hours of taking the second medicine, please get in contact with us.
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.
During an early medical abortion, most women will have a strong cramping, similar to period pains. There are many ways to lessen the pain:
You can buy ibuprofen tablets in 200mg or 400mg strengths and you may also be given codeine in 15mg or 30mg strengths.
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.
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
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.
No, there is no proven association with breast cancer and 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.
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.
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.
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.
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:
Northern Ireland www.informingchoicesni.org
When your treatment is complete, if you wish to provide any feedback about the service your recieved , please email email@example.com 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.