If you are from Scotland and want to access Pills by Post please visit this website for
more information about how to access abortion in your area.
This service is a safe and legal way to end a pregnancy at an early gestation without needing to attend a clinic for treatment. You will have a telephone consultation and full medical assessment with a trained nurse or midwife who will assess your suitability for treatment. If treatment is suitable and safe, you will receive abortion pills by post a few days later, or we can book you for an alternative treatment in clinic. Sometimes a scan or other in clinic checks are required before treatment.
If anything in your medical situation has changed since your consultation and medical assessment, please contact us before starting your treatment.
We will explain the known risks and complications of your treatment during your telephone assessment. The risks and complications of this treatment are shown below.
This video is used to support your informed consent to EMA (Pills by Post) without ultra sound. It is a very informative video and by the end of it, you will understand the risks, benefits and alternatives to medical abortion without ultrasound. Many of our clients tell us watching this video is very valuable. It is 11 minutes long and cover all the things you need to consider when deciding on EMA pills by post without ultrasound.
Lower abdominal pain/cramping and vaginal bleeding are experienced by all people having medical abortion. Pain can be severe in some cases, requiring the use of strong painkillers (like codeine). Most abortions are complete within 4 hours of using misoprostol but for some it takes longer. Light vaginal bleeding or spotting can continue until the next menstrual period even if the abortion is complete.
Expected side effects of treatment include:
Nausea, vomiting (sickness), diarrhoea, headache, dizziness, fever/chills (1 in 10). If side effects continue after 24 hours of taking the second medication, please contact us.
Significant unavoidable or frequently occurring risks
These are usually easy to treat and rarely have any long-term health effects:
Extra procedures that may be necessary
Death is very rarely linked to abortion treatment (less than 1 in 100,000 for all abortions).
You will receive your treatment package direct from the pharmacy from 1 to 3 days from your telephone consultation (sometimes longer with Bank Holidays). If your package is delayed in the post for a few days you should still take the tablets as directed once they arrive. The package is plain with no indication of its contents, it will be tracked but not signed for.
Your treatment pack will contain:
These medicines have been prescribed for you only. Do not pass it on to others:
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.
If at any point you decide to continue the pregnancy after taking the medications, it is important to know that there could be risks to the developing fetus. Misoprostol can cause birth defects and both mifepristone and misoprostol can cause miscarriage. Contact BPAS for further information and advice.
The timing when you administer your medication is important. If your pregnancy is of 10 weeks gestation you will need to come into the clinic to take your medications.
You will then pass the pregnancy at home.
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 below. Please telephone if you have any concerns or if you vomit within 30 minutes of swallowing the mifepristone.
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 and may wish to consider placing it between your cheek and gum. Contact us if you have any concerns.
Click here for the video instructions
Misoprostol tablets are placed in the vagina or between the cheek and gum. See below for more detail.
Misoprostol (the second medication) causes strong, painful cramps and heavy bleeding.
You will have 6 tablets of misoprostol.
Click here for the video instructions
Use 4 tablets placed either in your vagina or between your cheek and gum.
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 lying down, squatting or standing with one leg up - whatever is most comfortable for you.
Place 4 misoprostol tablets into the mouth between the upper cheek and gum 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.
Some clients describe the taste of misoprostol as unpleasant and the texture as chalky. Placing the tablets between the cheek and gum is associated with higher rates of nausea, vomiting and diarrhoea.
3 to 4 hours after the first misoprostol tablets, use the 2 remaining tablets by either placing them in your vagina or between your cheek and gum.
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. 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 the image below), therefore you should telephone BPAS on 0300 333 68 28 for advice if:
Call 999 if:
Pain (usually described as cramping) usually begins 1-2 hours after misoprostol, sometimes sooner. Bleeding usually starts within 2 to 4 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 you can also use pain relief from supermarkets and pharmacies. Please refer to the ‘Pain control’ section for information about managing your pain.
You may see other tissue when you pass the pregnancy. This is larger and more recognisable at higher gestations, but in most cases the fetus cannot be seen without magnification.
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 2 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.
Prolonged moderate to heavy bleeding can lead to significant blood loss and Anaemia so please get in touch if this occurs.
You will pass the pregnancy at home or another place of your choosing. You can decide how you wish 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.
In rare circumstances, 0.1% of women pass pregnancy tissue which is further advanced in gestation than they thought it would be. If this happens to you please contact our Aftercare line for help, support and advice regarding disposal of pregnancy remains.
If you have any other questions about the disposal of the pregnancy remains, please click here.
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 your pack may also contain codeine in 15mg or 30mg strengths. Codeine is not suitable for anyone under 12 years of age.
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.
Ibuprofen 200mg: You can take 3 tablets (600mg) by mouth every 6 hours or 4 tablets (800mg) by mouth every 8 hours as needed. Do not take more than 12 tablets in 24 hours.
Paracetamol 500mg: You can take up to 2 tablets (1000mg) by mouth every 4 to 6 hours as needed. Do not take more than 8 tablets in 24 hours.
Codeine 15mg: Take 2 or 4 tablets (30-60mg) 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 take more than 16 tablets in 24 hours.
Side effects of codeine include:
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.
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.
Click here for video instructions
I will contact BPAS if I experience any of the following signs that my treatment has not worked:
Telephone BPAS immediately on 0300 333 68 28 (or +44 1789 508 210) if you experience any signs listed above.
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:
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.
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.
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.
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.
Contact our Aftercare Line immediately on 0300 333 68 28 (or +44 1789 508 210) if:
Telephone 999 for an ambulance if you experience any of the following:
You can take a bath or shower as normal.
You can have sex as soon as you feel sufficiently recovered from the abortion. You can get pregnant almost immediately after treatment, so it is important to use contraception if you do not want to get pregnant.
Most women are fit and well enough to return to normal activities within a day or two. Rest until you feel ready to return to your normal routine.
No, there is no proven association with breast cancer and abortion.
Both mifepristone and misoprostol pass into the breast milk but the amounts are small and should not cause any adverse effects in breastfed infants. Breastfeeding may continue uninterrupted following mifepristone and misoprostol. If breastfeeding an infant under 6 months’ of age, express and discard milk whilst taking codeine and for the first feed after the last dose of codeine.
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 which is 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.
Getting tested for STIs is recommended if you are at risk of infection. Almost all methods of contraception can be started on the same day as 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. If you live in England, Scotland or Wales, you can see your GP or local contraception and sexual health service to obtain contraception after treatment. BPAS can provide some contraceptive methods and this will be discussed during your consultation.
To locate your nearest NHS contraception service or STI clinic, visit the following websites:
England: www.nhs.uk/service-search
Scotland: www.sexualhealthscotland.co.uk/get-help/sexual-health-service-finder
Wales: www.nhsdirect.wales.nhs.uk/LocalServices
If you want to provide any feedback about the service you have received, please email clientservices@bpas.org
After treatment, we will email you with a link to complete our satisfaction survey, if you agreed that we may do so.
There may be times you want to feedback formally or raise a complaint with us.
Our leaflet titled ‘Feedback and complaints policy’ explains our feedback and complaints process.
To raise a complaint you can: