Remote Treatment

 

Medical abortion: The abortion pill up to 9 weeks

Medical assessment

You will have your consultation and medical assessment over the telephone and have opted for treatment with medical abortion. Because of the gestation of your pregnancy is 9 weeks or less, you can 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

risks and complications

Treatment

Medical abortion: The abortion pill up to 9 weeks

What is the abortion pill?

The abortion pill is two medicines packaged together and labelled Medabon.

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.

Timings

You will swallow the first medicine (mifepristone) with water and will take the second medicine (misoprostol) 1 to 2 days later. You will pass the pregnancy at home. The timing when you administer your medication is important.

The latest you can start your treatment is at 63 days’ of pregnancy, as discussed during your consultation.

Mifepristone and Misoprostol

Step 1 – 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. Please telephone 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. Contact us if you have any concerns.

Step 2 – Misoprostol

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.

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 have been sent 4 tablets of misoprostol to take home

Use all 4 tablets by either placing them into your vagina or between your cheek and gum

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.


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.

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.

Passing the pregnancy (and bleeding)

Use sanitary towels to monitor your bleeding during abortion pill treatment. Bleeding is usually heavy - more than a period, and you may see 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, 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. After the pregnancy passes, most women will have light bleeding for about two weeks but you can have spotting up to your next period.

Your next period may be heavier than usual.

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.

If you have not started to bleed within 24 hours of taking the misoprostol telephone 0300 333 68 28 for advice.

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 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 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. If you plan to bury or burn the remains, ask a member of staff and they will give you some information about how you can do that safely.

If you have any other questions about the disposal of the pregnancy remains, please go to 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 your pack may also contain codeine 30mg.

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.


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
  • Two 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 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.
  • 2 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 2 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.

Recovery

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 feed 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:

  • 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 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
  • you have heavy vaginal bleeding and have soaked through 2 or more large maxi pads an hour, for the last 2 hours

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

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?

If you are breastfeeding at the time of your abortion, please be aware that a small amount of both mifepristone and misoprostol will pass into the breast milk. However, the amounts are small and are not expected to cause any adverse effects in breastfed infants. Breastfeeding may continue uninterrupted but you may wish to suspend breast feeding during treatment. Stop breastfeeding if you take codeine. Express and discard milk during use and for one feed after the last dose. Please talk to your healthcare professional to work out a plan.

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.

How can I get contraception and when can I start it?

Almost all methods of contraception can 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. Contact Informing Choices NI telephone 0345 122 8687 to find out about your local contraception service. See www.informingchoicesni.org for more information.

How can I get STI screening?

Routine STI screening is recommend for all women having an abortion. Contact Informing Choices NI telephone 0345 122 8687 to find out about your local service. See www.informingchoicesni.org for more information.

Feedback and complaints

When your treatment is complete, please fill in your treatment evaluation survey online from the link we email you.

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