If you are from Scotland and want to access Pills by Post please call us for more information.
Medical abortion: The abortion pill by post
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 should contact BPAS on our bookings and information line 03457 30 40 30 to book a telephone consultation and full medical assessment with a trained nurse or midwife who will assess your suitability for treatment. Most women are eligible for NHS funded treatment and we can discuss whether this applies to you when you call. 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.
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.
Expected effects of treatment
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.
Risks and complications of the abortion pill
Significant unavoidable or frequently occurring risks
These are usually easy to treat and rarely have any long-term health effects:
If you are treated without an ultrasound scan to date your pregnancy - the gestation of your pregnancy may be later than realised (less than 1 in 1,000). This can mean the abortion treatment fails, or there is more pain or bleeding, you may see a recognisable fetus or in extreme circumstances a live birth (1 in 10,000).
Unpredictable time to complete the procedure
Side effects of drugs such as nausea, vomiting, diarrhoea, headache, dizziness, fever/chills (1 in 10)
Retained products of conception - where the pregnancy is no longer growing but some of the pregnancy tissue is left behind in the womb (2 in 100)
Infection of the womb or fallopian tubes (2 in 1,000)
Unpredictable, irregular or prolonged bleeding after the abortion. Light bleeding or spotting can continue to next period (variable)
Lower abdominal pain and cramping (experienced by all). Pain can be severe requiring strong painkillers
Continuing pregnancy (less than 1 in 100)
Haemorrhage – very heavy bleeding (2 in 1000)
Undiagnosed ectopic pregnancy (2 in 1000)
Psychological problems (variable)
Extra procedures that may be necessary
Surgical abortion or uterine aspiration (1-2 in 100)
Blood transfusion (2 in 1000)
Laparoscopy or laparotomy – operation to look inside the abdomen (3 in 100,000)
Hysterectomy – surgical removal of the womb (2 in 100,000)
Intravenous antibiotics (2 in 10,000)
Salpingectomy (removal of fallopian tube) or salpingostomy (opening the fallopian tube) (1 in 10,000)
Death is very rarely linked to abortion treatment (less than 1 in 100,000 for all abortions).
Your treatment pack
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:
Medabon pack containing 1 tablet of mifepristone (step 1) and 4 tablets of misoprostol (step 2)
2 plastic wrapped misoprostol tablets (step 3)
Pregnancy test (step 4)
Codeine (only provided if requested and medically suitable)
Contraception and STI test (if requested and suitable) - Blood affects the results of this test, so it is best to complete this before starting your treatment.Click for details.
These medicines have been prescribed for you only. Do not pass it on to others:
It may harm them.
It is illegal to give your medication to anyone else because it is a Prescription Only Medicine (POM) and was prescribed for you personally.
It is illegal to intentionally use mifepristone at home above 10 weeks’ gestation.
However criminal penalties will not apply if this was inadvertent and you did not believe you were more than 10 weeks pregnant. This should never deter you from seeking medical help if you need it.
If you do not use this medicine, contact BPAS about how to dispose of or return the drug. Do not use it for another pregnancy as you could be prosecuted.
About medical abortion: The abortion pill
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.
How to take mifepristone and misoprostol
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.
Step 1 - You will swallow the first medicine (mifepristone) with water
Step 2 - 1 to 2 days later you will take the second medicine (misoprostol)
Step 3 - 3 to 4 hours after the first dose of misoprostol, you will take another dose
You will then pass the pregnancy at home.
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 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.
Use 4 tablets placed either in 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 lying down, squatting or standing with one leg up - whatever is most comfortable for you.
Into the mouth between cheek and gum
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.
Step 3 – repeat misoprostol
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.
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. 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:
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
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.
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:
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 in 15mg or 30mg strengths. Codeine is not suitable for anyone under 12 years of age.
How to use these medicines
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.
You can start with ibuprofen (or paracetamol) 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
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:
constipation, nausea or vomiting
confusion and dizziness
vertigo and headaches
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.
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)
I will contact BPAS if I experience any of the following signs that my treatment has not worked:
I did not bleed (or had only spotting, or only saw blood on a tissue when wiping) 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
You must use the pregnancy test from your treatment pack for your 3 week urine test.
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
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.
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 after treatment
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 bleeding or only spotting/smearing 24 hours after using misoprostol
lower abdominal pain worse on one side
light-headedness, dizziness or feeling faint
shoulder tip pain
if you were treated following a scan showing a pregnancy in your uterus and you have no bleeding or only spotting/smearing 5-7 days after using
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:
fainting or loss of consciousness
severe allergic reaction
acute confused state
concern for a heart attack or stroke
fits that aren’t stopping
you experience extremely heavy bleeding and feel unwell
What can I do?
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.
Other activities, including work
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.
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 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.
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 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.
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?
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: