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Pills by Post – Abortion Pill treatment at home

For women from England and Wales

(and NI in certain circumstances) 

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 (or if you are from Northern Ireland call 0300 500 8086) 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.

Medical assessment

You will have your consultation and medical assessment over the telephone and have opted for remote abortion pill treatment (pills by post).  

Consent

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.

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 (unblocking of fallopian tube) (1 in 10,000)

Death is very rarely linked to abortion treatment (less than 1 in 100,000 for all abortions).

Treatment

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 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 medically suitable)
  • Your chosen 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.

Click here to see what your package will look like (contents and medication brand names may vary)

How to take mifepristone and misoprostol

The timing when you administer your medication is important:

  • 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.

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 mifepristone 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:

  • 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.

How to take mifepristone and misoprostol

Remember:
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.
  • 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.

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.

Click here for the video instructions

Step 2 and 3 – 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.

Instructions for using misoprostol (second medication)

You have been sent 6 tablets of misoprostol.

Click here for the video instructions

Step 2 – misoprostol

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.

EMA misoprostol vaginal insertion

OR

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.

EMA misoprostol in mouth

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.

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.

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 check our website 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 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: Do not take more than 2.4g (2400mg) in 24 hours. Take 600mg to 800mg by mouth every 8 hours as needed.

Paracetamol 500mg: Do not take more than 8 tablets in 24 hours. You can take up to 2 tablets by mouth every 4 to 6 hours as needed.

Codeine

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.
Side effects of codeine include:

  • constipation, nausea or vomiting
  • drowsiness
  • confusion and dizziness
  • vertigo and headaches
  • dry mouth
  • feeling itchy
  • blurry vision

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.

Click here for video instructions for pain management

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)

Click here for video instructions

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 (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

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 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 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

What can I do?

Bathing

You can take a bath or shower as normal.

Sex

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?

Routine STI screening is recommended for all women having an abortion. 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.

To locate your nearest NHS contraception 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

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:

  • speak to a member of staff
  • call 0345 365 50 50 (or +44 1789 508 211) and ask to speak to the Client Engagement Manager. If you are deaf or hard of hearing and use a textphone you can call 0345 365 1450 (or +44 1789 416 584)
  • write to the Client Engagement Manager, British Pregnancy Advisory Service, 20 Timothys Bridge Rd, Stratford Enterprise Park, Stratford-upon-Avon, CV37 9BF, or email clientservices@bpas.org