Pills by Post - Remote Abortion Pill Treatment

Telephone consultation takes place before treatment

 

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.  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.

Risks and complications of the abortion pill

Treatment

You will receive your treatment package direct from the pharmacy from 1 to 3 days from your telephone consultation.  The package is plain with no indication of its contents, it will be tracked but not signed for.  Your pack will contain:

  • Abortion pill medication (1 tablet mifepristone and 6 tablets of misoprostol - packaged together or separately)
  • Pregnancy test
  • Codeine (only provided if suitable)
  • Progestogen only contraceptive pills (if requested and suitable)

About medical abortion: The abortion pill 

Medical abortion 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:

  • You will swallow the first medicine (mifepristone) with water
  • you will take the second medicine (misoprostol) 1 to 2 days later
  • 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

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.  You should still use the misoprostol even if you do bleed. 

Step 2 – Misoprostol

Misoprostol tablets are placed in the vagina or between the cheek and gum - use 4 tablets first and the remaining 2 tablets 3 to 4 hours after. See below for more detail.

Misoprostol (the second medication) causes strong, painful cramps and heavy bleeding.

Bleeding and cramping usually start within 2 to 4 hours after using the tablets, but may occur sooner. 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 6 tablets of misoprostol:

  1. Use the first 4 tablets by either placing them into your vagina or between your cheek and gum.
  2. Then 3 to 4 hours later use the remaining 2 tablets 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 laying down, squatting or standing with one leg up - whatever is most comfortable for you.  Insert the 2 remaining tablets 3 to 4 hours later.

EMA misoprostol vaginal insertion

OR

Into the mouth between cheek and gum

Place the 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.  Repeat with the remaining 2 tablets 3 to 4 hours later.

EMA misoprostol in mouth

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 (usually smaller than 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 no or minimal bleeding 

Telephone 0300 333 68 28 for advice if you have no or minimal bleeding: 

  • 24 hours after misoprostol - if you did not have a scan or your scan showed a pregnancy which may not have been viable (gestation sac visible only)  
  • 5 to 7 days after misoprostol - if your treatment follows a scan which showed a pregnancy in your uterus.

Side effects

For most women, early medical abortion is like 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 have any other questions about the disposal of the pregnancy remains see 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 in either 15mg or 30mg strengths.

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 included in the pack that will be correct for the strength that you have bought.

You may also receive codeine as part of your pills by post pack. There are two strengths of 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.

or

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


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
  • Three 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 will contact BPAS if I experience any of the following signs that my treatment has not worked:

  • I had no or minimal bleeding after using misoprostol 
  • 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

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

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 taken 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

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 a 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. Stop breastfeeding if you take codeine - express and discard milk during use and for one feed after the last dose. 

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.

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 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:

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 wish to provide any feedback about the service you received once your treatment is complete, please email clientservices@bpas.org.

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