If you are from Scotland and want to access Pills by Post please call us for more information.
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.
You will have your consultation and medical assessment over the telephone and have opted for remote abortion pill treatment (pills by post).
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.
Significant unavoidable or frequently occurring risks
These are usually easy to treat and rarely have any long-term health effects.
These may require transfer to hospital or surgical procedures and may have serious 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. 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:
Click here to see what your package will look like (contents and medication brand names may vary)
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:
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.
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.
You have been sent 6 tablets of misoprostol:
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.
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.
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.
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 (see figure below). 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 figure below) therefore you should telephone BPAS on 0300 333 68 28 for advice if:
Call 999 if you experience extremely heavy bleeding (see Flooding image 5) and feel unwell
Bleeding and cramping usually start 2-4 hours after taking misoprostol but sometimes it can take up to a few days for this to happen.
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 two 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.
For most women, early medical abortion is like an early miscarriage. It is normal to have bleeding and cramping. You might also:
If symptoms continue after 24 hours of taking the second medicine, please get in contact with us.
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.
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 either 15mg or 30mg strengths.
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.
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.
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
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.
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. Stop breastfeeding if you take codeine - express and discard milk during use and for one feed after the last dose.
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 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.
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:
Northern Ireland www.informingchoicesni.org