The abortion Pill up to 9 weeks
For pregnancies under 9 weeks' gestation you may take mifepristone and misoprostol at the same time, or you may leave the clinic after taking the mifepristone and take the misoprostol at home 1-3 days later. Taking both medicines at the same time is convenient but can cause more side effects - it is more effective to take both medicines at least one day apart. It is important that you understand the differences between your options - so please read the table below and talk to your healthcare professional about what is best for you.
Options table for medical abortion up to 9 weeks of Pregnancy
The abortion pill from 9 to 10 weeks
If you are more than 9 weeks' pregnant, you will leave the clinic after taking mifepristone and either take the misoprostol at home 1-2 days later or return to the clinic 1-2 days later to use the misoprostol.
Medical abortion process
You will take one mifepristone tablet by mouth in the clinic. You may have nausea or vomiting after taking mifepristone. If you vomit within 1 hour of taking mifepristone, you should inform the clinic as soon as possible because you may need to take the pill again.
Most women do not have pain or bleeding until they take misoprostol (the second medication). However if you think you may have miscarried between taking the mifepristone and misoprostol we will do an ultrasound scan to decide if you need further treatment.
Misoprostol tablets are either placed in the vagina or between the cheek and gum - see instructions for using misoprostol below.
You will be given some antibiotics to take (follow the instructions on the packet), pain medicine with instructions for use and advice on how to care for yourself. You will then leave the clinic to complete the abortion at home. You may feel more at ease if you have someone with you for this process.
Use sanitary towels to monitor your bleeding during early medical/abortion pill treatment.
Misoprostol (the second medication), causes strong cramps which can be very painful, and heavy bleeding, which can start 2 hours after using the tablets. Bleeding lasts a few hours, and is most painful when the pregnancy is being expelled. Many women pass the pregnancy between 2 and 4 hours later - timings vary, but it is OK if this happens sooner or later. Almost all women miscarry within a few days. You will be given codeine to help you manage the pain, and you can also use pain relief from supermarkets and pharmacies too. Please refer to the 'Pain control' section below, for information about managing your pain.
You may bleed heavily - possibly more than a period, and see large 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. Under 8 weeks, you are likely to see the sac which is white and fluffy with brown-red tissue surrounding it. A 10 week fetus is about the size of an olive and you may recognise its shape. If you are worried about what you may see when the abortion happens, please discuss this with your healthcare professional.
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 until your next period. 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 contact your BPAS clinic.
VIDEO: The abortion pill up to 10 weeks
Instructions for using misoprostol
You can either use misoprostol in the clinic or take it home. If you take it home, you will receive 6 tablets.
Place 4 tablets either in your vagina or in your mouth between your cheek and gum
Insert 4 tablets as high as possible in the vagina.
You can put the tablets in while you are lying down, squatting, or standing with one leg up - whatever is most comfortable. Don’t worry too much about the exact position of the tablets as they don't need to be in a specific place to be effective. It is important that the tablets do not fall out
In the mouth - between cheek and gum
Place 4 tablets in your mouth between both upper cheeks and gum (2 on each side in quick succession) 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
IF bleeding does not start after 4 hours you should repeat this process with the remaining 2 tablets either in the vagina or between your cheeks and gum.
Contact the BPAS clinic where you were treated or the telephone helpline 0300 33 6828 if you have any questions.
Do not throw away leftover tablets - please return them to BPAS or take them to a local pharmacy or GP surgery for safe disposal.
For most women, medical abortion is like an early miscarriage. It is normal for you to have bleeding and cramping. You might also:
- feel dizzy
- feel nauseous or vomit
- have a headache
- have diarrhoea
- have temporary flushes or sweats
These symptoms may come and go throughout your treatment but if they continue after 24 hours of taking the second medication (misoprostol), please contact the clinic where you were treated.
Risks and complications
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. Studies so far do not show that this causes any problems or adverse effects for breast fed infants. Breast feeding may continue uninterrupted but if you wish to suspend breast feeding during treatment, please talk to your healthcare professional to work out a plan.
During an early medical abortion, most women will have 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 pain medicine like ibuprofen, or codeine
How to get pain medicine
You can buy ibuprofen tablets in either 200mg or 400mg strengths at your local pharmacy. A BPAS healthcare professional will also offer you codeine 30mg, prescribed by one of our doctors, to take home.
Codeine 30mg is only available with a prescription. Some products that you can buy at the pharmacy have lower doses of codeine combined with either ibuprofen or paracetamol. However, they will not give you the same amount of pain relief as the codeine we provide.
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. It's up to you. You can also alternate the medicines depending on how you feel.
What dose you should take and how often you can take it
There are 2 strengths of ibuprofen tablets - follow the directions that apply for the strength you buy:
Ibuprofen (200mg): take 3 or 4 tablets by mouth every 8 hours as needed. No more than 12 tablets in 24 hours.
Ibuprofen (400mg): take 1 or 2 tablets by mouth every 8 hours as needed. No more than 6 tablets in 24 hours.
As well as Ibuprofen you can also take:
Codeine (30mg): take 1 or 2 tablets by mouth every 4 hours as needed but no more than 8 tablets in 24 hours. Clients of 12-18 years of age, may take 1 or 2 tablets by mouth every 6 hours as needed, but should not take more than 8 tablets in 24 hours. Codeine will not be given to anyone under the age of 12.
Do not drive or operate machinery when taking codeine.
If you have tried these options, but still have pain, please call the clinic or the BPAS Aftercare Line on 0300 333 68 28 (or +44 1789 508 210).
Client EMA experience
I received the treatment on Saturday morning at 11am and by 12.30pm I was already experiencing some twinges and cramps. These got progressively worse, so much so that by 1pm I was in pyjamas and in bed with a hot water bottle and a film. I took ibuprofen at this stage as although bleeding and cramping started properly about 2.5 hours into the treatment, it wasn't awful pain, just like strong and lingering period cramps. Then around 3 hours into the treatment I felt nauseous, I went very pale, quite shaky and cold, and the pain increased to very strong, dull aches that felt lots like very strong period pain. In no way did I feel like I needed to call out in pain or was out of control in anyway, it was all ok with codeine and a hot water bottle. I curled up in bed and watched my film to take my mind off it. 4.5 hours in (after 1 hour of very strong cramping and heavier bleeding) I needed the loo and as I sat down I felt something hot and jelly like fall out very fast. I didn't look but I assume it was the pregnancy as I instantly stopped shaking, had colour in my cheeks and felt and overwhelming sense of relief. Afterwards the cramping reduced somewhat and was completely manageable with a hot water bottle, ibuprofen and codeine occasionally. That evening I felt fine with no cramps at all and bleeding was heavy but not unlike a heavy period. The next day I was up and about as normal, bleeding just like a period and no cramping at all. All in all a very positive experience and I am eternally grateful to all the staff at Plymouth BPAS for your wonderful understanding and care