Medical abortion: The abortion pill Second appointment
THE ABORTION PILL UP TO 9 WEEKS
What is the abortion pill?
The abortion pill is a medicine that ends a pregnancy. The medical
name for the abortion pill is mifepristone. It works by blocking the
hormone progesterone. Without progesterone, the lining of the
uterus breaks down and the pregnancy cannot continue.
The abortion pill is followed by another medicine called
misoprostol which makes the womb contract, causing cramping
and bleeding similar to a miscarriage.
This method can be used up to 23 weeks and 5 days of pregnancy at
bpas. What to expect depends on whether your pregnancy is less
than or more than 9 weeks’ gestation. More information is below.
The abortion pill up to 9 weeks
First appointment
A bpas healthcare professional will give you the abortion pill
(mifepristone) to swallow when you are in the clinic.
If your blood group is Rhesus-negative you will have an Anti-D
injection.
You may then leave the clinic. Most women are able to carry
on their usual lives at home or work, but you may have some
bleeding and period-like pains.
It is unlikely that the abortion will happen after taking the first pill.
However, this can happen occasionally. If you think you may have
miscarried after taking the first pill it is likely we will do another
ultrasound scan at your next visit.
You may have nausea or vomiting. If you vomit within one and
a half hours of taking the pill, please inform the clinic as soon as
possible, as the tablet may not have been absorbed.
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THE ABORTION PILL UP TO 9 WEEKS
You will return to the clinic anywhere from 6 hours up to 3 days
later. At this visit, misoprostol tablets are placed in the vagina.
You can place the tablets yourself or have a healthcare
professional place them. You can put these tablets in while lying
down, squatting, or standing with one leg up - whatever is most
comfortable for you. Try to insert them as high up into your
vagina as possible. Don’t worry too much about the exact position
of the tablets in the vagina; it is not important for them to be in a
specific place to be effective.
You will be given some antibiotics to take, pain medicine with
instructions for use and advice on how to care for yourself.
Our Aftercare Line is also available to you at anytime,
7 days a week on 0800 247 1122.
The misoprostol tablets will cause you to have cramps and bleed
heavily. This usually starts about 2 hours after using the
misoprostol, but may start sooner. Bleeding and cramping usually
last a few hours. You may see large blood clots or tissue at the
time of the abortion and you will probably need pain medicine. For
more information on pain control please turn to pages 20 and 21.
Most women pass the pregnancy within 4 or 5 hours after taking the
misoprostol. For others it can be quicker or take longer. Almost all
women miscarry within a few days. It’s different for every woman.
Here are some comments from women who have had the
abortion pill:
“It felt like really bad period cramps. It was bearable and the pain
did pass. I used a hot water bottle which really helped.”
“The abortion pill wasn’t as easy as I thought. The pain
was quite intense for me.”
It’s normal to have some bleeding or spotting for up to 4 weeks
after the abortion. You should use sanitary pads as it makes it
easier to keep track of your bleeding.
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 Follow-up appointment
THE ABORTION PILL UP TO 9 WEEKS
The abortion pill is very effective, but it is still very important
to have a follow-up appointment to make sure it has worked.
Misoprostol may cause serious birth defects if the pregnancy
continues. If the abortion pill does not work for you, we would
recommend a surgical abortion to end the pregnancy.
Your follow-up appointment may be 1-2 weeks later in person or
3 weeks later by phone. You will also receive a pregnancy test with
instructions on how to use it. If you cannot return for a check up
in person, do the test 3 weeks after the treatment. If the test is
positive you must immediately call the bpas clinic, the number is at
the front of this guide, or call the Aftercare Line on 0800 247 1122.
A positive test may mean the treatment has not worked.
Side effects
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
You may feel more at ease if you have someone with you during
the abortion.
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Important!
THE ABORTION PILL UP TO 9 WEEKS
Serious complications may have warning signs. Contact the bpas
clinic or Aftercare Line straight away if you have:
• heavy bleeding that soaks through 2 sanitary pads an hour, for
2 hours or more in a row
• abdominal pain or discomfort that is not helped by medication,
rest, a hot water bottle, or a heating pad
• a fever of 38°C or higher
• an unpleasant smelling discharge from your vagina
• signs that you are still pregnant
• no bleeding 24 hours after using misoprostol
You should start to feel better each day after the abortion. Feeling
sick, having abdominal discomfort, diarrhoea, nausea, vomiting or
weakness more than 24 hours after taking misoprostol could be
a sign of a serious complication. Do not wait for your follow-up
appointment to contact bpas. Please call the Aftercare Line on
0800 247 1122.
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 Breastfeeding during medical abortion
THE ABORTION PILL UP TO 9 WEEKS
If you are breastfeeding at the time of your abortion, please be
aware that mifepristone will pass into the breastmilk. Studies so far
do not show that this causes any problem for the infant. However,
if you want to be cautious you can suspend breastfeeding for 2
days after taking the abortion pill.
A little bit of misoprostol will be present in breast milk after you
take it. If you are breastfeeding, the misoprostol may rarely cause
your infant to have diarrhoea. To reduce any risk you can choose
to wait 6 hours between using the misoprostol and breastfeeding.
Please let us know if you are breastfeeding so we can work out the
best plan together.
Pain control
After a 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, paracetamol and codeine
How to get pain medicine
You can buy ibuprofen tablets in either 200mg or 400mg strengths
and paracetamol 500mg tablets 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.
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How to use these medicines
THE ABORTION PILL UP TO 9 WEEKS
Ibuprofen and paracetamol are for mild to moderate pain.
Codeine is for moderate to severe pain.
You can start with ibuprofen and paracetamol, 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
Please remember, there are 2 strengths of ibuprofen tablets.
Follow the directions that are correct for the strength that you buy:
Ibuprofen (200mg): take 3 or 4 tablets by mouth every 8 hours
as needed. Do not take more than 12 tablets in 24 hours.
Or
Ibuprofen (400mg): take 1 or 2 tablets by mouth every 8 hours
as needed. Do not take more than 6 tablets in 24 hours.
As well as ibuprofen you can also take:
Paracetamol (500mg): take 2 tablets by mouth every 4 hours as
needed. Do not take more than 8 tablets in 24 hours.
Codeine (30mg): take 1 or 2 tablets by mouth every 4 hours as
needed. Do not take more than 8 tablets in 24 hours.
Please note:
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 0800 247 1122 for advice.
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 Risks and complications of the abortion pill before 9 weeks
THE ABORTION PILL UP TO 9 WEEKS
Significant, unavoidable or frequently occurring risks
These are usually easy to treat and rarely have any long-term
health effects.
• Unpredictable time to complete the procedure (variable)
• Side effects of drugs such as nausea, vomiting, diarrhoea,
headache, dizziness, fever/chills (common)
• Retained products of conception - where the pregnancy has
been successfully ended but some of the pregnancy tissue is left
behind in the womb (1 in 100)
• Infection (1 in 2,000 may be higher)
• Unpredictable, irregular or prolonged bleeding after the
abortion (variable)
• Pain during the procedure (common)
These may require transfer to hospital or surgical procedures,
and may have serious long-term health effects.
• Psychological problems (variable)
• Continuing pregnancy (1 in 100)
• Haemorrhage - very heavy bleeding (1 in 800)
• Undiagnosed ectopic pregnancy (1 in 7,000)
• Death (less than 1 in 100,000)
Extra procedures which may be necessary
• Surgical abortion or uterine aspiration
• Blood transfusion
• Laparoscopy or laparotomy - operation to look inside the
abdomen
• Hysterectomy - surgical removal of the womb (1 in 15,000)
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The abortion pill after 9 weeks
THE ABORTION PILL AFTER 9 WEEKS
The abortion pill is a medicine that ends a pregnancy. The medical
name for the abortion pill is mifepristone. It works by blocking the
hormone progesterone. Without progesterone, the lining of the
uterus breaks down and the pregnancy cannot continue.
The abortion pill is followed by another medicine called
misoprostol which makes the womb contract, causing cramping
and bleeding similar to a miscarriage.
This method can be used up to 23 weeks and 5 days of pregnancy at
bpas. What to expect depends on whether your pregnancy is less
than or more than 9 weeks’ gestation. More information is below.
First appointment
A healthcare professional will give you the abortion pill to swallow
while you are in the clinic.
If your blood group is Rhesus-negative you will also have an
Anti-D injection. You may then leave the clinic. Most women can
carry on their usual lives at home or work but you may have some
bleeding and period-like pains.
You may have nausea or vomiting. If you vomit within one and
a half hours of taking the pill, please inform the clinic as soon as
possible, as the tablet may not have been absorbed.
Second appointment
You will either return to the same bpas clinic or visit a different bpas
clinic 1 or 2 days later. You will be admitted and tablets of misoprostol
will be placed into your vagina. You may insert these tablets yourself
or have a healthcare professional insert them for you.
A nurse will be in attendance and your progress will be monitored.
You can rest in bed or be up and about as you wish.
The misoprostol tablets will cause you to have cramps and
bleeding. This usually starts about 2 hours after the misoprostol is
placed, but may start sooner. You may need pain medicine, which
we will provide. See page 20 for more information.
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