Misoprostol only:

Recommendations before using the medication:

  1. You will need 12 misoprostol pill. Each pill should be 200 mcg.

  2. If you have an intrauterine device (IUD) it’s best if you get it removed before using abortion pills. Having an IUD does not decrease the efficacy of the procedure, but it can increase the intensity of the pelvic pain.
  3. Use Misoprostol a day when you can rest and you do not have things to do. It is best to be in a place where you feel comfortable and safe.
  4. Have an emergency plan ready just in case. Although not many women experience a complication, it’s important to know what you would do in case of an emergency before using the pills.
    • Know which clinic or hospital you would go to taking into consideration that they would be able to assist you at whatever hour you arrive (open 24 hrs). You should be able to arrive there in 1 hour or less or, if you have anemia, 30 minutes or less.
    • Decide how you will get there and prepare money if you will need it. Keep in mind you will not be able to drive yourself as that would not be safe.
    • Will you have someone there who can go with you?
    • What will you say to medical staff? (We are going to explain this in great detail as you keep reading on, but if you used the pills in your mouth they will not have a way to detect you used them. Nevertheless, if you live in a place where safe abortion is restricted, they could try and pressure you to say that you provoked an abortion.)
  5. If possible, it’s great to have someone you trust with you throughout the process to help with whatever it is you might need. The idea is that they support you to feel comfortable and relaxed, but also that they help you in the event of an emergency. Make sure to share with them this guide so they are also familiar with the process.
  6. We recommend you use comfortable clothing and prepare in advance some light meals for the day you do the procedure so you don’t have to worry about that during your process.
    There are no dietary restrictions and throughout the entire process you may eat as you please. Have water ready so you can drink throughout the process and remain hydrated.

Instructions on how to use the medication:

Step 1: TAKE 800 MG OF IBUPROFEN 1 HOUR BEFORE USING MISOPROSTOL

We recommend this step to help decrease the pain you will feel from cramping. Ibuprofen works better if you take it before you start feeling pain, so do not wait until you feel pain to take it. Taking Ibuprofen will help you to feel more comfortable and will lesson the other side effects that Misoprostol can cause.

Step 2: PLACE 4 MISOPROSTOL PILLS UNDER YOUR TONGUE (SUBLINGUAL) IT IS VERY IMPORTANT THAT THE PILLS REMAIN UNDER YOUR TONGUE FOR 30 MINUTES.Place 4 misoprostol pills under your tongue (sublingual). It is very important that the pills remain under your tongue for 30 minutes. In these 30 minutes the pills will be absorbing into your system. After 30 minutes you may drink water to wash down what remains of the pills.

Step 3: WAIT 4 HOURS

Step 4: PLACE 4 MISOPROSTOL PILLS UNDER YOUR TONGUE (SUBLINGUAL). IT IS VERY IMPORTANT THAT THE PILLS REMAIN UNDER YOUR TONGUE FOR 30 MINUTES. In these 30 minutes the pills will be absorbing into your system. After 30 minutes you may drink water to wash down what remains of the pills.

Step 5: WAIT 4 HOURS

Step 6: PLACE THE LAST 4 MISOPROSTOL PILLS UNDER YOUR TONGUE (SUBLINGUAL). IT IS VERY IMPORTANT THAT THE PILLS REMAIN UNDER YOUR TONGUE FOR 30 MINUTES. In these 30 minutes the pills will be absorbing into your system. After 30 minutes you may drink water to wash down what remains of the pills.

If you vomit during the 30 minutes that the Misoprostol pills are under your tongue, it is likely they will not work. In this case, it is necessary to immediately repeat that dose. If you have to repeat a dose, please let us know as this could affect the efficacy of the abortion. This is why we recommend you use anti-nausea medicine before using Misoprostol and/or have extra Misoprostol if possible. If you vomit after the pills have been under your tongue for 30 minutes, there is no need to repeat the dose as the pills have already absorbed into your system.

Use all 12 pills even if you start to bleeding after using the first or second dose.

Expected Symptoms:

After using Misoprostol you will experience cramping and bleeding. It is not possible to know exactly when the pain and bleeding will start: it could be as soon as a few minutes after the first dose or even a few hours after the last dose. On average, the bleeding will be heavier than your regular period and it can continue like this for various hours. Bleeding is a good sign that the abortion is taking place. Some women will expel blood clots as well.

The intensity of the cramps is different for each woman, but they are usually between moderate to intense. The Ibuprofen will help with the pain.

IF 24 HOURS HAVE PASSED SINCE THE LAST DOSE AND YOU HAVE NOT STARTED BLEEDING OR THE BLEEDING HAS BEEN LIGHTER THAN YOUR NORMAL PERIOD, CONTACT US. DO NOT USE MORE MISOPROSTOL PILLS UNTIL WE CAN EVALUATE TOGETHER THE SITUATION.

Even if you start bleeding abundantly, consider that the abortion takes about 2 weeks to complete itself. This means that you can continue to bleed for various days or even weeks after using the pills. The bleeding can lightly increase and decrease (it can come and go), but as time passes it will slowly disappear. If your bleeding has significantly decreased and then suddenly increases again to be as heavy as it was the day you used Misoprostol, it is not necessarily a warning sign, but contact us so we can understand what is happening. Remember that each abortion experience is different and the symptoms can vary from woman to woman.

The majority of women who have pregnancy symptoms stop having them approximately 5 days after using Misoprostol. If you do not have pregnancy symptoms anymore, that is a good sign that you are no longer pregnant.

Pain management:

As we mentioned above, we recommend that you take 800 mg of Ibuprofen 1 hour before using the first dose of 4 Misoprostol pills. Ibuprofen is much more effective when you take it before you start to feel pain as oppose to taking it when you start to feel pain. After, you may take additional doses of 400 mg every 3 hours depending on how strong the pain is. Do not exceed 3200 mg of Ibuprofen in 24 hours.

Keep in mind that Ibuprofen will also help decrease the possible side effects of Misoprostol: fever, chills and headache. Having less pain and less side effects will help you to feel more comfortable and relaxed during the process.

Besides taking Ibuprofen to alleviate pain, you can also place a hot compress on your stomach and drink hot tea.

It is very important that you do not use medicine that is specifically for cramps because this can interfere with the Misoprostol and make your process less effective. Do not use Aspirin either as this can affect the coagulation of bleeding and cause a hemorrhage.

If you are allergic to Ibuprofen or cannot find it, contact us so we can recommend a different medication.

Side effects:

After using Misoprostol, some women experience side effects that can last for a few hours or a few days. These side effects include:

  • fever
  • diarrhea
  • nausea/ vomiting
  • headache
  • chills

Managing nausea:

You may take 10 mg of Domperidone 1 hour before using the first dose of Misoprostol. If you continue to feel nauseous and/or are vomiting throughout the process, you make take additional doses of 10 mg every 6 hours. Do not exceed 40 mg of Domperidone in 24 hours.

If you have been experiencing a lot of nausea and vomiting with your pregnancy, it is especially important that you use this medicine to avoid vomiting the pills before they take affect and start working.

If you are not able to find Domperidone, contact us so we can recommend another medication.

Precautions to take during the abortion process:

To avoid hemorrhaging and/or infection, it is important that for the following weeks, until your bleeding completely stops, you take the following precautions:

  • avoid introducing objects in your vagina, including tampons and the menstrual cup
  • avoid intense physical activity (exercising, carrying, pushing or pulling heavy objects, walking more than normal, or walking up too many flights of stairs)

Warning Signs:

It is very important to remain aware of your body and how you are feeling during the weeks the procedure lasts. Complications are not common, but it is important that you know how to immediately identify one of the warning signs.

If you have one of the following symptoms, this is considered a warning signs and you should immediately seek medical attention (in 1 hour or less or, if you have anemia, 30 minutes or less).

  • If you fill two pads or more (completely soaked front to back, side to side) in 1 hour or less and this last for 2 hours or more.
  • A fever of 38 degrees Celsius (100.4 degrees Fahrenheit) that does not decrease after taking Ibuprofen. (If you think you have a fever always confirm with a thermometer.)
  • A fever of 38 degrees Celsius (100.4 degrees Fahrenheit) that does not decrease 12 hours after using the last dose of Misoprostol. (If you think you have a fever always confirm with a thermometer.)
  • Pain that does not get better after taking Ibuprofen
  • The color or smell of your blood is very different from your regular period or has a bad smell.
  • If you have redness, itchiness or swollen hands, neck and face it’s likely you are having an allergic reaction to the medications. You can use an antihistaminic, but if you find it difficult to breathe then the allergic reaction is very serious and you need medical care immediately.

Seeking Medical Attention:

It is not necessary to seek medical attention unless you experience one of the warning signs mentioned above. If you experience a warning sign you should visit a clinic or hospital in 1 hour or less (or 30 minutes or less if you have anemia).

It is important to understand that medical staff has no way of knowing you used Misprostol if you used them how we recommend. There are no tests or analysis that exist in hospitals to detect this medication in your body. If they tell you they have a way to prove you used the pills, they are just saying this to scare you. This is why it is very important to prepare what you will say and how you will act before using the pills, especially if you live in a place where safe abortion is illegal.

If you used Misoprostol in your vagina, medical staff can find the pills or a trace of the pills in your vagina. This is why we do not recommend using the pills in your vagina.

It is equally important to understand that complications from an abortion with pills are the same exact complications that one could experience due to a miscarriage (spontaneous abortion). This means that it will seem as if you are having a miscarriage and they should treat you for that. Even though they will not know you used the pills, they will know that you were pregnant.

Think ahead of time what to say and how to act so you feel prepared. You can describe exactly what you are experiencing because the symptoms will be the same as a miscarriage.

Here we will leave you some ideas:

  • “I began bleeding and I do not feel well.”
  • “I have a lot of pain and I am not sure what is happening.”
  • “I’m bleeding but it does not seem like my normal period.”
  • “I have a high fever and I’m not feeling well.”

How to know if the abortion was successful:

Using Misoprostol alone is 85% effective. If you experienced all the expected symptoms of an abortion, it is not necessary to do a test to know if it was successful or not.

Even though this method is highly effective, some women will still want to be sure the pills worked. If you would like to confirm that your abortion was successful, you can do an ultrasound 15 days after using Misoprostol. If you do an ultrasound before 15 days has passed, it is likely they will diagnose you with an incomplete abortion because your body is still in the process of naturally expelling the tissues that are still in your uterus. Because of this, they could unnecessarily suggest medical intervention such as a surgical abortion.

You may also do a urine or blood test 4 weeks after using the pills. If you use either one of these test before 4 weeks, it is likely you will get a false positive result even if you are not pregnant anymore. This is because the pregnancy hormone takes a while to completely leave your
body.

Menstruation and Fertility:

Your period will return between 4-6 weeks after using the pills. In some cases it could take a little longer to return but it does not mean this is a warning sign.

Your fertility can return as soon as 10 days after using abortion pills. This means that if you have unprotected sex you can become pregnant again very soon after using abortion pills. Consider you can restart your sexual activity any time you want to.