Abortion with Mifepristone and Misoprostol

Before starting

Remember this information is useful for an abortion with pills in pregnancies that are 11 weeks or less counted from the first day of your last menstrual period [1]. Since we are not trained to support abortions over 11 weeks of pregnancy, we will do our best to refer you to someone who is capable of doing so.

Combining Mifepristone and Misoprostol is very effective (95%) [2] to end a pregnancy that is 11 weeks or less.

To confirm that this method is safe for you, we recommend reading the previous section about contraindications for using abortion pills. If you are not sure that this procedure is a good option for you, contact us.

Mifepristone and Misoprostol Dosage

– For women under 9 weeks pregnant, you will need 1 pill of Mifepristone and 4 pills of Misoprostol, and it is recommended to have an extra 4 pills of Misoprostol (a total of 8 pills of Misoprostol). [3]

– For women between 9-11 weeks pregnant, you will need 1 pill of Mifepristone and 4 pills of Misoprostol, and it is highly recommended to have an extra 4 pills of Misoprostol (a total of 8 pills of Misoprostol). [4]

The Mifepristone pill should be 200 mg (or the equivalent to 200 mg) and each Misoprostol pill should be 200 mcg. [5]

If the pills you are getting have different dosages of mg and/or mcg, you will need to recalculate the total number of pills so you can use the correct amount of medication.

If you have any questions, please do not hesitate to contact us. We are here to support you throughout your abortion process.

How to take Mifepristone and Misoprostol for a safe abortion

Step 1: Swallow the Mifepristone pill with water.

If you throw up in the first 30 minutes after swallowing Mifepristone, it is likely that the pill will not work. In this case, if you have extra Mifepristone, you’ll need to repeat step 1. If not, contact us.

Step 2: Wait 24-48 hours after having swallowed Mifepristone.

You may choose to wait between 24 hours and 48 hours to continue with the next step. Within that time frame, there is no difference in regards to effectiveness of Misoprostol.

Keep in mind that most of the symptoms that you will experience will begin shortly after using Misoprostol, so choose a time that is most convenient for you and your schedule. It is recommended to choose a time when you are at home without obligations.

Step 3: Take 800 mg of Ibuprofen 1 hour before using Misoprostol.

This step is not required, but it is highly recommended. Ibuprofen will reduce the intensity of the cramps and help you manage the possible side effects of Misoprostol such as headache, fever and/or chills[6]. Remember, Ibuprofen can be used throughout the procedure and after when needed. Women who are allergic to ibuprofen and NSAIDs can consult the FAQs page for recommendations on alternatives for pain management.

If you have an anti-nausea medicine, you can use it at this time.

Step 4: Place 4 Misoprostol pills under your tongue (sublingual) for 30 minutes.

It is very important that the pills remain under your tongue for 30 minutes to allow them time to be absorbed into your system. After 30 minutes you may drink water to swish and swallow any remnants of the pills. [7]

If you vomit during the 30 minutes when the Misoprostol pills are under your tongue, it is likely that they will not work. In this case, it is necessary to immediately repeat step 4.

If you vomit after the pills have been under your tongue for 30 minutes, there is no need to repeat step 4 as the pills have already been absorbed into your system.

Wait 3 hours

– For women under 9 weeks pregnant, proceed to step 5 only if 3 hours have passed since you have used Misoprostol and you have not had any bleeding or the bleeding has been lighter than your normal period.

– For women between 9-11 weeks pregnant, proceed to step 5 regardless of the bleeding flow.

You can also contact us.

Step 5: Place another 4 Misoprostol pills under your tongue (sublingual) for 30 minutes. [For women who are 9-11 weeks pregnant or who didn’t experience any bleeding at the last step]

If an additional 3 hours have passed and you still have no bleeding or cramping, contact us. Do not use more pills until we can evaluate the situation together.

Expected symptoms

After taking Mifepristone, the majority of women do not have any visible symptoms, meaning they do not feel anything. If you happen to bleed after taking Mifepristone, it is still very important that you use Misoprostol in order for the procedure to work. [8]

After taking Misoprostol you will experience cramping and bleeding. Some women (not all) will expel blood clots. It is not possible to know exactly when the cramping and bleeding will start, most often it is within 1-2 hours, but it could be several hours later. [9]

The expected bleeding should be heavier than your menstrual period, or at least similar to it. You may have bleeding on and off for several days or weeks after using the pills. Your bleeding and pregnancy symptoms should gradually improve over the next few weeks. [10]

For women who are between 10-11 weeks, you will have symptoms of bleeding and cramping, however you may also see the embryo when it passes [1]. Usually this embryo is mixed within blood and clot, and often goes unnoticed, but it is important to know that it is normal if you recognize it. Do not be alarmed, it can be disposed of wrapped in sanitary pads or flushed down the toilet.

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 your pregnancy symptoms start to decrease and disappear after using the pills, this is a good sign that you are no longer pregnant. [11]

Side effects of Mifepristone and Misoprostol

After using Misoprostol, some women experience side effects that can last for a few hours or days [12]. These side effects include:

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

Precautions

To avoid hemorrhaging and/or infection, it is important that for the following weeks, or until your bleeding lightens [13], you take the following precautions:

  • avoid introducing objects in your vagina, including tampons and the menstrual cup
  • avoid intense physical activity (exercising, carrying and pushing or pulling heavy objects, walking more than normal, or walking up too many flights of stairs)
    Note: There is no evidence for a recommended amount of time you must wait to have sex after using the abortion pills, but it is generally recommended that you wait until the heavier bleeding stops, and listen to your body and desire. [14]

Warning signs: seeking help

If you have one of the following symptoms, this is considered a warning sign that you might be experiencing a complication and you should immediately seek medical attention:

  • If you fill two or more pads (completely soaked front to back, side to side) in 1 hour or less and this lasts for 2 consecutive hours or more.
  • A fever of 38 degrees Celsius (100.4 degrees Fahrenheit) that does not decrease after taking Ibuprofen. Always confirm with a thermometer.
  • A fever of 38 degrees Celsius (100.4 degrees Fahrenheit) that does not decrease 24 hours after using Misoprostol. 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 is likely that you are having an allergic reaction to the medications. You can use an antihistamine, but if you find it difficult to breathe then the allergic reaction is very serious and you need medical care immediately. [15]

Sources

[1] National Abortion Federation. 2020 Clinical Policy Guidelines for Abortion Care. Retrieved from: https://5aa1b2xfmfh2e2mk03kk8rsx-wpengine.netdna-ssl.com/wp-content/uploads/2020_cpgs_final.pdf

[2] Guttmacher institute. Medication Abortion. Retrieved from: https://www.guttmacher.org/evidence-you-can-use/medication-abortion

[3] Platais I, Tsereteli T, Grebennikova G, Lotarevich T, Winikoff B. Prospective study of home use of mifepristone and misoprostol for medical abortion up to 10 weeks of pregnancy in Kazakhstan. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Prospective+study+of+home+use+of+mifepristone+and+misoprostol+for+medical+abortion+up+to+10+weeks+of+pregnancy+in+Kazakhstan

[4] Gynuity. Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review. Retrieved from: https://gynuity.org/resources/efficacy-of-misoprostol-alone-for-first-trimester-medical-abortion-a-systematic-review

[5] Elizabeth G. Raymond, Caitlin Shannon, Mark A, Weaver, Beverly Winikoff. First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Retrieved from: https://www.contraceptionjournal.org/article/S0010-7824(12)00643-9/fulltext

[6] Livshits, Anna et al. Fertility and Sterility, Volume 91, Issue 5, 1877 – 1880. Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study. Retrieved from: https://www.fertstert.org/article/S0015-0282(08)00176-3/fulltext

[7] World Health Organization. Safe abortion: technical and policy guidance for health systems. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/70914/;jsessionid=B7AEEBE4F34809D869F73B1ABA7F6221?sequence=1

[8] De Nonno LJ, Westhoff C, Fielding S, Schaff E. Timing of pain and bleeding after mifepristone-induced abortion. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/11239617

[9] Gynuity. providing medical abortion in low-resource settings: an introductory guidebook. Second Edition. Retrieved from: https://gynuity.org/assets/resources/clinguide_maguide2nd_edition_en.pdf

[10] Planned Parenthood. How does the abortion pill work? Retrieved from: https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-does-the-abortion-pill-work

[11] Gynuity. Self-Assessment of Medical Abortion Outcome using Symptoms and Home Pregnancy Testing. Retrieved from: https://gynuity.org/resources/self-assessment-of-medical-abortion-outcome-using-symptoms-and-home-pregnan

[12] National Abortion Federation. Expected Side Effects of Medical Abortion. Retrieved from: https://prochoice.org/online_cme/m2expected2.asp

[13] A.R. Davis, C.M. Robilotto, C.L. Westhoff, S. Forman, J. Zhang. Bleeding patterns after vaginal misoprostol for treatment of early pregnancy failure. Retrieved from: https://academic.oup.com/humrep/article/19/7/1655/2356520

[14] Ipas. (2019). Clinical Updates in Reproductive Health. L. Castleman & N. Kapp (Eds.). Chapel Hill, NC: Ipas. Retrieved from: https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

[15] NHS. Risks-Abortion. Retrieved from: https://www.nhs.uk/conditions/abortion/risks/