Mifepristone and Misoprostol

If you are having an abortion with Mifepristone and Misoprostol, these step-by-step instructions are for you. The more you know what to expect and the better you are prepared for the process, the easier it will be for you. Please read them carefully and let us know if you have any questions. We are here to support you through live chat or email before, during and after the procedure.

Recommendations before taking the medication:

  1. Use Misoprostol, the second medication, on a day where you can rest and you do not have any responsibilities. Make sure that you are somewhere where you feel comfortable and safe.
  2. If possible, have someone with you who you can trust and who can support you with whatever it is that you might need during the process. This person should help you to feel calm and comfortable. They should also be ready to assist you in the event of an emergency. Make sure you share these instructions with that person.
  3. Although complications are rare, have a plan in case of an emergency before using the pills. This is very important.

Things to think of while making this emergency plan:

  • • Where is the nearest hospital/clinic to you that is open 24 hours? You must know before starting the procedure exactly which hospital or clinic you will go to if necessary. (You must be able to get there within 1 hour or less. If you have anemia you must be able to get there within 30 minutes or less.)
  • • How will you get there? By bus? Taxi? Car? If by taxi or bus, do you have the money ready? If by car, is someone there with you who can drive? Remember: you cannot drive yourself to the hospital/clinic, it is not safe.
  • • What will you say once you arrive? (We will explain thoroughly as you keep reading, but if you used the pills in your mouth, they can not be detected. However, if you live in a place where abortion is restricted, they might pressure you to say that you used pills to cause an abortion.)

Instructions on how to use the medication:

If you received a package or are going to receive one from one of our distribution partners, that means you will have 1 pill of Mifepristone and 8 pills of Misoprostol. 4 of the 8 Misoprostol pills are extra and you will most likely only use 4 Misoprostol pills.

Click here if you bought, or plan to buy Mifepristone and Misoprostol locally.

Step 1: Swallow the Mifepristone pill with water.

Note: If you vomit within the first 30 minutes after taking Mifepristone, you must take it again. If you do not have access to another Mifepristone pill, it is important that you do the entire procedure for Misoprostol only. Click here for those instructions.

Step 2: Wait between 24 – 48 hours after taking Mifepristone

Step 3: Take 800mg of Ibuprofen 30 minutes before you use Misoprostol. This step is highly recommended in order to decrease the pain you will experience from cramping. Do not wait to take it until you start feeling pain as Ibuprofen works better when used before the pain starts. This will also help you to be more comfortable and relaxed.

Step 4: Place 4 Misoprostol pills underneath your tongue (sublingually). It is very important that the pills remain underneath your tongue for 30 minutes. During these 30 minutes the medication is absorbing itself into your system. After 30 minutes you may drink water to wash down what remains in your mouth.

Note: If you vomit within the first 30 minutes that the 4 pills of Misoprostol are in your mouth, you need to repeat step 4 again with the 4 extra pills. If you vomit after the first 30 minutes, you do not need to use an extra dose as the medicine has already absorbed itself into your system.

Main Symptoms:

After using Mifepristone, the majority of women will not have any visible symptoms, but some will experience light bleeding and/or nausea. If you experience bleeding after using Mifepristone, it is very important that you continue the protocol and use Misoprostol. Misoprostol is the medicine that will expel the pregnancy.

After using Misoprostol, you will experience cramping and bleeding. The bleeding will be heavier than your regular period and can last as long as 12 hours, but some women experience less hours of heavy bleeding. The blood should be the same color and smell as your menstrual period. The intensity of the cramping is different for each woman: it can be between moderate and intense. Ibuprofen will help with cramping.

An abortion with pills is a process that takes about 15 days to complete. This means that it is normal for you to experience bleeding 2-3 weeks after taking the pills, but all your symptoms should diminish in their intensity, not increase (the bleeding with not remain heavy during those next few weeks and you will not have cramping). Normally women report that symptoms of their pregnancy (if they had any at all) disappear within 5 days or less after using Misoprostol.

If 3 hours have passed since using Misoprostol and you have not experienced these symptoms (bleeding and cramping) or you feel like you have had very little bleeding and cramping, please follow these steps:

Step 1: Place 2 more Misoprostol pills underneath your tongue. It is very important that the pills remain underneath your tongue for 30 minutes.

Step 2: Wait 3 hours. If you still have very little bleeding and/or cramping after using these 2 extra Misoprostol pills, use the last 2 Misoprostol pills.

If you still have no bleeding and/or cramping after 3 hours of using all the extra Misoprostol pills, please contact us immediately.

Pain management:

As mentioned in the steps above, we highly recommend that you take Ibuprofen (800 mg) 30 minutes before taking the 4 Misoprotsol pills. After this you can take additional doses of 400 mg every 6 to 8 hours as needed depending on how intense your pain is. Do not exceed 5 doses in 24 hours.

It’s very important that you DO NOT use medication that is specifically for menstrual cramps because this will interfere with the effects of Misoprostol. DO NOT take aspirin because this will interfere with your bleeding.

If you are allergic to Ibuprofen, contact us so that we can help you find a safe medication to use for pain.

You can also get pain relief by placing a hot pad on your stomach and/or by drinking hot tea.

Secondary Side Effects:

Some women will experience certain side effects after using Misoprostol. These side effects are normal and temporary. They include:

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

Warning Signs:

It is very important that throughout the entire process you remain alert and aware of your body and how you are feeling. Although complications are rare, it is necessary that you are able to immediately identify a potential complication. If you experience one of the following symptoms you must seek medical attention immediately (no more than 1 hour from the moment you start experiencing a potencial complication, or no more than 30 minutes if you have anemia):

    • If you fill 2 or more pads (completely covered with blood front to back and side to side) in 1 hour or less and this last for 2 hours or more. It is important to understand that bleeding from an abortion is very different than bleeding from a hemorrhage. If you are hemorrhaging the bleeding with flow without stopping as if it were an open faucet. You may also feel dizzy and faint.
    • A fever (38 degrees celsius or more – always check with a thermometer) that does not get better after taking Ibuprofen
    • A fever (38 degrees celsius or more – always check with a thermometer) that does not go away after 12 hours or so
    • Pain that does not decrease after taking Ibuprofen

Seeking Medical Attention:

You do not need to seek medical attention unless you experience one of the warning signs we mentioned above. In the event that you are experiencing one of the warning signs, you must visit a hospital or clinic as soon as possible.

It is important to understand that medical personnel has no way of detecting Mifepristone or Misoprostol if you took the medication as we recommended it. There are no lab tests a hospital or clinic can perform in order to detect the pills in your system. If they tell you they have a way of finding out, they are just saying this to scare you. This is why it’s important to go prepared and know ahead of time what you will say, especially if abortion is legally restricted where you live. Note: If you used Misoprostol vaginally, medical staff can find the pills, or remains of them in your vagina. This is why we do not recommend using Misoprostol vaginally.

It’s also very important that you understand that complications from a medical abortion are the same exact complications one would experience from a spontaneous abortion (also known as a miscarriage). This means that it will appear as if you are having a miscarriage and they will treat you for exactly that.

Below are some things you can say if you need to seek medical attention. Think ahead of time what you will say and always be prepared.

  • “I started to bleed and I don’t feel well.”
  • “I’m bleeding and I’m afraid that something is wrong.”
  • “I started to bleed and I’m not sure what is happening.”
  • “I started bleeding and this is not like my normal period.”

Precautions to take during the abortion process:

Misoprostol slightly dilates the entrance of your cervix which means that you are more susceptible to infection and or hemorrhaging during this time. For this reason it is important that you take some precautions for 2-3 weeks:

  • avoid swimming
  • avoid introducing objects into the vagina, including tampons
  • avoid having penetrative vaginal sex for at least one week (if this is not posible, it is important to use a condom to avoid infections)
  • avoiding physical activity (working out, carrying/pushing heavy objects, excessive walking, climbing flights of stairs, etc.)

Menstruation and Fertility:

Your period will return between 4-6 weeks, but you can become fertile again within 8 days after, meaning you can become pregnant again shortly after using abortion pills.

Live chat us or write us an email at help@safe2choose.org if you have any questions. We will be more than happy to support you.