The leaflet is detailed below, or you can download the 'Treatment at Home for Early Medical Abortion During Covid-19 Pandemic (Up To 9 Weeks + 6 Days - Tablet Method) Information Leaflet' in PDF.
Please read this leaflet carefully and keep it throughout your treatment as it contains important information regarding your procedure and aftercare.
Points to be aware of before you start the procedure
It is important before you take the first tablet that you are certain of your decision to proceed with the abortion.
There are known risks to the fetus from the medication and therefore, we must recommend that once you have taken the tablet(s) that you continue with the abortion.
- It is recommended that you do not smoke or drink any alcohol once the procedure has commenced.
- Due to the unpredictability of the procedure we recommend you inform us of any travel plans arranged.
- If you are breastfeeding you may continue during the medical procedure as only small amounts of the drugs, Mifepristone and Misoprostol pass into the breast milk and are therefore not expected to cause adverse effects in the breastfed infant.
Early Medical Abortion Procedure
You have been sent both parts of your treatment to take at home. Please read these instructions carefully and if you have any concerns or questions please call the Bedford Centre on 0151 708 9988 ext 4509 prior to taking ANY of the tablets.
The treatment consists of two parts;
-The first part is a single tablet called mifepristone 200 mgs taken orally
-The second part is 6 tablets called misoprostol 200 mcg to be taken vaginally or orally 48 hours (two days) after taking the first tablet.
First Part of your Treatment
You have been sent a single tablet called Mifepristone 200 mcg to swallow with water. If you vomit within 30 minutes of taking it please contact the Bedford Centre as we will need to arrange sending out another tablet. Following this tablet you may experience some nausea and / or vomiting also bleeding and period type pain.
It is important to note that bleeding at this stage does not mean that you have passed the pregnancy therefore you should continue with the next stage of treatment as planned.
If you have discomfort you can take over the counter pain relief such as Paracetamol and Ibuprofen as per package directions.
Second Part of Treatment at Home
You are advised to have a responsible adult stay with you at home when you take the Misoprostol tablets and to remain with you for the rest of the day and overnight
You have been given 6 tablets called Misoprostol to be taken at home 48 hours after the first medication. Use four Tablets first and the remaining two tablets 3 hours later
The misoprostol tablets can be taken in two ways as follows:
Option 1 - this is the preferred method as you will experience fewer side effects
Using your finger insert 4 tablets into the top of your vagina as high as you can place them. –the exact location does not matter only that they do not fall out
This can be done while laying down , squatting or standing with one leg up whatever is most comfortable for you.
Please rest for 30mins to 1 hour to allow the tablets to work . Do not be alarmed you may visually see some of the tablets when you visit the toilet this will not stop the treatment from working. Insert the remaining 2 tablets 3 -4 hours later
Option 2 -
Place 2 tablets on each side of your mouth (4 tablets in total), between cheek and gum and allow the tablets to dissolve for 30 minutes. If after 30 minutes they have not completely dissolved, swallow what is left with water. Take the remaining 2 tablets in the same way 3-4 hours later
What to Expect After the Final Medication at Home
- You will experience vaginal bleeding which can be heavy with blood clots and this may be accompanied by passage of the pregnancy tissue.
- Period type pain (cramps) usually 1-2 hours after using the tablet. For any pain and discomfort you experience you can use Paracetamol and Ibuprofen. Please read the patient information leaflet with the packet and take as directed.
- You may experience some nausea, vomiting, dizziness, possible diarrhoea or cold or hot flushes. These are known side effects from these tablets and will not stop the process / tablet from working.
- For most people the procedure is likely to be completed within 4-6 hours of taking the Misoprostol, however it may take up to a few days.
We request that you contact the Bedford Centre for advice 7 days after taking the Misoprostol tablets if you have only had a slight blood loss without clots or you have not had any bleeding or you continue to have symptoms of pregnancy.
This may mean that the procedure has been unsuccessful.
Known Risks of Early Medical Abortion
- You will have been informed of the known risks and possible complications of this treatment during your phone consultation when you were consented for it verbally. The information is provided not to alarm you but so that you can make an informed decision regarding your treatment and is summarised as follows:
Common or unavoidable risks which are usually treatable without any long-term effects:
- Unpredictable time to complete procedure ( variable)
- Pain during procedure ( common )
- Retained pregnancy tissue requiring further treatment
- Infection (2 in 1000)
- Side effects of drugs –nausea, vomiting, diarrhoea, headaches, chills ,dizziness ( common)
Risks which may require further treatment or surgical treatment at home or in hospital
- The risk of a failed procedure and continuing pregnancy (up to 1 in 100 under 9 weeks, up to 3 in a 100 between 9 and 10 weeks)
- Excessive bleeding (haemorrhage) requiring blood transfusion.
- Undiagnosed ectopic pregnancy – this is rare.(1 in 7000)
- Emotional / psychological distress following an abortion - f you are not coping, we would suggest that you contact your GP so that counselling or support can be arranged.
- Risk of death is very rare.
- The need for extra procedures including surgical abortion ( 3 in a 100 below 9 weeks , 7 in a 100 between 9 and 10 weeks of pregnancy) , blood transfusion,( rare) laparoscopy/laparotomy ( operation to look inside abdomen-rare)
Follow Up Information
You have been given a pregnancy test, which you should use to perform home pregnancy test two weeks after taking the first medication ( mifepristone orally) It is very important that you follow this advice as this will determine whether the abortion has been successful.
Please only use the pregnancy test you are supplied with as they are different to the tests you can buy.
You must contact the Bedford Centre on 0151 708 9988 ext. 4509 if the pregnancy test is positive. We will arrange an appointment for you to be reviewed
If you do not contact the Bedford Centre we will assume that you have performed the home pregnancy test on the date requested and that it has shown a negative result.
Advice Following Early Medical Abortion
- As already discussed, you are advised to have a responsible adult with you, who is aware of the treatment and remain with you until the following morning.
- You are advised not to travel long distances, especially by air, until you have performed a negative home pregnancy at 2 weeks post treatment. If you do decide to travel we strongly recommend you inform your travel insurance provider that you are undergoing a procedure.
- Bleeding following the procedure is very individual. It can last for up to 3 weeks as a continuation of the procedure, this is not a period. It is not unusual for the bleeding to stop and start during this time. With this bleeding we advise you to use sanitary towels not tampons.
- You are advised to maintain your normal hygiene routine, however whilst you are bleeding, when showering it is important that you do not apply the jet of water directly to the vagina (douching) as this may increase the risk of infection.
- You are advised to avoid sexual intercourse until you have a negative pregnancy test Using condoms may help to reduce the risk of infection.
You can get pregnant before your next period if adequate contraception is not used.
- Your next period should occur 4 – 6 weeks following the procedure; however this can be affected by the method of contraception you are using. The bleeding on this period may be heavier than you are normally used to.
- It is advisable that you limit any strenuous activity including prolonged sports activities until your bleeding has settled.
If you should develop any of the following, contact either the Gynaecology Emergency Department at the Liverpool Women’s Hospital 0151 702 4140 or contact your local Accident & Emergency Department:
- Heavy and continuous bleeding that soaks through 2 or more pads in an hour for a period of 2 hours.
- Severe repeated or continuous abdominal pains - if not eased with the tablets you have taken for pain relief.
- Violent shivering attacks / chills.
- High temperature.
- Offensive (smelly) vaginal discharge.
If you require any further advice regarding this method of abortion you can contact The Bedford Centre on 0151-708-9988 extension 4509 between 08.00hrs and 16.30hrs. Monday to Friday
During the procedure if you require out of hours advice for any of the above list the Gynaecology Emergency Department is open 24 hours a day on 0151-702-4140.
This leaflet can be made available in difference formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at email@example.com
Liverpool Women’s NHS Foundation Trust
Tel: 0151 708 9988
Issue Date: 21.05.2020
Review Date: 21.05.2023
© Liverpool Women’s NHS Foundation Trust