How to Safely Use Medical Abortion Pills at Home

Mifepristone and misoprostol can be used together to have an abortion. When used in combination, you need to take one Mifepristone pill (200 mg) and at least four misoprostol pills (200 mcg each). These dosages are recommended when using 200mg mifepristone and 200mg misoprostol pills. If you get similar types of pills but with 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 medicine.

To ensure a successful abortion, it is recommended that you have at least eight misoprostol pills in total, especially if you are 9–13 weeks pregnant. If you only have four misoprostol pills, you can still use them.

To relieve medical abortion side effects, one can also take pain medicine and anti-nausea medication.

Procedure for Abortion with Pills

Step 1: Take Mifepristone

Swallow one mifepristone pill (200mg) with water. Most people do not feel side effects from this medicine.

Wait at least 24 hours but no more than 48 hours to move on to the next step. Choose a time when you will have easy access to a bathroom and won't be disturbed much. Once you start taking the misoprostol, it's best if you can stay somewhere you feel safe and comfortable for at least 12 hours, but ideally 24 hours.

Step 2: Take Pain Medication

Take a pain reliever like ibuprofen (800mg) about 30 minutes before using the misoprostol, as cramping will start soon after. Acetaminophen or paracetamol (1000mg) can also be used, though it may not work as well as ibuprofen.

Wait 30 minutes.

Step 3: Take Misoprostol

Misoprostol is used differently from other medications, and there are different ways it can be used for abortion. Our team recommends using misoprostol under your tongue (sub-lingually) because the written instructions are clear and easy to follow.

Put 4 misoprostol pills (200 mcg each) under your tongue and hold them there for 30 minutes. You can swallow your saliva, but don't eat or drink during these 30 minutes. Some brands of misoprostol pills may dissolve more easily than others. That should not worry you. After 30 minutes, drink some water and swallow what's left of the pills.

Important: If you vomit within 30 minutes or while the misoprostol is still in your mouth, repeat Step 3. If you vomit after 30 minutes, you don't need to repeat because the medicine has already been absorbed.

Cramping and bleeding can start as soon as 30 minutes after taking misoprostol or up to 24 hours later. Typically, most people start bleeding within 4-6 hours after taking misoprostol. You can continue to take pain medicine throughout the abortion process. Follow the pain medicine instructions. Do not exceed the recommended dosage per day, and do not use regular aspirin, as it increases your bleeding risk.

Step 4: Take a Second Dose (if required)

If you are less than 9 weeks pregnant, you probably won't need a second dose. But if you haven't bled as much as a menstrual period within 24 hours, or if you are worried your bleeding is too light, you can use 4 more misoprostol pills the same way as before to ensure a successful abortion.

If you are 9-13 weeks pregnant, it is a good idea to use 4 more misoprostol pills 4 hours after the first misoprostol dose (repeat as in step 3). This makes the pills work better and is more likely to result in a successful abortion.

Mifepristone: Most people don't feel any symptoms after taking mifepristone. However, some people may experience light bleeding. Even if you bleed, it's very important to take the misoprostol pills to complete the abortion.

Misoprostol: After taking misoprostol, you will have cramping and bleeding. This is normal and means the medicine is working. You can expect to pass blood clots, which can be different sizes depending on how far along the pregnancy is. In an early pregnancy, even small blood clots can show the abortion worked. If having an abortion after 10 weeks, you will likely expel bigger blood clots and pregnancy tissues.

During the abortion, you are likely to experience very strong cramping as your uterus contracts to remove the pregnancy. Pain relievers, like ibuprofen, a hot water bottle, or massaging the area between your navel and pubic bone, can help with the cramping. Sitting on the toilet might also help. For nausea, try drinking clear fluids or eating lightly.

Your bleeding is likely to be heavier than a normal period, and it is common for it to last for several days. It is also okay if the bleeding stops and starts again before drying out completely. It may also continue until your next period, a common occurrence for pregnancies of between 4 and 6 weeks. All these are normal abortion related bleeding patterns that should not worry you.

Other possible side effects

During the abortion, it is common to experience some of the following side effects.

• Fever
• Diarrhoea
• Nausea or vomiting
• Headache
• Dizziness
• Chills

This will often go away within 24 hours of using misoprostol:

Most people will stop having pregnancy symptoms like nausea or frequent urination within a few days. Breast tenderness is often the last symptom to go away and can take up to 10 days after using misoprostol.

Get medical help right away if you:

• Soak through 2 or more pads per hour for 2 or more hours in a row.
• Have a fever of 100.4°F (38°C) that starts at least 24 hours after taking misoprostol and does not go down after taking ibuprofen.
• Have severe pain that doesn't get better after using pain medication like ibuprofen. While cramping is normal, long and intolerable pain may require medical intervention.
• Feel very sick or have a bad-smelling vaginal discharge. Blood can smell unpleasant and be brown, dark almost black, or bright red, but if you have a discharge of another colour that smells rotten, it may be an infection.
• Have an allergic reaction (like redness or swelling of the face or neck, or difficulty breathing).

In the weeks after your abortion:

• Use pads at first to see how much you are bleeding. You can switch to a tampon or cup later.
• It is safe to have sex when you feel ready. However, it's important to remember that you can get pregnant again as soon as 2 weeks after an abortion, even if you are still bleeding.
• Take a pregnancy test 4-5 weeks after the abortion to make sure it was successful. Taking a test sooner may give a false positive result. If the test is still positive at 5 weeks or if you still have pregnancy symptoms, see a healthcare provider to check if the abortion worked.
• It's normal to feel different emotions after a pregnancy ends. Some people feel better right away, and others need more time. Talking about your feelings with someone you trust can help if you need support.
• While the medical abortion process may cause discomfort, one should be able to resume normal duties as soon as the inconvenient side effects have passed.