Medical abortion

How should I take Mifepristone and Misoprostol?

These instructions are for a pregnancy that is up to 10 weeks (70 days). The evidence suggests that mifepristone plus misoprostol are very safe and effective to 10 weeks. After 12 weeks, there is a higher chance of a complication and the medicines are used differently.

1st - Mifepristone should be swallowed with a glass of water.

2nd - 24 hours later the woman should put 4 pills of misoprostol buccally (between the gum and the cheek).

She should put two tablets into her mouth, between her gum and cheek, on the left side and two more tablets between the gum and cheek, on the right side.

All four pills should be left in the mouth for approximately 30 minutes to dissolve. Women shouldn’t eat or drink anything while the pills are dissolving. Anything left in the mouth after 30 minutes should be swallowed. Before and after using the misoprostol she can eat and drink normally, but should not use drugs or alcohol; she needs to pay attention to her body.

What if I don’t take misoprostol after 24 hours?

Misoprostol should be used 24 hours after swallowing the mifepristone for best results. However, research has shown that misoprostol can be used with success in the first trimester if taken from 8 hours up to 72 hours after mifepristone.

How should I use misoprostol after the mifepristone?

Buccal use:

24h after using mifepristone women are advised to use misoprostol between the cheek and gums, let it dissolve and swallow the remains 30 minutes later.

Women are advised to use the pills buccally (in the cheek) because the side effects (like nausea, vomiting, diarrhea, abdominal pain) tend to be less intense when compared to using misoprostol under the tongue.

However, there are other ways to use the misoprostol:

Misoprostol is very effective when administered buccally, sublingually (under the tongue) or vaginally (inside the vagina) Misoprostol is NOT very effective when swallowed. It is digested into the stomach and does not work very well.

When misoprostol is used buccally, sublingually or vaginally the medicine is directly absorbed into the blood. However, since pills used in the vagina may be seen by a doctor, and since under the tongue (sublingual) causes more nausea and stomach problems, the buccal method is most recommended.

  • Sublingual use: tablets are placed under the tongue and swallowed after 30 minutes;
  • Vaginal use: tablets are placed in the vagina as deep as possible next to the cervix (you should wash your hands before inserting the pills). The woman should lie down for 30 minutes so that the tablets are absorbed and don’t fall out.

If for some reason a woman decides to use the pills vaginally, it is important women are aware that in most countries it is illegal to self-induce an abortion and that the pills can stay up to 4 days in vagina before it is totally dissolved. So if a woman has a complication and she has to see a doctor or go to the hospital she should make sure to take out all the remains of the medicines before she sees the doctor or she could face legal problems. If she does not have a doctor she trusts, she can say she was having a miscarriage; the symptoms of a natural miscarriage and a medical abortion are exactly the same.

What happens if I vomit after taking the pills?

If a woman has a lot of nausea and is worried about vomiting up the pills, she can take a medicine that treats vomiting and nausea (called antiemetic medicine) before she uses the medicines. It is advisable to either take domperidone or metaclopramide as these medicines won’t interfere with the abortion process.

If a woman vomits the mifepristone less than 1,5 hours after she took it, the effect of the medicine may be impaired. However, she can continue the procedure and take misoprostol.

If she vomits mifepristone more than 1,5 hours after taking it, it should not be a problem because the medicine has already been absorbed into the body.

The misoprostol will be effective as long as the woman doesn’t vomit the medicine in the 30 minutes she keeps it between the gums and cheek. If she vomits the misoprostol before it is best to take another dose.

Misoprostol has no taste.

Can I use painkillers? When?

Ibuprofen is the most effective painkiller to use during a medical abortion and does not have any influence on the abortion. Ibuprofen can be taken after or before using the misoprostol. Acetaminophen (paracetamol) or NSAIDs such as naproxine can also be used but are less effective than ibuprofen.

A hot-water bottle or heating pad, sitting or lying comfortably, listening to the music, a good book or movie, and support from friends and family can all help to relieve pain.

Should I use antibiotics?

To take an antibiotic as a prophylactic is not recommended. The risk of infection with medical abortion is very low (less than 1%).

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