Abortion Pill Aftercare Instructions

You may download and print the following instructions here.

The misoprostol you received in your take-home bag is the second step to completing your medication abortion.

Misoprostol causes uterine contractions and bleeding that will expel your pregnancy. Follow the directions below for the dosing method agreed upon with your counselor:

★ 30 minutes prior to administering the misoprostol we recommend taking
1 meclizine pill (for nausea) and 1 ibuprofen 800 (for discomfort)

VAGINAL (preferred method): 24 to 72 hours after taking the mifepristone, wash and thoroughly dry the provided applicator. Wash your hands thoroughly, put 4 misoprostol tablets into the applicator and place the pills high into the vagina, close to the cervix. Try to stay off your feet for an hour following insertion. The FDA recommends waiting at least 24 hours for the best chance of success.

BUCCAL: 24 to 48 hours after taking the mifepristone, dissolve 4 tablets of misoprostol buccally (between your cheeks and lower gums) for 30 minutes. Then take a small sip of water and swallow any remaining pill fragments.

SUBLINGUAL: 24 to 48 hours after taking the mifepristone insert 4 tablets of misoprostol sublingually (underneath your tongue) and keep them there for 30 minutes. Then take a small sip of water and swallow any remaining pill fragments.

★ If bleeding has not occurred within 48 hours of the first dose of misoprostol, repeat the misoprostol dose, using up the remaining 4 misoprostol tablets.

★ Patients over 9 weeks will insert the 4 remaining misoprostol tablets 4 hours after first dose.

WHAT CAN I EXPECT TO HAPPEN NEXT?

• Bleeding and cramping typically begin 2 to 4 hours after taking the misoprostol tablets. Every uterus responds differently – some patients may start earlier or later than this typical time frame. Lower abdominal cramping and bleeding is a sign that the pregnancy tissue is passing down through the cervix.
•  When the abortion happens, the bleeding could be heavy with large clots. Some patients report lesser bleeding, cramping, and clotting, yet still pass the pregnancy. The bleeding and cramping can last for several hours. Blood clots from pea-size to the size of an orange can be expected. The pregnancy tissue itself is VERY small and will expel among the bleeding and clots. We urge you to stay home during this time. Once this tissue has passed the bleeding and cramping will begin to ease.
• The bleeding can start and stop for several weeks, and you may have spotting until your next period. Use
  maxi pads as needed until you have your next period (usually about 4 to 8 weeks).

FOR PAIN / DISCOMFORT:

• Ibuprofen 800 is the best choice for cramps; take every 6-8 hours.
• A prescription for Tylenol 3 (acetaminophen with codeine) has been sent to your pharmacy for pain not controlled by ibuprofen; take every 4-6 hours if needed. It is OK to use both medications during the abortion process.
• Do not take aspirin as it may cause you to bleed heavily. Uterine massage and warm compresses may also provide relief.

Please remember that you should start to feel better each day after the abortion. Feeling sick, having abdominal pain/discomfort, diarrhea, nausea, vomiting, fever, chills or weakness more than 24 hours after taking the misoprostol could indicate that you are developing a serious infection. Call Scotsdale Women’s Center at (313) 538-2020 right away if you develop any of these symptoms.