General Information - Medication Abortion

What to Expect when HAVING A MEDICATION ABORTION

After the Mifepristone

Today you will receive mifepristone (Mifeprex). This is the first step in having a medication abortion. The second step will be to take the misoprostol.

The effects of mifepristone (Mifeprex) are usually mild and do not last long. You may experience nausea or mild cramping from the mifepristone (Mifeprex). You may already have had some similar symptoms that are caused by pregnancy. It’s also common to have some bleeding or spotting, but it is rare for a woman to abort after the mifepristone alone. If you do have the abortion with the mifepristone alone you still MUST use the Misoprostol.

Using the Misoprostol

You will be given four misoprostol tablets (800 mcg) to take home with you. You will take the misoprostol on day 2 or 3 (24-48 hours after the mifepristone). You will also be given two prescriptions that you will take to a pharmacy to get filled; one is for an anti-nausea medication, the other is a prescription pain medication. These prescriptions generally are not expensive (usually around $10/each). You can take these prescriptions to any pharmacy to be filled.

How to use the misoprostol:

Eat lightly and drink plenty of water the day before you take the misoprostol and also while the abortion is taking place. Eating rich, fried, or spicy foods or not drinking enough water may make you feel sick to your stomach.

Plan ahead for this day so you are comfortable, have privacy and a support person available. Make sure you have maxi pads, an over the counter pain medication such as Ibuprofen or Aleve, a heating pad or hot water bottle and a thermometer at home. Fill your prescriptions for the pain medication and the anti-nausea medications before you use the misoprostol. You might want to have your favorite juices or beverages, your favorite videos, etc.

Choose a time to take the misoprostol when you can rest for a while.

One hour before you use the misoprostol have something to eat and take 1 Phenergan tablet (prescription anti-nausea medication, may be dispensed by the pharmacy as Promethazine)

One half hour before you use the misoprostol take some pain medication; either 1-2 Tylenol or 1-2 Tylenol with Codeine (prescription pain medication) if needed.

Have a drink of water and place all four tablets (800 mcgs) of misoprostol between your cheek and gum (buccally) 2 on each side of your mouth. After 30 minutes, swallow any remaining pill fragments. Swallow the pills after 30 minutes whether or not the tablets have dissolved completely.

After Taking the Misoprostol

Cramps — In about one to seven hours, you will begin to get cramps that may be quite strong. When you begin to experience cramps, take 600-800 mg of Ibuprofen. You may take acetaminophen (Tylenol), or ibuprofen (Motrin) every four to six hours or other medication for cramps given to you by the clinic. If you are taking Tylenol with codeine for pain, you should not drive or do other things that require concentration. DO NOT take aspirin.

Bleeding — Bleeding usually starts between 30 minutes and 10 hours after the cramps begin. If you have bleeding heavier than a period, you may be having the abortion. You should have some bleeding or spotting. Some women have heavy bleeding for several hours that may soak through maxi pads.

You may have some nausea, vomiting, diarrhea, dizziness, or mild fever and chills for a short period of time.

Do not wait until you are in a lot of pain before taking the pain medication!

Recommended medications for cramps are:

Ibuprofen 200 mg (Advil, Motrin IB, other over-the-counter products) – three tablets (600 mg) every 6 hours or four tablets (800 mg) every 8 hours. Maximum 2400 mg (12 tablets) in 24 hours.

Naproxen 220mg (Aleve) – one or two tablets every 8-12 hours. Maximum 1375mg in 24 hours. Take the maximum dose for only a short period of time (24-48 hours).

We recommend you use either of these two medications as your main pain medication.

Other pain medications you can take in addition to Ibuprofen or Naproxen if you need better pain control are:

Acetaminophen (Tylenol and other over-the-counter products) three 325 mg tablets or two 500 mg tablets every 4-6 hours (maximum 4000 mg in 24 hours)

Acetaminophen with codeine (Tylenol #3 – one or two tablets every 4-6 hours (maximum 12 tablets in 24 hours). You will be given a prescription for this medication to fill at a pharmacy.

Propoxyphen/Acetaminophen – one tablet every 4 hours (maximum 6 tablets in 24 hours). Those who are unable to take Tylenol #3 may be given a prescription for this medication to fill at a pharmacy.

Other things besides medication can provide comfort:

putting a hot water bottle or heating pad on the abdomen
standing in the shower
sitting on the toilet
having your support person rub your back
uterine massage (massage the lowest part of your abdomen)
standing or walking around

Fever and Chills — Some women experience mild fever (100.4°F) and chills after taking misoprostol. Acetaminophen (Tylenol) or ibuprofen (Motrin) should help

Other Side Effects — Some women experience nausea, vomiting, or diarrhea when they take misoprostol.

During the Abortion

Most women who have had a medication abortion say that it is like having a miscarriage. Don’t be alarmed if the bleeding is quite heavy and you pass large blood clots during the abortion. The cramps may also be really strong although some women do report having little to no cramping during the abortion. The bleeding and cramping can last for several hours. Blood clots may be up to the size of a lemon. This is to be expected. The pregnancy tissue itself is very small and may not be noticed with the bleeding and clots. Occasionally, if the pregnancy has developed about eight weeks, a recognizable embryo may be seen. Once the pregnancy tissue has been discharged, the bleeding and cramping usually begin to ease.

After the Abortion

Bleeding — Bleeding after an abortion is perfectly normal. The amount of bleeding you will have is difficult to predict since women’s bodies all react differently. Some women have little or no bleeding; some spot for a few days or for several weeks; some bleed, then stop, then start again; some have bleeding similar to a normal menstrual period for a week or two. Some women pass clots. In general, your bleeding should get lighter and lighter.

You should have a normal menstrual period four to eight weeks after your abortion is complete.

Cramping — After the pregnancy tissue is discharged, there may be some mild cramping. You may take acetaminophen (Tylenol) or ibuprofen (Motrin), if you need to. You can alternate it with prescription medication you may have received. You may use a heating pad or hot water bottle.

Fever — Although you can have a fever on the day you use misoprostol, it is NOT normal to have a fever after that day. If your temperature goes up, it could be a sign that an infection is developing. Do not take your temperature right after smoking, drinking, or eating.

Breast Changes — Any pregnancy-related breast tenderness usually goes away within a few days of discharging the pregnancy tissue but can take up to several weeks to completely go away. It is possible, though not likely, that your breasts may leak a milky discharge. If they do, wear a snug-fitting bra; this should go away in a day or two.

Nausea — Any pregnancy related nausea should go away within 24–48 hours.

Feeling Tired — Because there is a sudden change in your hormones after the pregnancy tissue is discharged, you may feel tired and/or a little depressed for a few days.

Activity — You may go back to your usual activities — school, working, driving, as soon as you feel up to it. Some women feel well enough to do so right after the abortion, though most prefer to rest and relax until the next day. You should not take part in strenuous activity, such as heavy exercise, swimming, lifting, horseback riding, bicycling, jogging, etc., for several days. You should not do strenuous activities if you are bleeding more heavily than with a period.

Vaginal Intercourse — It’s best to wait until heavier bleeding has lightened up and you have chosen a method of birth control. We recommend that you wait to have sex for one week after medication abortion.

Contraception — Your body will not be in its regular cycle at first. It will be impossible to predict when you are at risk of getting pregnant. Assume you can become pregnant ANY TIME after the abortion. Use a birth control method EVERY TIME you have intercourse.

If you were prescribed birth control, start it the day after you use the Misoprostol or within 7 days. Do NOT wait for your first period.
Use condoms

Tampons or Pads? When you use pads, it makes it easier to tell how much you’re bleeding. While you are having the abortion, you should use maxi pads. We recommend you continue to use pads for one week after your abortion.

Antibiotic – All medication abortion patients are sent home with an antibiotic. Doxycycline is the usual antibiotic you will receive. If you are allergic to Doxycycline, please tell us now and we will find a different antibiotic to give to you. Doxycycline is an antibiotic used to treat or prevent an infection. Begin taking the Doxycycline the same day you are given the Mifeprex (TODAY).

Take one Doxycycline capsule two times a day (morning and evening) until it is all gone
You should take this medication with food

KEEP ALL MEDICATIONS

OUT OF THE REACH OF

CHILDREN.

If you are having a medical emergency or are worried about what you are experiencing OR if you are experiencing any of the warning signs listed below, please call us at our local number 701-298-9999 or toll-free 1-888-928-9009. After normal business hours you will reach our answering service. We will return your call, so be at a phone we can call you back at.

Do NOT wait for your follow up appointment if you:

§ have a fever of 100.4°F or higher that lasts for more than four hours

§ have heavy vaginal bleeding and are soaking through two or more maxi pads an hour, for two hours or more in a row

§ have clots for two hours or more that are larger than a lemon

§ bleed heavily for more than 12 hours in a row

§ throw up for more than four to six hours and are not able to keep anything down

§ have severe abdominal pain or discomfort not helped by medication, rest, hot water bottle, or heating pad

§ have severe cramping 24 hours after the misoprostol

§ feel sick — including weakness, nausea, abdominal pain or discomfort, vomiting, or diarrhea — more than 24 hours after taking misoprostol

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