This article will address what to consider when self-managing an abortion with pills and how to best prepare for an abortion.
Preparing to use Misoprostol
When deciding when to have your abortion, keep in mind what other commitments or activities you have going on. The process can cause some uncomfortable side effects that are most prevalent in the first 24 hours. Even though you may feel fine after a day, you may want to schedule an extra day to rest and recover, just in case.
If you cannot take an extra day to rest, it is advisable to postpone all daily activities, at least on the day you plan to take the abortion pills. However, most people who are caring for others are not able to avoid their responsibilities. In these cases, it is advisable to ask for support from friends or family .
In addition to having a clear schedule, here are a few things you can do before using Misoprostol:
- keep hydrated;
- have ibuprofen on hand to help with the pain;
- avoid greasy or spicy foods;
- have pads on hand;
- have antinausea medication like domperidoneready for potential nausea;
- eat light meals; and
- keep a heating pad handy for cramping.
Taking Misoprostol
Depending on the protocol you are using, you might take Mifepristone and Misoprostol or just Misoprostol alone.
- If you are taking mifepristone and misoprostol, you need to take one pill that contains 200 mg of mifepristone. Most people do not experience any side effects after taking mifepristone, so you can go about your day-to-day activities. However, some people may experience some bleeding. After 24-48 hours, you should take four (4) to eight (8) pills of misoprostol 200 mcg. The amount of pills will depend on your gestational age.
- If you are taking misoprostol alone, you need twelve (12) pills of misoprostol 200 mcg each.
Visit safe2choose.org for videos on how to administer Mifepristone and Misoprostol and how to administer Misoprostol only.
Routes of administration
There are several routes of administration when it comes to Misoprostol. For example, you can take it vaginally, in your cheeks (buccally), or under the tongue (sublingually). When you take the pills will depend on the route of administration you choose.
When deciding which method to use, consider these factors:
- If you feel nauseous, the vaginal route may be better.
- If abortion is restricted in your area, take Misoprostol via the cheeks or sublingually. Misoprostol may still be detectable in a pelvic exam for up to four days after administration. Thus, the buccal or sublingual methods are more discreet and won’t leave a trace.
Vaginally
At safe2choose, it is advised that you choose the sublingual or buccal route to administer Misoprostol, rather than vaginally, because traces of Misoprostol may still be detectable up to four days after administration. It’s strongly suggested that you have a look at your country’s abortion laws and restrictions carefully before using the vaginal route.
Take 800 mg of Ibuprofen to help minimize cramping 30 minutes prior to taking Misoprostol.
Start by washing your hands. You can lie down or squat to insert the tablets; however, do not insert them over the toilet. Insert all four tablets into your vagina with your finger, as far as you can comfortably go. Lie down for 30 minutes. Afterwards, you can move around as you please. You may see the pills or remnants of the pills. This is okay, as long as you allow the medication to absorb for 30 minutes.
Cramping and bleeding can start as early as 30 minutes to a few hours afterwards.
In the cheek
Take 800 mg of Ibuprofen to help minimize cramping 30 minutes prior to taking Misoprostol. Take a sip of water to moisten your mouth. Then, place the four Misoprostol pills in between your cheek and gums, placing two on each side of the mouth. Let the pills sit in your cheeks for 30 minutes. After 30 minutes, swallow what remains of the pills.
If you vomit during the 30 minutes the Misoprostol is in your cheeks, you can either repeat the step or seek counseling.
Under the tongue
Take a sip of water to moisten your mouth. Then, place the four Misoprostol pills under your tongue, and let them sit for 30 minutes. After 30 minutes, swallow what remains of the pills with water.
Following doses
For mifepristone & misoprostol regimen, it is strongly recommended to use from 4 to 8 pills of misoprostol. It’s better to have 8 misoprostol pills in total because you might need all of them to make sure the abortion is complete, especially if you are 9-13 weeks pregnant.
If you can't obtain 8 Misoprostol pills, you may choose to proceed with only 4 pills, but the effectiveness will be reduced, especially if you are between 10-13 weeks pregnant.
For Misoprostol alone, it is strongly recommended to use 12 pills of Misoprostol. If you can't obtain 12 Misoprostol pills, you may choose to proceed with only 8 pills, but the effectiveness will be reduced, especially if you are between 10-13 weeks pregnant.
What to expect from Misoprostol
You will experience heavy bleeding and cramping after Misoprostol administration. You may also experience symptoms such as
- chills,
- nausea,
- diarrhea, and
- dizziness.
You can treat pain with up to 800 mg of ibuprofen and up to 1,000 mg of extra-strength Tylenol every six to eight hours, as needed. The dosage of painkillers should not exceed 3,200 mg over the course of 24 hours. For nausea, you can take 8 mg of ondansetron every six hours, as needed.
When to contact us
In certain situations, you should reach out to a counselor, over chat or email at safe2choose, to discuss the next steps. These situations include
- vomiting within 30 minutes of taking Mifepristone or while it’s in your cheeks (the pills won't have had the desirable effect and you will need to repeat that step);
- serious pain that does not get better with painkillers;
- bleeding so much that you soak four pads in two hours or less;
- a high fever 24 hours after taking Misoprostol;
- blood clots larger than the size of a lemon;
- an allergic reaction; and
- no bleeding or clots within 24 hours of taking Misoprostol.
