Medical abortion of early pregnancy at home

This leaflet answers common questions about having a medical abortion of early pregnancy at home. If you would like further information, or have any worries, please do not hesitate to ask your nurse or doctor.

What is a medical abortion?

A medical abortion involves taking medication to end a pregnancy. It is the most common type of abortion for women in the earlier stages of pregnancy.

Who can have a medical abortion at home?

You can have a medical abortion at home up to 10 weeks of pregnancy. This is calculated from the first day of your last menstrual period, or by doing an ultrasound scan.

Medical abortion is a safe option for most people, but there are a few reasons why it may not be suitable for you or may require further planning. These may include:

• A known allergy to medications used in medical abortion.
• Chronic adrenal failure.
• Acute porphyria (a rare metabolic disorder).
• Severe uncontrolled asthma.
• Severe anaemia.
• Bleeding disorders or if you are taking blood thinning medication.
• Using long-term steroid medication.

You should tell the doctor or nurse if you think you any of these apply to you. You will also be asked if you have experienced any lower abdominal pain or bleeding since your last period. In rare cases this could be a sign of an ectopic pregnancy, this is when a pregnancy is developing outside of the womb.

An alternative option to a medical abortion, is a surgical abortion. This is a procedure where a pregnancy is removed by a thin suction tube inserted through the neck of the womb under either general or local anaesthetic.

Your doctor or nurse will discuss all the suitable options available to you before the procedure or treatment.

What will happen before my treatment?  

The doctor or nurse will carry out a medical assessment where you be asked questions about your current pregnancy, and if you have any medical issues or take any regular medications. This is to ensure that medical abortion is a safe and appropriate option for you. You will be advised if you need to have an ultrasound scan to determine how many weeks pregnant you are.

They will also ask about your feelings about this pregnancy and your decision to have an abortion. This is to check that no one is pressuring you into having an abortion, and to support you with your decision if you need it. Whether or not you have an abortion is your choice and you will be treated in a non-judgemental and respectful manner.

If you have any worries or concerns, or are unsure about what to do, please discuss it with the doctor or nurse. A counselling service is available if you need further support, please ask a member of staff for details.

During your assessment, you will be advised about the process of having a medical abortion at home and any possible complications. You will then be asked to sign a consent form to confirm that you understand the information given to you. This does not mean that you are obliged to proceed with the treatment, and you are able to change your mind at any time.

The nurse or doctor will also discuss contraception with you and the different options that are available. You will also be offered a self-taken swab test for sexually transmitted infections (STIs).

What are the risks of a having medical abortion?

Abortion is a very common and safe procedure and complications are rare, especially earlier in pregnancy. Possible complications include:

• Infection of the womb - less than 1 in 100.
• Failure of the procedure (where the medication fails to end the pregnancy) - less than 2 in 100.
• Retained products of conception (where some of the pregnancy tissue may be left inside the womb) - less than 5 in 100.
• Severe bleeding (very heavy bleeding that may require a blood transfusion) - less than 1 in 1000.

If the medications used fail to end the pregnancy, or you have retained pregnancy tissue, a surgical procedure may be recommended.

What happens during a medical abortion?

A medical abortion involves taking two medications. The first medication is called mifepristone, which blocks the hormone progesterone that is allowing the pregnancy to continue. This will usually be given to you as part of your clinic appointment.

You may experience some light bleeding after taking the mifepristone. Heavier bleeding is unlikely, and you can go about your normal activities. If vomiting occurs within 90 minutes of taking this medication, you should contact the clinic as the treatment will be less likely to work and you may need to take this medication again.

You will be given a second medication to take home with you. This is called misoprostol and it should be taken between 24 and 48 hours after the mifepristone tablet. Misoprostol causes the neck of the womb to soften and open and causes the womb to contract, which expels the pregnancy.

You will experience cramping pains and bleeding, which will be heavier than a normal period. You will also likely see blood clots. This usually starts within one to two hours after taking the misoprostol. You should use large sanitary pads during this time and avoid using tampons or a menstrual cup. The abortion is usually complete within four hours but can take up to 24 hours.

During your clinic appointment you will also be given painkillers to help with any pain or discomfort. The doctor or nurse will give you instructions on how to take these. A hot water bottle can also be helpful for relieving discomfort. You should avoid taking aspirin-containing pain medication, as this can make bleeding heavier.

Other possible side effects of the abortion medications can include nausea and vomiting, diarrhoea, and flushing or chills. These should resolve within 24 hours of the treatment.

We recommend that you have someone with you on the day of the abortion if possible. You should have something light to eat and drink plenty of water.

Pregnancy tissue

If you are less than nine weeks pregnant at the time of your abortion, any pregnancy tissue is unlikely to be recognisable. You can dispose of your sanitary pads in the usual way. If you have any concerns or wish to discuss this further, please speak to one of the doctors or nurses.

What happens after a medical abortion?

After the heavier bleeding has settled, you may experience lighter bleeding like a period for up to two or even three weeks. This should get lighter with time and most people feel well enough to return to work and other normal activities within a day or two. You can resume sexual activity whenever you feel comfortable to do so.

Most women feel relieved after an abortion, but it can be normal to go through a range of emotions including sadness and maybe even guilt. If you would like to talk to someone about how you are feeling after the abortion, you can be referred to the counselling service, please discuss this with the doctor or nurse.

When should I start using contraception again?

If you have been given contraception in our clinic such as pills or patches these should be started straight away, ideally on the day of the abortion, or as soon as possible afterwards. This is because you are at risk of getting pregnant again very quickly, as early as one week after the abortion. You can also have an implant fitted when you attend your appointment (on the day that you take the first pill). If you do not start your pills or patches within five days of the abortion, you will need to use condoms or avoid sex for a few days (seven days for the combined pill or patch and 48 hours for the progestogen-only pill (‘mini-pill’)).

If you are planning to have a contraceptive coil fitted, it is recommended that this is delayed until about 7 to 10 days after the medical abortion, when the bleeding will have gotten lighter. You should avoid any unprotected sex until the time of the coil fitting. Please visit the Sexwise website further information on contraceptive coils and implants.

Follow up after a medical abortion

We will arrange to call you within a few days of your medical abortion to ask how you are feeling and check that everything went as expected with the treatment. You do not need to attend the clinic again after a medical abortion unless there is a problem, or you have any other concerns.

You will need to purchase a home pregnancy test four weeks after the abortion to confirm that the treatment has worked. Please call the clinic if this is positive, or if you think you might still be pregnant (for instance you are having ongoing pregnancy symptoms such as breast tenderness or sickness). You are advised to wait four weeks until doing the pregnancy test, as the test may still show as positive before this time (as the pregnancy hormones take some time to go back to normal in your body).

When should I seek help?

During the abortion treatment

If you have any of the following symptoms, you should seek medical attention immediately:

• Very heavy bleeding that soaks through more than two maxi sanitary pads in an hour, for two hours in a row.
• Feeling very dizzy or faint.
• Severe abdominal pain that is not controlled by the pain relief medications.

After the abortion

You should seek help if you have any of the following:

• Bleeding that is not getting lighter with time, or cramps that are continuing or worsening.
• Vaginal discharge that smells unpleasant.
• Constant lower abdominal pain or deep pain during sex.
• Fever or feeling shivery.

You can call the clinic within working hours on 020 7830 2495, your GP or NHS 111. You should call 999 or go to the nearest hospital emergency department if your symptoms are serious or do not improve.