1.What is a medical abortion (abortion pill)?

A medical abortion is an alternative to a surgical abortion procedure for pregnancies up to 70 days gestation. It is an early pregnancy termination process that is achieved with the use of a medication kit called Mifegymiso. Medical abortion termination is a two step process.

The First Step (Day 1)

 Mifepristone (1 tablet/green pack) will be administered orally at the Clinic as directed by your doctor.

The Second Step (Day 2)

Misoprostol tablets (4 tablets/orange pack) is administered 24-48 hours after the First Step - it is up to you when you take the misoprostol tablets as long as it is within this time period. It is important to administer the pills in a comfortable environment that enables you to rest as needed, as well to have a support person with you at the time.

4 Misoprostol tablets from the orange pack are taken at the same time. You will administer misoprostol tablets by holding the tablets in your mouth, between the cheek and gum, for 30 minutes. After 30 minutes, any residual medication can be swallowed with a glass of water.

After taking the 4 pills, you are expected to have vaginal bleeding, cramps, and to pass blood clots and some pregnancy tissue. In most cases, this occurs within 4 hours; however, it may occur anywhere between 30 minutes and 48 hours after taking the misoprostol tablets. It is recommended to rest for 3 hours after taking the misoprostol tablets.

It is not uncommon that you experience bleeding after taking mifepristone (first step) and before taking misoprostol (second step).

Most common symptoms you may experience as part of the medical abortion process are:

Vaginal bleeding:

• the onset of bleeding is usually within 4 hours, most women experience the onset within 48 hours

• bleeding can range from light to heavy and it is normal to see blood clots and tissues

• the bleeding may be heavy for 2 to 3 days

• light bleeding can continue for 30 days or more

Cramping:

• cramping can start within 4 hours of taking the misoprostol tablets

• cramping can range from mild to severe and is usually more than a typical menstrual period

• significant cramping should diminish once the pregnancy is expelled. This does not usually last longer than 24 hours

You may experience the following side effects that usually do not last more than 24 hours:

• headache

• breast tenderness

• fainting

• fatigue

• hot flushes and chills

• nausea, vomiting, diarrhea, dizziness

Pain management

The amount of pain patients feel with a medical abortion varies. Some patients experience mild pain like normal period pain while other patients are very uncomfortable and have to use pain medication.

• rest

•  hot packs on your abdomen or back

• massaging of the lower abdomen frequently

• pain relief medications as directed by your doctor

*Travel away from home during your medical abortion treatment (14 days) is not recommended so that you can visit the clinic if necessary.

2. Why chose a medical abortion (abortion pill)?

Patients may choose a medical abortion (abortion pill) because they feel it is a more natural, non-invasive process that can be completed in the privacy and comfort of their home.

3. Are medical abortions safe?

There is no evidence that stopping your pregnancy with the use of Mifegymiso (abortion pill) will have any impact on future fertility or any other aspect of your overall health.

4. Are medical abortions effective?

The efficacy will vary based on how far along you are in your pregnancy when you take the medication:

At 8 weeks gestation or less medical termination of pregnancy works about 94-98% of the time.

At 8-9 weeks gestation medical termination of pregnancy works about 94-96% of the time.

At 9-10 weeks gestation medical termination of pregnancy works about 91-93% of the time. 

Please note that with an extra dose of medicine, medical termination of pregnancy works about 99% of the time.

5. What happens if the medical abortion process doesn’t work?

If the medical abortion process does not complete your doctor will discuss options with you with each option being assessed on a case-by-case basis. They include:

• an additional dose of medication

• surgical termination

• dilation and curettage (D & C) procedure

6. Will medical termination of pregnancy affect my period?

Medical termination of pregnancy starts a new menstrual cycle so your period should go back to normal after 4 to 8 weeks. Please note that you will continue to test positive for pregnancy for 4 to 5 weeks after your medical abortion while your pregnancy hormones continue to drop.

You will return to fertility very quickly so it is imperative that you use contraception if you choose to engage in sexual activity.

7. How much bleeding can I expect during and after a medical abortion?

The amount of bleeding a patient may experience varies: it can range from light to heavy and it is normal to see blood clots and tissue.

On average the bleeding lasts for 11 days, it may be heavy for 2 to 3 days, and light bleeding can continue for 30 days or more.

9. Are there any significant side effects to having a medical termination of pregnancy?

If you have any of the following symptoms, you could be experiencing a medical emergency and you need to contact the Clinic:

• You have not begun bleeding within 24hours of taking Misoprostol.

• Persistent heavy bleeding - soaking 2 or more maxi pads in an hour for 2 hours in a row.

• Blood clots bigger than a lemon.

• Severe pain or cramping that does not improve with medication.

• Chills and fever of 38°C or higher.

• Nausea, vomiting and/or diarrhea that lasts more than 24 hours.

• Fainting.

• Vaginal discharge with foul smell.

• Experiencing pregnancy symptoms (fatigue, morning sickness, or breast tenderness) more than two weeks after your medical abortion procedure.

11. For how long will I need to rest after a medical abortion?

Normal side effects to medical abortion can be managed with rest. Some patients prefer to take it easy for a day or two after a medical termination of pregnancy until they can return to their usual activity levels.

• It is strongly advised no intense exercise for a minimum of one week as an increase to activity levels could result in more cramping and bleeding.

• It is normal to experience breast tenderness and swelling for up to 2 weeks.

• Avoid stimulation of the nipples to reduce breast discharge.

• It is common to pass blood clots, particularly when getting out of bed.

Most pregnancy symptoms will begin to decrease within 24 hours after the termination, with nausea usually gone by the third day.

12. How long should I wait to have sex after a medical abortion?

You should wait a minimum of one week before returning to any vaginal sexual activity.  

13. How soon can I start taking birth control after a medical abortion?

You can start a new birth control method immediately after having a medical abortion as you will return to fertility quickly. Birth control informative counselling will be provided to you during your appointment.

14. Why do I need testing for chlamydia and gonorrhoea at the time of a medical abortion?

Chlamydia and Gonorrhea are the most reported sexually transmitted infections in Canada. The majority of women do not realize they have either because they typically don’t present with any symptoms. If you have bacteriuria in your vagina or cervix during a medical termination of pregnancy, it can travel higher into your pelvis, causing serious and immediate health problems such as pelvic inflammatory disease (severe infection) and future health problems such as infertility and ectopic pregnancy. For these reasons it is imperative to screen for these infections in order to prevent any future issues and community transmission.

15. Can a medical abortion (abortion pill) affect breastfeeding?

Both misoprostol and mifepristone can pass into your breast milk, but these amounts are small and should not trigger any problems for your infant. If possible, we recommend pumping prior to your appointment and bottle feeding.

16. Do I need a referral to schedule an appointment for a medical abortion (abortion pill)?

You do not need a referral to schedule an appointment. You have the option to self refer and call the Clinic directly or be referred by your family doctor.  

17. What can I expect during my medical abortion appointment?

Clients are scheduled for two appointments for medical termination of pregnancy.

During your first appointment you will have a consultation with your doctor and the nurse who will review your medical history, preform a physical examination, complete a blood draw, and complete an ultrasound.

Your medical abortion process will start by taking Mifepristone during your appointment.

Your second appointment is a follow-up appointment to ensure a successful completion of medical termination of pregnancy. This appointment is extremely important because it allows your doctor to confirm that the medical abortion process was a successful. We will schedule your follow-up appointments on the day of your initial appointment.

18. How many days in advance can I make an appointment for a medial abortion?

We understand the time sensitive limitations of a medical abortion and do not always require advance notice for bookings. We make every effort to book your appointment as quickly as possible and do our best to accommodate same day appointments.

19. Do I need parental consent to have a medical abortion if I am under 18 years of age?

No, patients do not require parental or guardian consent to have a medical abortion.

20. Do you accept private insurance if I do not have OHIP?

Yes, we accept private insurance. Medical termination of pregnancy (medical abortion or abortion pill) is covered by Guard.Me, Blue Cross, UHIP (University Health Insurance Plan), CHIP (College Health Insurance Plan), and IFH (Interim Federal Health Program).

21. Will anyone find out that I ended my pregnancy?

We do not disclose any information about your visit to anyone without your written consent. Your visit is entirely confidential.