If you are not sure having an abortion is the right decision for you, do not take the medication. It is important that you are confident in your decision before you start your medication abortion. Once you take the medications the process cannot be stopped or reversed.

You are welcome to contact SHORE Centre for continued support and counselling about your options. If you decide to continue your pregnancy we can help you with the next steps of arranging prenatal care and connecting with community agencies to support your continued pregnancy.

Click here for more information about on-going support from SHORE Centre.

Our Options Team is available to support you at every step of your abortion process. You can book a support appointment online by clicking here.

Mia is your virtual companion during your medication abortion with SHORE Centre and is available 24/7. Mia will answer your questions, send you reminders and information about the medication, and follow up with you, all by text message. Mia will also alert your care team when there is a need for them to follow-up with you because of concerns. Mia is designed to be an ally for you through the medication abortion process. You will receive your first message from Mia shortly after your prescription has been sent to the pharmacy.

Telehealth Ontario (1-866-797-0000) is a free, confidential service and is available 24/7. You can call to get health advice or information from a Registered Nurse, with interpretation services available in over 300 languages.

For information on taking care of yourself emotionally after an abortion or joining our monthly peer support group, please visit: https://clinic.shorecentre.ca/after/

There is one pill of mifepristone in the green box inside medication abortion packaging. Swallow the pill with a glass of water. Most people don’t feel any different after take mifepristone, although some people may feel nauseous. A small number start bleeding and cramping because the pregnancy tissue has started to empty from the uterus. Once you take mifepristone, your abortion cannot be stopped or reversed.

If you throw up within 1 hour of taking Step 1 (Mifepristone). Example: You take Step 1 (Mifepristone) at 6:00 PM and throw up at 6:40 PM.

• Call the pharmacy where you filled your prescription immediately, you may need an additional dose of Mifepristone
• Take Step 2 as planned and monitor for bleeding and cramping
• Contact SHORE Centre at 519-743-9360 and leave a voicemail message so we can provide additional instructions

If you throw up after 1 hour of taking Step 1 (Mifepristone). Example: You take Step 1 (Mifepristone) at 6:00 PM and throw up at 7:40 PM.

• The medication should not be impacted by you throwing up.
• Take Step 2 as planned

Yes. The process is most effective when the mifepristone and misoprostol are both used.

Between 24 hours and 48 hours after taking mifepristone (Step 1), you will take a second medication called misoprostol (Step 2). There are 4 pills of misoprostol in the orange box inside the medication abortion packaging.

Where to place the misoprostol tablets.

To take Misoprostol (Step 2): 
– First take a sip of water to moisten your mouth.
– Then place all 4 pills in your mouth with 2 pills on the left side and 2 pills on the right side in between your gum and cheek (see diagram).
– Set a timer for 30 minutes and let medication begin to dissolve.
– After 30 minutes take a sip of water and swallow everything in your mouth.

Yes. The pills are still safe and usually effective if swallowed. Monitor for bleeding and cramping, if you do not have any bleeding or cramping within 24 hours follow the instructions from your clinician for taking the second dose of Step 2 (misoprostol) that you were prescribed.

You may have more nausea, cramping and/or diarrhea when the pills are swallowed rather than dissolved in the mouth. Although you may feel more uncomfortable, this is not dangerous. For pregnancies between 7 and 9 weeks the effectiveness of misoprostol when swallowed orally is slightly lower than when dissolved in the mouth or the vagina, but it still works the vast majority of the time.

No. Sometimes, even after 30 minutes, the misoprostol does not dissolve fully. Instead, it may have become soft or “gummy”. This is okay. Just take a sip of water and swallow everything that is left in your mouth.

If you throw up during the 30 minutes you are dissolving Step 2 (misoprostol). Example: You put Step 2 (misoprostol) in your mouth to dissolve at 6:00 PM and you throw up at 6:15 PM.

• Monitor for bleeding and cramping, if you do not have any bleeding or cramping within 24 hours follow the instructions from your clinician for taking the second dose of Step 2 (misoprostol) that you were prescribed.

If you throw up after the 30 minutes you are dissolving Step 2 (misoprostol). Example: You disssolve Step 2 (misoprostol) in your mouth for 30 minutes from 6:00 PM to 6:30 PM and then swallow. You then throw up 5 minutes later at 6:35 PM.

• The medication should not be impacted by you throwing up.
• Expect bleeding and cramping to start within the next 24 hours
• Monitor for bleeding and cramping, if you do not have any bleeding or cramping within 24 hours follow the instructions from your clinician for taking the second dose of Step 2 (misoprostol) that you were prescribed.

If it has been less than 24 hours, no. Low grade fever, chills, nausea, vomiting, diarrhea and flu-like symptoms are all side effects of misoprostol and should resolve within 6 hours of using the misoprostol. The fevers, chills and cramping caused by misoprostol can be alleviated by using the medication prescribed by your clinician for pain relief. Contact us for more information on pain and symptom management if the medication you received is not working as expected.

If it has been more than 24 hours and you feel ill, have abdominal pain, nausea, vomiting or diarrhea, or have a fever greater than 100.4 you should seek emergency medical care as soon as possible.

Yes. Bleeding with a medication abortion is usually heavier than a period and often accompanied by clots. The heaviest bleeding typically occurs 2 to 5 hours after using misoprostol and usually slows within 24 hours. Some people, however, bleed heavily for up to 48 hours and may pass clots days or even weeks later. This is common and is not dangerous.

If you do not have any bleeding or cramping within 24 hours follow the instructions from your clinician for taking the second dose of Step 2 (misoprostol) that you were prescribed. This can happen most often with very early pregnancies.

The misoprostol should still be used if you have not already started to have cramping and bleeding. Mifepristone alone works about 65% of the time. Research most strongly supports using misoprostol between 24-48 hours after the Mifepristone. Misoprostol also works when it is used earlier or later, and using it late is much more effective than not using it at all.

Monitor for bleeding and cramping, if you do not have any bleeding or cramping within 24 hours follow the instructions from your clinician for taking the second dose of Step 2 (misoprostol) that you were prescribed.

Not necessarily, your clinician will have discussed your follow up plan which may include a blood test or an at home urine pregnancy test. 

It is important to complete your follow-up test. We cannot confirm if the medication ended the pregnancy as expected without it. Follow up is essential for ensuring your medication abortion was successful. If the medication did not work as expected you may need additional treatment.

Yes. On average, people can have bleeding for 9 -14 days following a medication abortion, however some people bleed or pass clots for as long as 4 weeks. After the first few days of heavy bleeding some people will have little or no bleeding, some will have bleeding that stops and starts, and others will have bleeding similar to a menstrual period for several weeks.

Sometimes the first period following a medication abortion is especially heavy. If you have no other symptoms of concern, the bleeding is not dangerous and it is safe to wait for it to stop on its own. If you have questions or would like to have another follow up appointment with your clinician please contact us.

Medication abortion does not have any long term impact on your health or fertility. Most people will ovulate within two or three weeks and will resume menstruation within four to five weeks after the abortion. It is possible to become pregnant within weeks of having a medication abortion.

If you would like to use birth control to reduce your risk of pregnancy, please contact us to learn more about your options. The clinician you saw for your medical abortion will be able to prescribe all methods of birth control at your follow-up appointment.

In general, it is not advised to insert anything into your vagina for approximately one week after a medication abortion. After one week you can decide when the right time is for you to resume using tampons, menstrual cup, and having sexual intercourse.

The exception to not putting anything into the vagina would be for people who choose the vaginal ring for birth control, they should insert it 1 day after taking Step 2 (misoprostol) or as instructed by their clinician.

Bleeding: Bleeding is not a side effect, but a sign that the pills are working. Caution: Very heavy bleeding or hemorrhaging affects about 2 in 1,000 people. If you are soaking through 2 pads in 2 hours or passing very large blood clots the size of a lemon or bigger, you are bleeding very heavily. It’s also a cause for concern if you pass blood clots for more than 2 hours. Please get emergency medical help.

Pain: Pain in the abdomen and the pelvic area typically begins within 3 hours of taking Step 2 (misoprostol) although it is possible to experience cramps and pain after mifepristone (step 1). The pain may be similar to your period, but may be worse if you usually have painful periods.⁷ The further into the pregnancy you are, the more uncomfortable you may feel. You may even experience back pain.

Headache: Headaches are another common side effect of medication abortion. Some people may also feel dizzy. The dizziness, headaches, and weakness are caused by hormonal fluctuations brought about by Step 2 (misoprostol). The headaches and the weakness will likely last for 2 days and the dizziness should subside in 1 day. The best thing to do is allow yourself some downtime to rest, this process can take a toll on your system.

Nausea and Vomiting: Feeling nauseous or vomiting is common during a medication abortion. Using the Step 2 (misoprostol) may make your nausea worse. That nausea may last for two days.

Diarrhea: Step 2 (Misoprostol) may cause diarrhea, which involves having 3 or more bowel movements that are loose or watery in a single day. Should you get diarrhea, drink lots of water to stay hydrated.

Fever and Chills: Some people may have fever and/or chills after taking Step 1 (mifepristone) and Step 2 (misoprostol). The fever usually only last for about one day. If your fever is greater than 100.4°F and lasts longer than 24 hours after using Step 2 (misoprostol) contact your clinician as soon as possible.

Infection: Abortion pills have low risk of infection, however it may be possible to develop an infection while using the medication . A persistent high fever above 100.4 F, pain, and severe bleeding are signs of an infection. You should seek medical attention as soon as possible if you suspect you may have an infection. If left untreated, an infection may result in more serious and potentially fatal health complications.

Incomplete Abortion: Sometimes, the medication may not work exactly as planned. This may result in incomplete expulsion of the pregnancy. If this happens, surgical intervention may be required. This happens in approximately 2.5 to 5.1% of all people who have a medication abortion. Watch out for prolonged pain, pain felt when you press down on the abdominal region, cramps, or continued bleeding in the weeks following the abortion. Having your follow up blood work 7-10 days after you take Step 1 (mifepristone) is the best way to know for sure if the medication worked and the process is going as expected.

Continued Pregnancy: Very rarely, in less than 2% of people, the abortion pills may not end the pregnancy. If you continue to experience pregnancy symptoms, it could be a case of failed or missed abortion. This means that the pregnancy is continuing to grow. The pills become less effective as you near the 9th week of pregnancy.

Canadian Institute for Health Information. (2015). Induced Abortions Reported in Canada in 2015.

Celopharma. (2016). Mifegymiso Medication Guide.

Costescu, D., Guilbert, E., Bernardin, B., Black, A., Norman, W. V., Pymar, H., Society of Obstetricians and Gynaecologists of Canada. (2016). Medical Abortion. Journal of Obstetrics and Gynaecology Canada, 38(4), 366-389. doi:10.1016/j.jogc.2016.01.002

Society of Obstetricians and Gynaecologists of Canada. (2016). Mifegymiso Online Training Modules.

Creinin, Mitchell D., Jill L. Schwartz, Helen C. Pymar, and Wendy Fink. “Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial.” BJOG: An International Journal of Obstetrics & Gynaecology 108, no. 5 (2001): 469-473.Ending pregnancy with medications. U.S. National Library of Medicine.

Diarrhea During Pregnancy. American Pregnancy Association.

El-Refaey, Hazem, Dhamnasekar Rajasekar, Mona Abdalla, Lynda Calder, and Allan Templeton. “Induction of abortion with mifepristone (RU 486) and oral or vaginal misoprostol.” New England Journal of Medicine 332, no. 15 (1995): 983-987.

Ending pregnancy with medications. U.S. National Library of Medicine.

Kruse, Beth, Suzanne Poppema, Mitchell D. Creinin, and Maureen Paul. “Management of side effects and complications in medical abortion.” American journal of obstetrics and gynecology 183, no. 2 (2000): S65-S75.

Medical abortion:The Abortion pill up to 10 weeks. British Pregnancy Advisory Service.

Possible Physical Side Effects After Abortion. American Pregnancy Association.

Rørbye, Christina, Mogens Nørgaard, and Lisbeth Nilas. “Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study.” Human Reproduction 20, no. 3 (2005): 834-838.

Shannon, Caitlin S., Beverly Winikoff, Richard Hausknecht, Eric Schaff, Paul D. Blumenthal, Deborah Oyer, Heather Sankey, Jessica Wolff, and Rachel Goldberg. “Multicenter trial of a simplified mifepristone medical abortion regimen.” Obstetrics & Gynecology 105, no. 2 (2005): 345-351.

Spitz, Irving M., C. Wayne Bardin, Lauri Benton, and Ann Robbins. “Early pregnancy termination with mifepristone and misoprostol in the United States.” New England Journal of Medicine 338, no. 18 (1998): 1241-1247.

Tang, Oi Shan, Carina CW Chan, Ernest HY Ng, Sharon WH Lee, and Pak Chung Ho. “A prospective, randomized, placebo‐controlled trial on the use of mifepristone with sublingual or vaginal misoprostol for medical abortions of less than 9 weeks gestation.” Human Reproduction 18, no. 11 (2003): 2315-2318.

The Safety of Abortion. National Abortion Federation.