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Getting Started

After you have picked up your prescription from the pharmacy, you can take Mifegymiso according to the plan you made with your clinician.

Mia, your virtual companion is available 24 hours a day, 7 days a week to answer your questions by text message.

You can review the handouts you got from us by clicking the links below to open the PDF file.

Abortion Pill Instruction Handout
Abortion Pill Checklist
Information about Pregnancy of Unknown Location 
Information for People with Rh Negative Blood Types

Click the questions below to see the answers to commonly asked questions people have when taking Mifegymiso.

What if I change my mind after I leave SHORE Centre?

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 take Mifegymiso. Once you take the medications the process cannot be 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.

Who can I talk to for support?
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/

How do I to take Mifepristone (Step 1)?
There is one pill of mifepristone in the green box inside the Mifegymiso 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 reversed.
What if I throw up after taking Step 1 (Mifeprisone)?

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

 

If I start to bleed after I take Mifepristone (Step 1) do I still need to take Misoprostol (Step 2)?
Yes. The process is most effective when the mifepristone and misoprostol are both used.
How do I take Misoprostol (Step 2)

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 Mifegymiso packaging.

Image of a mouth with misoprostol tablets on each side between the cheek and gum.

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.

What if I throw up after taking Step 2 (Misoprostol)?

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
I accidentally swallowed the misoprostol pills before the 30 minutes was up. Is that okay?
Yes. The pills are still safe and usually effective if swallowed. If you do not have any bleeding within 48 hours you should call SHORE Centre for further instructions. 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.
It has been 30 minutes and the Misoprostol (Step 2) is not fully dissolved. Should I wait longer?
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.
I took the misoprostol 4 hours ago and for the last 2 hours I have been vomiting and have a fever of 101 degrees. Is something is wrong?
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 Ibuprofen. Contact SHORE Centre for more information on pain and symptom management.

If you feel ill, have abdominal pain, nausea, vomiting or diarrhea, or has a fever greater than 100.4 more than 24 hours after using misoprostol you should be seen by a clinician as soon as possible.

I took the misoprostol 6 hours ago and am still having heavy bleeding and passing large blood clots, is this normal?
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.
I took the misoprostol pills 24 hours ago and I still haven’t had any bleeding. What should I do?
This can happen most often with very early pregnancies. If an intrauterine pregnancy was seen on ultrasound, there is nothing to worry about and a little more time is often all that is needed. In this case, options include waiting another 24 hours then calling SHORE Centre back if you still have not started bleeding. Another option may be to prescribe a second dose of misoprostol right away.
What do I do if I wasn’t able to take the misoprostol pills as scheduled and it has been 72 hours or more?
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.
Do I have to do the follow up blood work?
Yes. Until we receive the results of your follow up blood work we cannot confirm if the medication ended the pregnancy as expected. Having your follow-up blood work as directed after you use Misoprostol and is essential for ensuring your medication abortion was successful. If the medication did not work as expected you may need additional treatment.
I had my medication abortion 3-5 weeks ago and I’m still bleeding. Is that normal?
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.

How long after having a medication abortion can I become pregnant?
Mifegymiso 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 SHORE Centre 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.

How long after having a medication abortion can I use tampons, Diva Cup or resume sexual intercourse?
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, Diva Cup, and having sexual intercourse.

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

What are the side effects of using Mifegymiso?
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 women. 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 misoprostol (step 2) 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 using Mifegymiso. Some people may also feel dizzy. The dizziness, headaches, and weakness are caused by hormonal fluctuations brought about by the misoprostol (step 2). 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 misoprostol (step 2) may make your nausea worse. That nausea may last for two days.

Diarrhea: Misoprostol (step 2) 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 mifepristone (step 1) and misoprostol (step 2). 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 misoprostol (step 2) 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 use Mifegymiso. 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 use mifepristone (step 1) 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.

References
 

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.

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