After you have picked up your prescription from the pharmacy, read through the Abortion Pill Instruction Handout and take Mifegymiso according to the plan you made with your clinician.
We recommend using the Abortion Pill Checklist to help keep you on track at home. You can write down when you took medication, monitor bleeding and side effects, and important dates for follow up.
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 by clicking the orange text, this will open the PDF file.
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?
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)?
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)?
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.
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?
It has been 30 minutes and the Misoprostol (Step 2) is not fully dissolved. Should I wait longer?
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?
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?
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?
What do I do if I wasn’t able to take the misoprostol pills as scheduled and it has been 72 hours or more?
Do I have to do the follow up blood work?
I had my medication abortion 3-5 weeks ago and I’m still bleeding. Is that normal?
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?
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?
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?
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.
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.
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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.
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