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What is the abortion pill?

 

In Canada, the medication used to end a pregnancy is called Mifegymiso which is a combination of two medications, mifepristone and misoprostol. Both medications come packaged together and the boxes are colour coded and labeled.

These medications are approved for use by Health Canada. Research studies have shown this treatment to be a safe and effective method of ending a pregnancy.

Picture of medication box for Mifegymiso

Mifegymiso Packaging

The first medication is Mifepristone (Step 1) it is one tablet and comes packaged in the green box.

The second medication is Misoprostol (Step 2) it is 4 tablets and comes packaged in the orange box.

 

 

 

How effective is Mifegymiso?

The success rate of medical abortions using Mifegymiso depends on how far along you are in pregnancy:
7 weeks, or 49 days ………… the medications are 92% to 99% effective
8 weeks, or 56 days ………… the medications are 91% to 98% effective
9 weeks, or 63 days …………. the medications are 87% to 98% effective

Who should not take Mifegymiso?

You should not take Mifegymiso if:

 

  • You are unsure about your decision to end your pregnancy
  • You do NOT have access to emergency medical care. You must be able to get medical help in
    the 14 days after you take the mifepristone tablet
  • You have an intrauterine contraceptive device (IUD, Mirena, Jaydess, Kyleena) in your uterus
  • You have any allergies to mifepristone or misoprostol
  • You have a chronic adrenal disease
  • You take corticosteroids on a regular basis
  • You have a bleeding problem or take a blood thinner (anticoagulant like coumadin)
  • You have inherited porphyria. This is a blood disease that causes skin symptoms as a result of oversensitivity to sunlight
  • You have uncontrolled asthma
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.

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 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.

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. People who choose the vaginal ring (Nuvaring) for birth control should insert it 2 or 3 days after taking mifepristone.

 

Who can I talk to for support?

 

At any time throughout this process, if you have questions, concerns, or would just like to talk to someone at SHORE Centre please feel free to call us at 519-743-9360 Monday to Friday between 9:00 AM and 4:00 PM.

Outside of our office hours you can also email options@shorecentre.ca. Please note that our office is closed on Saturday, Sunday and all statutory holidays. We will do our best to reply to all emails in one business day or less.

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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