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How to use the pills when you are more than 13 weeks pregnant

HOW TO TAKE THE PILLS IF THE PREGNANCY IS MORE THAN 13 WEEKS:

Step 1: Swallow the 1 mifepristone pill (200mg) with water.

WAIT 24-48 HOURS BEFORE CONTINUING:

Step 2: 1 hour before you take misoprostol, take ibuprofen (Advil or Motrin) 800mg (4 over-the-counter pills) or naproxen (Aleve) 440 mg (2 over-the-counter pills) by mouth. If you are allergic to ibuprofen, you can take acetaminophen (Tylenol) 1000 mg by mouth instead.

Step 3: 24-48 hours after taking mifepristone and 1 hour after taking pain medication, take 4 misoprostol pills (total 800mcg). You can take misoprostol in different ways:

  • In the mouth: Put 4 pills under your tongue, or between your cheeks and gums. Hold them there for 30 minutes or until they dissolve. After 30 minutes, swallow whatever remains of the pills.
  • In the vagina: Insert 4 pills deep into the vagina and lie down for 30 minutes. This route is not recommended if you don’t want anyone to find out about the abortion, because pieces of the pills can be found in the vagina for several days.

Step 4: 3 hours later, take another 2 misoprostol pills (total 400mcg).

Step 5: 3 hours later, take another 2 misoprostol pills (total 400mcg).

Step 6: Keep taking 2 misoprostol pills every 3 hours until all of the pregnancy tissue is out. On average, it takes around 3-5 rounds of misoprostol (or 6-10 hours), but some people will need more doses.

You may have some misoprostol pills left over after following these instructions. Do NOT throw them away. Keep them in case you have a problem later and we tell you to take them. 

Important Notes for Abortion with Pills After 12 Weeks:

If you have had 2 or more C-sections and you are more than 12 weeks pregnant, there is a small increased risk (less than 0.3%) of uterine rupture. This is a rare but dangerous complication. If you have severe ongoing pain during or after the abortion, go to the hospital immediately.

If you have a Rh-negative blood type and are having an abortion after 12 weeks, you should receive a shot called Rhogam. This will prevent problems in future pregnancies. See here for more information.

WHAT TO EXPECT

Bleeding and cramping: Bleeding and cramping usually starts 2-4 hours after taking misoprostol (the second pill). For most people, it feels heavier than a normal menstrual period and includes blood clots. For some people, the pain can be more severe. Bleeding and cramping should slow down after the pregnancy is out, which is typically within 24 hours.

Pain medicine: Keep taking ibuprofen (Motrin or Advil) 800mg every 8 hours or naproxen (Aleve) 440mg every 12 hours and/or Tylenol 1000mg every 6 hours as needed for pain. Other ways to relieve pain include using a heating pad on the abdomen, being in a comfortable environment, listening to music, and having someone to support you.

Side effects: Nausea, vomiting, diarrhea, fever, and chills are all side effects of misoprostol. They normally go away on their own after a few hours. Eating a little bit during the abortion helps reduce nausea.

If you are very nauseous and feel like throwing up all the time, it is important to eat small amounts of food regularly and drink plenty of fluids. There are things you can try for nausea that do not need a prescription. Make sure to take any nausea treatments at least an hour before you take both the mifepristone and the misoprostol:

  1. Dimenhydrinate (Dramamine)
  2. Doxylamine succinate (Unisom)
  3. Bismuth subsalicylate (Pepto-Bismol)
  4. Ginger tea, ginger ale, or ginger candies
  5. Vitamin B6

If none of those help, you can ask your medical provider for a prescription. Some common medications prescribed for nausea are:

  1. Ondansetron (Zofran)
  2. Promethazine (Phenergan)

If you vomit more than 30 minutes after swallowing the Mifepristone this will not affect the abortion. If you vomit more than 20 minutes after taking misoprostol by mouth, this will not affect the abortion either. If you put the misoprostol in your vagina and vomit afterward at any point, it will not affect the abortion either.

However, if you vomit less than 30 minutes after swallowing the mifepristone or less than 20 minutes after putting the misoprostol in your cheeks or under your tongue, you might not absorb enough medication for the pills to work. 

If you vomit less than 30 minutes after taking the mifepristone tablet, please send us an email for further instructions.

If you vomit less than 20 minutes after taking the misoprostol, you should put another 4 misoprostol pills under your tongue or in your cheeks. If you are too nauseous and cannot keep the misoprostol under the tongue, you can also put them in your vagina.You can wait for a short time until you feel less nauseous, but do not wait more than 48 hours after you swallow the Mifepristone.

What you might see: This depends on how long you have been pregnant. Up to 7 weeks, you probably won’t see anything other than blood and clots. You could see a small amount of white tissue like a piece of sponge, which is the pregnancy tissue. Starting around 9 weeks, you might see an embryo less than an inch long (about the size of a coffee bean or peanut).

After 12 weeks, the pregnancy is larger and more developed, so you will likely see something that looks more like a fetus. At 12 weeks, the pregnancy is around 2 inches long, or about the size of a lime. At 14 weeks, the pregnancy is around 3.5 inches long, or about the size of an orange. Seeing the fetus can be upsetting for some people, so it’s good to be prepared and have a plan for how to dispose of the pregnancy tissue. See the bottom of this email for additional resources to support you with this.

AFTER THE ABORTION

You do not need a routine follow-up appointment. As long as you feel okay, you had the expected bleeding and cramping, and you no longer feel pregnant, then the abortion was probably successful.

To confirm the abortion was successful, you can do a home urine pregnancy test 5 weeks after the abortion. If you do a pregnancy test before 5 weeks, it might still be positive from leftover hormones that are still in your body. If you want, you can also do an ultrasound to confirm the abortion was successful, but this is not required.

We recommend you use a test with lines so that you can see if the line is fading.  We do not recommend Clear Blue brand tests because they are too sensitive and can give false positive results.

Pregnancy symptoms like sore breasts, nausea, etc. should go away 1-2 weeks after the abortion. You might have light bleeding on and off for 4-8 weeks until your next period. Your next menstrual period may be delayed up to 8 weeks and heavier than usual.

Most people can go back to normal activities after 1-2 days. You can have sex again when you feel ready. Every person is different, and it’s important that you listen to your body. You may also feel a variety of different emotions and moods during and after the abortion, which is normal. For emotional support, see the resources at the bottom of this email.

You can get pregnant again as soon as 8 days after an abortion. If you want to use birth control, you can get answers to your birth control questions with Planned Parenthood’s online chat. You can also Find a Title X clinic near you for free or low-cost birth control. In almost all states, they can help people under 18 get birth control without needing to involve their parents.

WHEN TO SEEK HELP

An abortion with pills is very safe and very effective. Severe, life-threatening complications occur in less than 0.5% of cases. It's important to know when to seek help.

Sometimes the abortion pills don’t fully work. Contact us or another health care provider if you have any of these signs that the abortion pills didn’t fully work:

  • Little or no bleeding 24 hours after taking the misoprostol, OR
  • Moderate to heavy bleeding that lasts for 5-7 days, OR
  • You still feel pregnant 1-2 weeks after taking the pills.

You can call or text the Medical Line for Aid Access at 1-888-963-1144. Our medical providers are available from 12pm-9pm EST (9am-6pm PST).

You can also call or text the Miscarriage and Abortion Hotline at 1-833-246-2632 to speak with a medical provider. They are available from 8AM to 1AM EST and will respond within an hour.

In rare cases of a serious complication, you might need a surgical procedure or blood transfusion.

 Go to a hospital right away if you have any of the following signs of a serious complication:

  1. Heavy bleeding: Bleeding that fills 2 pads per hour for 2 hours, or bleeding that is so heavy you feel dizzy or light-headed. Before leaving for the hospital, take 2 misoprostol pills under the tongue to help stop the bleeding.
  2. Fever: If you have a fever of more than 100.4° F for more than 24 hours, or you have a fever of more than 102° F at any time, there might be an infection that needs treatment with antibiotics.
  3. Severe pain or feeling very ill: Pain that is very severe and keeps going that does not feel better with the pain medications listed above or feeling very sick overall.

What to say at the hospital: You do NOT have to say that you took abortion pills. They cannot be detected (if you did not take them vaginally) and they have the same effect as a natural miscarriage. If you prefer, just tell the hospital staff you think you are having a miscarriage and describe the symptoms you are concerned about.

ADDITIONAL RESOURCES

  • For more information about abortion with pills, visit the Aid Access FAQ page.
  • Call or text the Medical Line for Aid Access at 1-888-963-1144. Our medical providers are available from 12pm-9pm EST (9am-6pm PST).
  • You can also call or text the Miscarriage and Abortion Hotline at 1-833-246-2632 to speak with a medical provider. They are available from 8AM to 1AM EST and will respond within an hour.
  • For legal information about doing an abortion yourself at home, call the Repro Legal Helpline (844-868-2812).
  • For emotional support, call/text Reprocare (833-226-7821) or Exhale (617-749-2948)