What to expect with a medical termination
MS-2 Step process
Medical termination of first trimester pregnancy or MS-2 Step® (mifepristone, misoprostol), is a safe and effective method of terminating a pregnancy up to 9 weeks using medication rather than surgery.
There are two medicines used for a termination of first trimester pregnancy.
First a mifepristone tablet is taken and then 36 to 48 hours later, misoprostol tablets are taken.
Mifepristone is an anti-hormone. It acts by blocking the effects of progesterone, a hormone that is needed for pregnancy to continue.
Misoprostol is a prostaglandin and causes contractions of the uterus and relaxation of the cervix which helps push out the contents of the uterus.
Both mifepristone and misoprostol work together to end a pregnancy.
Before you are given the medicines, your doctor will talk with you and may perform a physical examination and request you to have an ultrasound. If the doctor assesses that your pregnancy is up to less than 9 weeks or 63 days duration and if a medical termination is suitable for you, then you may be eligible start the treatment.
How to take the medicines
There are two steps in this process.
The first step
You will take one tablet of mifepristone.
The second step
36 to 48 hours after you take mifepristone you need to take the misoprostol tablets. It is up to you when you take the tablets within this time period. You should plan the process to fit in with your daily schedule.
Your doctor will also prescribe an anti-nausea medication which you can take 30 minutes prior to the misoprostol tablets.
You will then take four misoprostol tablets.
It is recommended to dip the tablets in a cup of water then hold them in your mouth between your cheek and gum for 30 minutes. They will go chalky but won’t dissolve entirely. Any fragments that haven’t dissolved can just be swallowed with a glass of water.
You may start to experience symptoms such as cramping pain and bleeding anywhere from 30 minutes to 6 hours after taking these tablets. The bleeding lasts on average for 10 to 16 days and may be heavy.
Most women require no further medication, however, if no bleeding has occurred within 24 hours after taking the misoprostol, you should contact your doctor as soon as possible.
Please call Pear Tree Family Practice (08 7228 5818) or Health Direct 1800 022 222 (24/7) if you are at all worried.
Signs and symptoms of the termination
There are a few possible symptoms that you may experience as part of the termination process. It is important to understand these symptoms and any risks that may arise from using this treatment.
- The onset of bleeding is usually within 4 hours of taking the misoprostol tablets and most women will experience the onset within 48 hours.
- Bleeding can range from light to heavy. Bleeding is usually more than a typical menstrual period. You may notice the pregnancy sac coming out with the gush of blood. Some people may see some jelly like substance and some tissue clots. Some people see what they recognise as an embryo which at this early stage of development will be around the size of a large kidney bean. You may want to consider ahead of time how you wish to manage this.
- Bleeding should reduce once the pregnancy is expelled.
- Vaginal bleeding does not mean that the pregnancy has been expelled. A follow up assessment is very important, to confirm termination of pregnancy.
- Sometimes bleeding can occur after taking the mifepristone but before taking the misoprostol.
- The bleeding lasts on average for 10 to 16 days. Light bleeding can continue for 30 days or more but does not normally go beyond the first period following your treatment
If you saturate or flood two (or more) sanitary pads per hour for two consecutive hours this could be considered “problem bleeding”. If you experience problem bleeding please attend your closet Emergency Department. If you are concerned about the amount of bleeding you are experiencing, please call Pear Tree Family Practice (08 7228 5818).
- Cramping can start within 4 hours of taking the misoprostol tablets.
- Cramping can range from mild to severe and is usually more than a typical menstrual period.
- Significant cramping should diminish once the pregnancy is expelled and does not usually last longer than 24 hours.
To help manage your pain, ensure that you:
- use hot packs on your abdomen or back
- massage the lower abdomen frequently
- take pain relief medications, always as directed by your doctor. Paracetamol and ibuprofen are often effective for pain management. Your doctor may prescribe you some other pain relief.
- It is recommended to take two tablets of ibuprofen after food, before you take the misoprostol tablets
- You may also take 1-2 panadeine forte as prescribed by your doctor
Other possible side effects:
- breast tenderness
- hot flushes, skin rashes or itching
- abdominal discomfort, abdominal pain, cramps
- short term fever and chills
- These side effects are usually short term and do not last more than 24 hours.
If you are experiencing nausea or vomiting you can take the anti-nausea medication your doctor prescribed.
If you experience problems or are at all concerned about side effects you should contact Pear Tree Family Practice (08 7228 5818) or Health Direct 1800 022 222 (24/7) if you are at all worried.
Possible adverse effects of treatment
Although cramping and bleeding are expected as part of ending a pregnancy, rarely, serious and potentially life-threatening bleeding, infections or other problems can occur following a medical abortion. The use of this treatment is not risk free.
Prompt medical attention is needed in the following circumstances. You should contact your doctor for immediate medical attention if you experience:
- heavy vaginal bleeding (soaking two (or more) sanitary pads per hour for two consecutive hours or have large fist-sized clots)
- prolonged heavy bleeding or severe cramping:
- it is expected that, on average, bleeding will occur for 10 to 16 days after Mifepristone administration and may initially be heavy – you should return to your doctor for any bleeding occurs after this time
- cramping which is not improved by pain relief medication
- fever, chills or malaise lasting six hours or more
- any abnormal vaginal discharge
- severe abdominal pain
- feeling sick (including weakness, nausea, vomiting, diarrhoea, abdominal discomfort, cramps, fatigue, chills) with or without a fever more than 24 hours after taking misoprostol tablets.
You should also contact your doctor if you are worried about any of the following:
- breast tenderness
- hot flushes; skin rashes or itching
It is possible that other side effects may occur in some people which have not been discovered yet. Other side effects not listed in this leaflet may also occur in some people. You should discuss possible side effects that you may experience with your doctor.
If you experience problems or are at all concerned about side effects contact Pear Tree Family Practice (08 7228 5818) or Health Direct 1800 022 222 (24/7), even if you are concerned about symptoms that are not listed here.
You MUST adhere to any follow up arrangements or appointments as advised by your doctor. Follow up is very important so that your doctor can confirm that the termination of pregnancy is complete and exclude possible complications.
If the termination is not complete, your doctor will discuss your treatment options, which may include surgery. It is recommended that you do not travel away from home during the time that you are bleeding so that you can visit your doctor or clinic if necessary.
Your physical and emotional wellbeing
It is important to make arrangements to ensure that you are comfortable during the abortion process and that you can rest for 24 hours afterwards.
We recommended having a support person that you can contact and that are able to provide any help if required.
As you will most likely experience pain during the process, pain relief is most effective if used early. Take pain relieving medication prior to using misoprostol and every 4 hours as needed. Use a hot pack on the abdomen. You can also massage your lower abdomen and/or back.
As discussed above, the process will result in bleeding the can last on average for 10 to 16 days. Please use sanitary protection pads, and do not use tampons or menstrual cups for 7 days after the process.
We recommend eating light meals and drinking plenty of fluids and avoiding alcohol.
You may also experience a range of emotions during this process. This is not uncomon for people to experience a variety of mixed emotions including relief, sadness, grief, regret, and guilt, which may ve related to the termination or other personal issues. Some people feel that having a termination was a positive step towards gaining control of their body and llife. In some cases these positive feelings can be mixed with other feelings such as sadness, loss, anger or guilt. Its important to remember that you may experience various emotions after the process, this does not necessarliy mean that you made the wrong decision.
Your body goes through certain changes after the process and different factors can contribute to your emotions. It can be related to some of these examples;
- relief and releasing tension
- feeling physically uncomfortable
- emotional feelings due to the pain relief medication
- the drop in the amount of hormones in your body
- change in the type of contraception you are now using
- relationship changes
- lack of support, e.g. from family, friends
- societal stigma about abortion
If you feel you need support and to talk further, please make an appointment to discuss further with your GP. You may also contact a variety of support services after hours
Marie Stopes International 1300 515 883 (24/7)
Health Direct 1800 022 222 (24/7)
Life Line 13 11 14
Beyond Blue 1300 22 4636
National sexual assault, family and domestic violence counselling (24/7) 1800 737 732
- you can search also access local support services and search the internet using Daisy a free App that protects your privacy https://www.1800respect.org.au/daisy
In an emergency or life threatening situation, call 000