If you are having any symptoms or have any questions, please call 811 to speak with a registered nurse 24 hours a day.

What is a medical abortion?

A medical abortion uses 2 different medications, taken 1 to 2 days apart.  The medications end a pregnancy and make the uterus push out the pregnancy tissue (like a miscarriage).

Can I have a medical abortion?

You may be able to have a medical abortion if:

• Your pregnancy is 9 weeks (63 days) or less, counting from the first day of your last regular period.
• Your pregnancy is in your uterus, not in your fallopian tubes (ectopic pregnancy).
• You do not have an intrauterine device (IUD) in place.

When you meet with a health care provider, they will ask you about your health and any prescription medications you are taking. This will help them find out if you are eligible for a medical abortion.

Important

A medical abortion can cause very strong pain and bleeding. If you are not sure that you can manage these symptoms at home, you may wish to consider a procedural abortion instead. Talk about your concerns with your health care provider to help you decide.

In rare cases, you may have very heavy bleeding that needs medical attention. For this reason, if you have a medical abortion, you must be able to get to an Emergency Department right away.

What happens during a medical abortion?

• You may have an ultrasound to make sure you are no more than 9 weeks (63 days) pregnant.
• You may have blood work to check your blood type and pregnancy hormone level.
• You will have an appointment with a healthcare provider to talk about the procedure in detail.
• You will be given a prescription for a medication called Mifegymiso.
• This prescription can be filled at any pharmacy.
• Mifegymiso is free for any person with a Nova Scotia health card (MSI).

What supplies will I need before taking Mifegymiso?

• You will need several large period (maxi) pads. Do not use tampons or period cups during your medical abortion.
• You may take over-the-counter pain medication like acetaminophen (Tylenol®), ibuprofen (Advil ®, Midol®), or naproxen (Aleve®). Be sure to have these medications on hand before starting.
• Other comfort measures, like a heating pad or a hot water bottle, can also help with pain.

How to take the medications

Step 1: Mifepristone (green box)

• Swallow 1 mifepristone tablet with water.
• Once you take mifepristone, there is no way to reverse the effects. This tablet will end the pregnancy.
• Most people do not feel different after taking this tablet. A small number of people have mild bleeding or cramping.
• After taking mifepristone, wait 24 to 48 hours.

Step 2: Misoprostol (orange box)

• Misoprostol softens the cervix and tells your body to push out the tissue (like a miscarriage). You will have strong, painful cramps during this step.
• Take pain medication about 30 minutes before taking misoprostol:
• For example, you can take both acetaminophen (1000 mg) and ibuprofen (400 to 800 mg) with food.
• There are 2 ways to take misoprostol. If you have nausea (feeling sick to your stomach), it is recommended to take misoprostol vaginally (option 1). Both ways work equally well.

Option 1. Vaginally

24 to 48 hours after you take the mifepristone tablet (Step 1 on page 2), insert (put) all 4 misoprostol tablets in your vagina. Insert them as high up as you can, like you insert a tampon or a period cup.

Option 2. Orally (by mouth)

24 to 48 hours after you take the mifepristone tablet (Step 1 above), place all 4 misoprostol tablets in your mouth at the same time. Place 2 tablets between your cheek and gums on each side. Do not swallow these tablets. Leave them there for 30 minutes. After 30 minutes, drink some water to swallow any pieces that are left.

What will happen after taking misoprostol?

• Within 1 to 4 hours of taking misoprostol, you will start to have cramping, bleeding, and pass clots and tissue. This is the tissue starting to empty from the uterus.
• You may have very heavy bleeding with clots as small as quarters, or as big as lemons.
• You may have bleeding and cramping for several hours (4 to 12 hours), until all the tissue passes. After that, you will have bleeding for 1 to 2 weeks. Sometimes the bleeding will continue for 4 to 6 weeks.

Side effects

For 24 hours after taking misoprostol, you may have:

• A fever (temperature above 38 °C or 100.4 °F)
• Chills
• Diarrhea (loose, watery poop)

These symptoms are common. If you are worried about any of these symptoms, contact the ROSE Clinic (in Nove Scotia) or Sexual Health, Options & Reproductive Services (PEI).  See contact information below.

Follow-up appointment(s)

• You will have a follow-up appointment 7 to 14 days after you take mifepristone (the first medication in the green box).
• During this appointment, the doctor will check that your medical abortion worked. You may need another blood test.
• After your blood test, a nurse will call to confirm whether your medical abortion is complete and answer any questions you may have.

What are the possible risks?

• There is a 0.5% chance that the medication will not work and you will still be pregnant. If this happens, it is recommended that you have a procedural abortion in the health centre, as Mifegymiso causes birth defects.
• There is a 3 to 5% chance the misoprostol will not work and you will still have tissue in your uterus. You may need to take more misoprostol, or have the tissue removed during a procedure. This is called a D&C.
• There is very small risk of developing an infection in your uterus. If you have an infection, you will have symptoms 1 or 2 days after taking misoprostol (Step 2 above).

Call the clinic if you have any of these signs of infection:

• Fever (temperature above 38 °C or 100.4 °F
• Chills
• Bad-smelling vaginal discharge
• There is a very small risk of heavy bleeding (soaking more than 2 pads an hour for 2 hours in a row).

If you are light-headed, dizzy, or have a very fast heartbeat (feeling like your heart is racing) with a lot of bleeding, go to the nearest Emergency Department right away. Do not drive yourself.

Sex and birth control

• You can have sex as soon as you feel ready after your procedure.
• You can get pregnant again 7 days after your procedure, even if you are still bleeding.
• You can start using the birth control pill or patch, vaginal ring, or contraceptive implant right away.
• You should use condoms for 7 days after starting birth control pills, a patch, or a ring, so that the birth control has time to start working.
• You can have an IUD put in when a health care provider confirms you are no longer pregnant.
• If you do not start using birth control, your next period will start in 4 to 6 weeks. This period may be heavier and more painful than your regular period.

FOR MORE INFORMATION

Nova Scotia: 

• If you have questions before your procedure, call the self-referral line:
  • Phone (toll-free): 1-833-352-0719
  • Or visit: nshealth.ca/abortion
• If you have questions after your procedure, please call the ROSE Clinic nurse:
  • Phone: 902-473-7072
  • Hours: 7 a.m. to 3 p.m. (Monday to Friday)
• You will need to leave your name and a phone number for the nurse to call you back.
  • All voicemail messages are confidential. We will return your call as soon as possible. Your conversations with the nurse and counsellor are private and confidential.
  • If it is an emergency, call 911 or go to the nearest Emergency Department right away.

Prince Edward Island:

Call the Sexual Health, Options & Reproductive Services (SHORS) 1-844-365-8258 or visit https://www.princeedwardisland.ca/en/information/health-pei/medical-abortion