Advice for individuals having medical abortion

Providers of medical abortion must supply individuals with a written outline of the symptoms they may experience, a list of symptoms that need urgent medical review1, and a letter with sufficient information about the procedure to allow another practitioner to manage any complications. Patients should be given details of how to access 24-hour emergency care. Access to hospital emergency services must be available (within 2 hours travel time) for 14 days after mifepristone is taken. Advise the individual that once a medical abortion has started, it should be completed.

Mifepristone and misoprostol are safe to use during breastfeeding. Advise that it is not necessary for breastmilk to be expressed and discarded.

Provide a pathology request form for a follow-up quantitative serum human chorionic gonadotrophin (hCG) measurement, to be taken 7 days after the mifepristone dose. Emphasise the importance of this test to confirm there is no continuing viable pregnancy. Explain that the presence of bleeding does not always indicate that the treatment has been successful. Ensure recall and reminders are in place to confirm that the test has been performed.

If access to blood testing is difficult, a low-sensitivity urinary hCG test, taken at least 2 weeks after the dose of mifepristone, can be considered instead of baseline and follow-up quantitative serum hCG measurements. See Follow-up after medical abortion for more information.

Table 1. Advice after a medical abortion: patient information

Printable table

General advice after a medical abortion

A follow-up blood test is very important to check that the abortion has been successful. The test needs to be taken 7 days after you took the first tablet (mifepristone). Other forms of testing may be appropriate for some people, but your clinic will discuss these with you if they are an option.

For 7 days after taking the second tablet (misoprostol), to reduce the risk of infection, avoid:

  • sexual intercourse
  • use of tampons or menstrual cups
  • swimming
  • taking a bath or using a spa.

When to go to an emergency department

Go to an emergency department if at any time you have:

  • very heavy bleeding, such as any of the following:
    • your bleeding fills more than two large pads in an hour for more than 2 hours in a row
    • you are passing clots the size of a small lemon or larger
    • you feel faint and think the bleeding is heavy even if you are not sure about how much you are bleeding
  • any of the following symptoms (which could mean an ectopic pregnancy in the Fallopian tube):
    • severe abdominal (tummy) pain
    • pain in your pelvis on one side
    • pain in the tips of your shoulders
  • other concerns and you don’t have access to medical advice (eg from the prescribing clinic).

When to contact the clinic that prescribed the abortion drugs

If you have any of the symptoms below, you might still be pregnant. Contact the clinic if:

  • at 24 hours after taking misoprostol, you either:
    • have had no or little bleeding (less than a normal period), or
    • have not passed any pregnancy tissue, or any clots larger than a small grape
  • at 48 hours after taking misoprostol, you still have nausea
  • you had some initial bleeding, but it stopped within 4 days of taking misoprostol
  • at 14 days after taking misoprostol, you still have breast tenderness.

If you have any of the symptoms below, there might still be some pregnancy tissue (eg placenta) in the uterus (womb). Contact the clinic if:

  • at 7 days after taking misoprostol:
    • you are still passing clots
    • you still have cramping pain
    • you still have bleeding that is heavier than a period
    • you have bleeding that stopped and restarted and has been as heavy as a period for the last 24 hours or more
  • at 14 days after taking misoprostol you have bleeding that is not much less than when it started
  • at 4 to 5 weeks after taking misoprostol you still have bleeding that is different to your usual menstrual cycle.

Contact the clinic if you have any of the symptoms below, as they can indicate that you have an infection of the uterus:

  • pelvic pain
  • pain during sex
  • unusual vaginal discharge
  • fever (over 38°C)
  • tenderness on touching the abdomen (tummy) or pelvis
  • nausea or vomiting
  • feeling unwell.

Contact the clinic that prescribed the abortion drugs if you have any concerns about the medical abortion.

1 Registered providers can order patient information brochures from the MS-2 Step website or the Sexual Health Victoria website.Return