• Reference Number: HEY-1402-2023
• Departments: Gynaecology
• Last Updated: 30 November 2023

Introduction about Early Medical Abortion (EMA)

Early Medical Abortion is a medical treatment that involves taking oral and/or vaginal medication to cause an abortion in a pregnancy that is less than 9 weeks and 6 days.

You will be given both stages of the medication in hospital (or the clinic). It does not involve surgery.

Although this document refers to the term woman/women, it is applicable to anyone that can become pregnant regardless of whether you identify as a woman or not. 

Are there any risks with this type of treatment?

Problems (risks) at the time of the abortion are not very common. The main risks are:

• Excessive bleeding (less than 1 in 1000 risk in early abortions). This may require a blood transfusion.
• Failure of the abortion and continuing pregnancy (less than 1 in 100 risk in early abortions). This may require further treatment. 

Are there any risks after the abortion?

You are more likely to get problems after an abortion. Again these problems are not common. The main risks are:

• Retained tissue (approximately 3-6 in 100 risk, dependent upon gestation). This may require further treatment.
• Infection of the uterus (up to 1 in 10 risk). This is usually due to a pre-existing infection.

You will also be offered screening before the treatment. If an infection is not detected or remains untreated it may become severe, causing Pelvic Inflammatory Disease (PID).

• Some women may experience short term emotional distress after an abortion. There is a slight increased risk to mental health disorders after an abortion compared with childbirth, but no evidence that these problems are actually caused by the abortion. They are often a continuation of problems experienced before the abortion.
• There is no proven evidence that having an abortion will cause a future ectopic pregnancy or infertility.

Will I have any side effects from the drugs?

You may get some of the following side effects. Once the treatment has worked these side effects usually stop.

• Nausea 40 in 100 women
• Vomiting 20 in 100 women
• Diarrhoea 15 in 100 women
• Headache 16 in 100 women
• Dizziness 25 in 100 women
• Flushes / sweats 25 in 100 women 

How many times will I need to attend the hospital?

Usually only twice. You can come to the hospital on your own; if your partner or another family member/friend accompanies you they will need to wait outside of the hospital. You will need someone who is aware of your treatment to stay with you at home overnight on the day that you have the Misoprostol tablets. 

What happens at this appointment?

A nurse will check your details and you will be given one oral Mifepristone 200mg tablet to swallow with some water. This is the first stage of the treatment. This tablet blocks the action of the hormone (progesterone) that supports the pregnancy. This tablet is very slow acting and prepares the body for the second stage of the treatment. When you have taken the Mifepristone you can leave the hospital after 30 minutes. If you vomit within one hour you will need to contact the department, as the tablet may not have been absorbed and you may require another tablet.

You will be offered a full sexual health screening when you attend clinic. Antibiotics will be provided if required and follow up will be requested via the Health Advising team at Conifer House.

You can carry on with your normal activities and home life. You may experience some vaginal bleeding and have period type pains. You can take simple pain relief such as Paracetamol and Ibuprofen. It is unlikely that the abortion itself will happen after the first tablet. However, some women will bleed heavily and actually pass the pregnancy. If you are worried you should contact the clinic or the emergency contact telephone numbers below.

You may also be given your chosen contraceptive method. This will depend on what you have decided to use following the abortion. The nursing staff will discuss this with you.  If you are wanting to use the Combined Oral Contraceptive Pill (COCP) or the Progesterone Only Pill (POP) as contraception then the nurse will advise you when to start taking your pill. It is important that you do not have any sexual intercourse until your vaginal bleeding has stopped as this may increase your risks of developing an infection.

What happens next?

24 to 48 hours after taking the Mifepristone tablets you need to have four x 200mcg Misoprostol tablets. This is the second stage of the treatment completed at hospital and it is essential that you complete this treatment even if you have had vagina bleeding following the Mifepristone tablet.

The tablets will be administered bucally whereby the tablets will be placed high between the upper lip and gum and allowed to dissolve. You need to make sure that you leave the tablets to dissolve for at least 30 minutes before you have a drink, rinse your mouth or swallow the tablets. The tablets do not have a pleasant taste and will feel chalky in your mouth. Taking the tablets this way may also mean that you experience more of the known side effects and they may be more severe.

For some women it may be necessary to insert the tablets vaginally if you are suffering with vomiting.

Once you start to bleed (usually a couple of hours after having the Misoprostol tablets), you may see large blood clots or pregnancy tissue. The pregnancy tissue will be larger and more recognisable at higher gestations. Under 8 weeks, you are only likely to see the pregnancy sac which is where the early pregnancy develops. If you are closer to 9 weeks and 6 days pregnant the foetus is about 3cm long (the size of a large grape) and you may recognise its shape. If you are worried about what you may see then please discuss this with the nurse in the clinic.

Most women pass the pregnancy within 4 to 5 hours after taking the Misoprostol tablets. For others it can be quicker or take longer. Once the pregnancy passes, the amount of vaginal bleeding should noticeably reduce.  You may find it comfortable to lie down, but some women will feel more comfortable walking around, or sitting down. It is up to you and how you feel.

You will be assigned your own toilet to use in the clinic which is for your sole use. The toilet will have collection bowls which are placed over the toilet to collect anything that you pass. The nurse will then take this away each time you use the toilet. You must take care not to flush anything down the toilet.

If the nurse does not think you have passed the pregnancy after 3-4 hours then you will need to have a further two Misoprostol 200 mcg tablets. Some women can take longer to pass the pregnancy and in this case you will be discharged home, the pregnancy should pass within 24hrs. You will be given a low sensitivity urine pregnancy test (LSUPT) to use 3 weeks after you have had your treatment. This pregnancy test is to confirm that the procedure was successful.

YOU MUST CONTACT THE CLINIC IF YOU HAVE A POSITIVE PREGNANCY TEST RESULT

A nurse from the clinic will contact you within 72 hours to follow-up on the telephone number that you have provided if you did not pass the pregnancy in clinic. Please ensure that you have your phone to hand and switched on if it is a mobile phone. The phone call will appear as blocked or withheld. We are able to leave a voice message but are unable to send a text message.

Will I have any pain?

Most women have some period type pains/cramps during and immediately following the treatment. In some instances this can be intense. Usually this intense pain does not last for long. Once the pregnancy passes, the amount of pain experienced should noticeably reduce. In a few women the period type pain may last for approximately 5 days after the abortion. The pain/cramps should be relieved by taking simple pain relief tablets such as Paracetamol or Ibuprofen. 

How long will I bleed for after the treatment?

You may experience vaginal bleeding for 2 to 3 weeks following the treatment. However, some women bleed less than this, while others may bleed up until their next period. Tampons should not be used as they can increase the risk of infection. 

Do I need to have a follow up appointment?

No. A nurse from the clinic will contact you 72 hours after treatment on your given telephone number to check that you are okay if you did not pass the pregnancy in clinic. Please ensure that you have your phone to hand and switched on if it is a mobile phone. The phone call will appear as blocked or withheld. We are able to leave a voice message but are unable to send a text message.

If we have not contacted you then please contact the clinic on 01482 607829.

Is there anything I should look out for when I go home?

You should contact the Women and Children’s Hospital on the contact numbers below or your GP if any of the following apply to you:

• You have severe pain which is not relieved with simple pain relief tablets
• You feel feverish
• You have excessive vaginal bleeding
• You have an offensive vaginal discharge
• Your period is later than expected and you still feel pregnant

Sepsis can be caused by an infection and whilst it is rare, it can be serious especially if it is not detected. Symptoms of sepsis can be like having the flu at first. If you have any of the signs below it is important to seek urgent medical advice:

• Confusion
• Slurred speech
• Extreme shivering
• Severe muscle pain
• Being unable to urinate
• Severe Breathlessness
• Cold, clammy and pale or blotchy skin 

Who can I contact if I have any questions?

If you have any concerns or need further information then please do not hesitate to contact:

• Gynaecology Pregnancy Advisory Service clinic (8am to 6pm Monday to Friday) – 01482 607829
• Cedar Ward (6pm to 8am Monday to Sunday) 01482 604387
• Early Pregnancy Assessment Unit – EPAU (8am to 3pm Saturday and Sunday) 01482 608767

If you require any counselling support please self-refer on the following number: 

• Temenos Psychotherapy & Counselling 01482 844038 

For contraception information please use the following website: http://www.fpa.org/uk/

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.