After Care FAQs
Is it normal to have some bleeding after Step 1 (Mifepristone)?
The step 1 medication is called Mifepristone, it blocks a hormone that is needed to maintain a pregnancy. It also causes the cervix to soften and makes the uterus more sensitive to the second step medication. Most people do not notice any symptoms after taking Step 1. But some people may get light bleeding or spotting. Very occasionally people experience heavy bleeding, and potentially pass some tissue before taking the 2nd step medication. No matter what level of bleeding occurs, or if you feel that you have passed tissue, it is still recommended that you take the 2nd step of the medication as planned. Wear a pad after taking step 1.
How long do I need to wait between Step 1 and Step 2?
At Clinic 66 Online we generally recommend that you take the 2nd step medication around 36 hours after Step 1. This provides enough time for the medication to work, which means the medications should be most effective with this regime. The maximum time is 48 hours. There is some evidence to suggest that if you are under 7 weeks pregnant at the time of taking Step 1, this interval can be reduced to 24 hours if needed.
I vomited after taking the 2nd step medication (Misoprostol). Will the process still work?
You will have been prescribed medication (Ondansetron or Metoclopramide) to reduce the chance of this happening, we recommend taking this approximately 30-60mins prior to the 2nd step medication. If you vomit and it has been at least 30 minutes since you took the medication, there is no need to be concerned. If it was less than 30 minutes since you took the medication, you may need to repeat the dose. Contact the Clinic 66 Online text line on 0428 329 287 as soon as possible for further advice.
I took my 2nd step more than 8 hours ago and I haven't had much bleeding. What should I do?
For some people, the medication can take up to 24 hours to work; however, if it has been more than 12 hours since you took step 2 we recommend that you contact the Clinic66 online text line on 0428 329 287 for further advice. We may recommend undertaking some blood tests to see if your pregnancy hormone is decreasing or recommend repeating the procedure with more medication. Treatment options are also impacted by the stage of your pregnancy, and the day of the week (for example, if you are almost 9 weeks, and it’s a Friday, we will generally re-prescribe the medication).
I have persistent pain; what should I do?
For most people, pain and cramping usually starts within a few hours after taking step 2 of the medication (the 4x misoprostol tablets). It can be a strong pain, but most people manage the pain, and it typically settles once the tissue from the pregnancy has passed. During your second consultation, pain management will be discussed .We generally recommend taking high dose ibuprofen 30-45 minutes prior to taking the second step of the medication and then continuing every 6-8 hours. You can also take regular paracetamol 2 tablets every 4-6 hours (OR 1-2 x Panadeine forte if prescribed) Some people find that massaging their lower abdomen, using a heat pack, walking or taking a warm shower can also help. It is also important to rest and avoid strenuous activity. Be with someone who cares about you. Some people experience mild cramping that lasts several days. This pain should not be as intense as the day of the misoprostol, and is easily managed with simple ibuprofen and/or paracetamol at usual doses. If the pain is severe, you will need to be assessed face to face, in your local Emergency Department. We cannot physically assess you via Telehealth. If the cramping persists beyond 7 days, please contact Clinic 66 Online via SMS at the number provided to you in your welcome package. Please note that this SMS number is only monitored during usual business hours. If your pain improves and then returns later, it could be a sign of infection and you may require antibiotics. In such cases, it's recommended to schedule an appointment with a local healthcare provider. If you cannot find one, then send us a message and we will make an appointment for you with one of our doctors, but not if it is a weekend or after hours.
Abnormal bleeding patterns
It's normal to experience heavy bleeding with clots for the first day after taking the second step of the medication. Some people may even notice a significant gush of blood and/or passage of the pregnancy tissue. As the days progress, the bleeding should gradually become lighter, lasting on average between 10 to 16 days. Some people have light bleeding or spotting until their next menstrual period. It is recommended that you contact Clinic 66 Online if your bleeding; - is heavier than your normal period, or are continuing to pass clots, 7 days after the 2nd step of the medication - settles but then becomes heavy again (bleeding for at least 24 hours) - remains heavy or it has been more than two weeks since taking the second step of the medication and the bleeding hasn't significantly reduced. - continues after your next menstrual period . Your period will usually return 4-8 weeks after the abortion (but bleeding may be affected by hormonal contraception if you are using it) - is accompanied by pain or cramping beyond the first few days - you have changes in your discharge that make you concerned you could have an infection Seek immediate medical attention at your local emergency department, if you are soaking 2 or more super/maternity pads per hours for 2 consecutive hours (4 pads over 2 hours), are passing clots the size of your fist, are feeling faint/ light-headed/ dizzy, or you or your support person are concerned.
Misoprostol for Retained Products of Conception; why you have been asked to take it and where to get it.
If you have advised us of ongoing bleeding, you may have “retained products of conception”. This means that some of the tissue has not quite come away from the lining of the uterus. This is a relatively common complication of an early medical abortion. We generally do not request an ultrasound to investigate this any further. That's because, in the early stages after a medical abortion, it's normal to have blood clots, debris, and a thickened uterine lining. We may ask you to have a blood test performed to ensure that you do not have an ongoing pregnancy. There are 3 options for managing “retained products”, and the decision between these 3 depends on your symptoms and preferences. These are: - Conservative management: this means waiting for your body to naturally expel the tissue. This is most appropriate in the early weeks post-medication and if the bleeding isn’t significantly heavy. - Medical management: This means repeating the 2nd step of the medication (Misoprostol) to induce the uterus to contract. This should detach the retained products, but may not. This is an option if you do not want to wait, or your bleeding is at a level that the doctor recommends not waiting. For managing “retained products”, you should take 4x misoprostol tablets in the same manner as the second step of an early medication abortion. If tissue hasn't passed within four hours you take an additional two tablets in the same way. Misoprostol is a normal pharmacy medication . However it can sometimes be difficult to find a pharmacy that will dispense this medication, even if you have a prescription, which we will give you. If needed, Clinic 66 Online can arrange for the misoprostol medication to be sent to you directly. - Surgical management: Admission as a day procedure at a hospital or private clinic for a “D&C” ( dilation and curettage). This is where the tissue is surgically removed from the uterus. D&C is recommended if your bleeding is very heavy, particularly if you are known to be anaemic (low red blood cell count) or iron deficient. D&C may also be recommended if you have an infection. - If you need a “D&C”, you will need to be admitted to a local hospital . Our doctors can speak to your local health care providers and refer you.
Do I need another ultrasound after I’ve taken the MS2step medication?
We do not routinely recommend that you have another ultrasound after taking the MS-2 step medication. An ultrasound is considered only in very specific situations, such as if you have: - a significant increase in bleeding after having passed tissue suspected to be the pregnancy - heavy bleeding that is persisting after taking the medication - a suspected ongoing pregnancy . We suspect this if you have ongoing signs and symptoms of pregnancy or you have a positive urine pregnancy test 5 weeks after your abortion process. A scan done earlier than 3 weeks is unlikely to be helpful due to ongoing blood clots expected to still be present in the uterus. All women will have an abnormal ultrasound if a scan is done 3 weeks after a medical abortion.
Could I have an infection?
The risk of a serious infection after having an early medical abortion is low (less than 1%). You can reduce the risk by not putting anything in the vagina for 2 weeks after the abortion. Symptoms that suggest that you have an infection may include: - Abdominal pain or tenderness - Abnormal or smelly vaginal discharge - Feeling unwell - Nausea, vomiting, or diarrhoea - Temperature >38C If you are experiencing any of these symptoms and your period has not yet returned, we recommend that you follow up with a medical service local to you, or go to the Emergency Department. You can take the “Emergency Care Letter” from the doctor that was sent to you when you were prescribed the medical abortion. If these symptoms start after your next period, or you think they are unrelated to the medical abortion, then we recommend that you follow up through your local health care provider for routine face to face care. We cannot examine you physically by Telehealth. That is why you need to see your local doctor. If you are experiencing any of the following symptoms it is recommended that you present to your local emergency department: - No improvement with antibiotics given to you to treat a suspected infection related to the abortion - Severe pain - Fever >38C - Increased heart rate (tachycardia) - Vomiting - Faint/light-headed - Feeling very unwell
When can I start exercising again?
As soon as you feel well enough, it is safe to start exercising again. In the early days some people may notice that they may experience some cramps and bleeding with exercise. If you experience this you may wish to slow down and rest a little longer. As long as the bleeding is not heavy and you do not have an offensive vaginal discharge or fevers this should settle over time.
When will I get my period again?
The answer to this is quite variable from person to person however, we would anticipate that your regular cycle returns within about 4-8 weeks after having a medical abortion. This depends on several factors including what your cycle was like prior to the abortion and what form of contraception that you may have started.
Do I need to wait until I get my next period before I start contraception?
No. If you are having unprotected sex and delay contraception until your next period it is possible that you may fall pregnant again as ovulation occurs prior to your period starting. Fertility returns very quickly after completing an early medical abortion. It is possible to ovulate again within 5 days of taking the first step of the medication for early medical abortion. We therefore recommend starting contraception as soon as possible. If you have started contraception after having your medical abortion and have ongoing pregnancy-like symptoms (such as sore breasts or nausea) do not assume it is a side effect to your contraception and please let us, or your local healthcare professional know, so that we can investigate whether or not the abortion has been successful.
I have a positive pregnancy test 5 weeks after my medical abortion. Am I still pregnant?
We know that the majority of people after an early medical abortion will have a negative urine pregnancy test by 5 weeks. It is possible to have a positive pregnancy test up to 5 weeks after an early medical abortion as most urine pregnancy tests available are very sensitive and are able to detect very small amounts of the pregnancy hormone known as human chorionic gonadotropin (more commonly known as hCG). During early pregnancy, this hormone goes up quickly and often takes some time to go back to zero after an abortion. If you have retained products after the medication (even a short time) this may also stop the hormones from reducing to normal levels. So, if you have a positive urine pregnancy test, it might just mean that your body needs a bit more time to clear out this hormone. This is especially true if you think the abortion worked, you're not bleeding anymore, and you don't have any pregnancy symptoms. In such cases, we'd usually suggest taking another urine pregnancy test in 7 days time, especially if the test was only faintly positive. If you don't feel confident that the abortion worked, you're still bleeding, or you have ongoing pregnancy symptoms, please contact Clinic 66 Online via SMS on 0428 329 287 for an appointment to get a blood test as soon as possible. This helps us see how the hormone level is changing, and it lets us give you more specific advice. It is also very important to consider whether this is a new pregnancy. It is possible to fall pregnant again 7 days after an abortion and this must be considered if you have recently had unprotected sex. Please use effective contraception after having a medical abortion to reduce the risk of another unplanned pregnancy.
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