Your EMA Home Medication Pack

This guide is designed to support you through your early medical abortion (EMA) at home. We understand this can be a challenging time, and our goal is to provide you with clear, step-by-step instructions to ensure your safety and comfort. This pack contains your prescribed medications and all the information you need to manage the process from start to finish.

Please read this guide carefully before you begin. It is structured to follow your journey, from understanding the procedure to your recovery and follow-up care. Keep it handy to reference as you go. You could also watch our videos if you prefer.

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1. Understanding your medical abortion 2. Important safety information 3. Your personalised medication guide 4. Step-by-step: taking the abortion medication 5. Managing pain and discomfort 6. Immediate aftercare and recovery 7. Monitoring your recovery 8. Follow-up requirements 9. Ongoing support and when to seek help

PHASE 1: Preparation and understanding

This first phase is about ensuring you have all the information you need before you take any medication. Understanding the process, potential risks, and your rights is crucial for a safe and informed experience.

1. Understanding your medical abortion

A medical abortion is a safe and effective method for ending a pregnancy that is less than 10 weeks in gestation. It involves taking two different medications, Mifepristone and Misoprostol, approximately 24 hours apart. This process is designed so you can complete the abortion and miscarry in a safe, private space of your choosing.

Mifepristone, the first medication, works by blocking the effects of progesterone, a hormone essential for the pregnancy to continue.
Misoprostol, the second medication, is taken 24 hours later and causes the uterus (womb) to contract and begin the miscarriage process.

You should expect to experience cramping and bleeding, similar to a heavy period, which will build in intensity until the pregnancy tissue has passed. This experience varies for each person, but the most intense phase is usually short-lived.

It is safe to breastfeed while undergoing an early medical abortion and you can eat and drink normally during most of the process.

2. Important safety information

Your safety is our highest priority. Please review the following benefits and risks associated with a medical abortion.

Benefits

A medical abortion is a non-invasive procedure that offers privacy and allows you to be in a comfortable, self-directed environment.

Common side effects

During the process, it is common to experience nausea, diarrhea, chills, hot sweats, light-headedness, lower back pain, weakness, and fatigue.

Risk of hemorrhage

There is a small risk of excessive bleeding (hemorrhage) that requires urgent medical attention.

Risk of incomplete abortion

It is possible that some pregnancy tissue may remain in your uterus, which could require further medical intervention.

Risk of infection

Symptoms of infection include fever, chills, odorous vaginal discharge, constant pelvic or abdominal cramps, and feeling generally unwell.

Risk of allergic reaction

Although rare, an allergic reaction to the medication is possible.

Ectopic pregnancy warning: An ultrasound is the only way to confirm a pregnancy is located inside the uterus. Without a scan, there is a risk of an undiagnosed ectopic pregnancy (a pregnancy growing outside the uterus). A medical abortion will not treat an ectopic pregnancy, which can be a life-threatening condition. If you experience sharp or constant abdominal pain (especially on one side), shoulder pain, dizziness, or fainting, you must go to your local emergency medical center immediately.

PHASE 2: Taking your medication

This phase provides a step-by-step guide for taking your medication. It is important to plan a day and time for this process when you can rest and have support available.

3. Your personalised medication guide

During your consultation, our nurse prescribed a specific set of medications to manage nausea and pain. Please follow the instructions for the medications provided in your pack.

Anti-nausea medication (Antiemetics)

Nausea can be a side effect of the abortion medication. We recommend taking your anti-nausea tablet 30 minutes before you take Mifepristone (Day 1) and Misoprostol (Day 2) to help prevent sickness and ensure the abortion tablets are fully absorbed. There are two different types of antiemetics, we will prescribe one of the following medications.

OPTION 1: Ondansetron also known as Periset or Onrex

Take one tablet (8mg) 30 minutes before taking the abortion medication
on day one mifepristone and on day two misoprostol
Place tablet under your tongue it dissolves very quickly
You may take additional doses every 6 to 8 hours as needed for nausea
Do not exceed 24mg total in a 24-hour period

Important Notes: You can take them with or without food. Contact The Women’s Clinic if your nausea is severe or not relieved by medication

OPTION 2: Metoclopramide also known as Maxolon

Take one tablet (usually 10mg) 30 minutes before taking the abortion medication on day one mifepristone and on day two misoprostol
Take one tablet with water
You may take additional doses every 6 – 8 hours as needed for nausea
Do not exceed 40mg total in a 24-hour period

Important Notes: You can take them with or without food. Contact The Women’s Clinic if your nausea is severe or not relieved by medication

Pain relief medication

It is normal to experience pain during a medical abortion. The pain usually comes on shortly before you miscarry the pregnancy and is caused by contractions of the uterus (womb). The severity of the pain varies from person to person and usually settles quickly once the miscarriage has finished. To manage this, take your first dose of pain relief immediately before you take the Misoprostol tablets on Day 2. There are three options for pain relief – which option is best for you will be based on your discussion with one of our nurses.

OPTION 1: Ibuprofen and Tramadol

Take 2 Ibuprofen tablets immediately before you place the Misoprostol tablets in your mouth, between your cheeks and gums.
Continue to take 2 Ibuprofen tablets every 4 hours until you have miscarried. With a maximum of 8 tablets in a 24 hour period.
If you need extra pain relief you can also take 1-2 Tramadol tablets every 4 hours. With a maximum of 6 tablets in a 24 hour period.

OPTION 2: Paracetamol and Ibuprofen

Take 2 Paracetamol and 2 Ibuprofen tablets immediately before you place the Misoprostol tablets in your mouth, between your cheeks and gums (before step 2 on ‘Taking the abortion pill at home’ sheet).
Continue to take 2 Paracetamol & 2 Ibuprofen tablets every 4 hours until you have miscarried. With a maximum of 8 tablets in a 24 hour period.

OPTION 3: Paracetamol and Tramadol

Take 2 Paracetamol tablets immediately before you place the Misoprostol tablets in your mouth, between your cheeks and gums.
Continue to take 2 Paracetamol tablets every 4 hours until you have miscarried. With a maximum of 8 tablets in a 24 hour period.
If you need extra pain relief you can also take 1-2 Tramadol tablets every 4 hours. With a maximum of 6 tablets in a 24 hour period.

4. Step-by-step: taking the abortion medication

DAY 1: Taking Mifepristone

Take your anti-nausea medication 30 minutes before.
Swallow the Mifepristone tablet with water.

DAY 2: Taking Misoprostol (24 hours after Mifepristone)

Take your anti-nausea medication 30 minutes before.
Take your first dose of pain relief medication.
Place the Misoprostol tablets in your mouth, between your cheeks and gums. Let them dissolve for one hour. Do not eat or drink during this hour.
After one hour, swallow any remaining fragments with water.

The miscarriage process should begin within a few hours. You will experience bleeding and cramping, which will intensify until the pregnancy passes.

5. Managing pain and discomfort

In addition to your prescribed medication, these non-medical methods can help manage pain:

Place a heat pack or hot water bottle on your abdomen or lower back.
Ask someone to rub your back.
Walk around if you feel able to.

Remember that this pain is a normal part of the process and will begin to settle once the miscarriage is complete.

PHASE 3: Recovery and follow-up

After the miscarriage is complete, your body will begin to recover. This phase outlines what to expect and the important follow-up steps you need to take.

6. Immediate aftercare and recovery

Rest is important

Take it easy for the rest of the day and for the next few days. You may continue to experience cramping and bleeding, which can include gushes of blood or passing clots. This is normal. Resume your normal activities only when you feel ready.

What to do with the pregnancy tissue

The pregnancy tissue will likely be contained within blood clots. You may see a small embryo if you are over 7 weeks pregnant. You can either pass the tissue directly into the toilet or, if you wish to keep it for burial, transfer it from a sanitary pad to a biodegradable bag or container.

7. Monitoring your recovery

Bleeding & clotting

You may bleed on and off for up to six weeks and pass clots for up to 10 days.

Pregnancy symptoms

Nausea and breast tenderness should disappear within a few days. If they persist, please contact us.

Your period

Your period should return in 4 to 8 weeks. The first one may be heavier or lighter than usual.

Fertility

Your fertility returns to normal almost immediately. You can get pregnant again right away.

8. Follow-up requirements

Mandatory follow-up test

You are required to confirm the abortion is complete using the CheckTOP test provided or by getting a blood test. Standard store-bought pregnancy tests are not suitable for this.

STI screening

If you provided swabs for STI screening, we will contact you only if the results are positive to arrange treatment. No news is good news.

9. Ongoing support and when to seek help

We are here to support you. Please contact us if you would like to arrange post-abortion counseling or discuss contraception options.

Contact us or your GP if you experience:

Severe or prolonged abdominal cramps.
Unusual or foul-smelling vaginal discharge.
Ongoing pregnancy symptoms.

Go to an emergency department if you experience:

Severe, continuous heavy bleeding (soaking through two or more maxi pads per hour for two hours in a row).
Fever or chills that are not improving.
Fainting or extreme dizziness.

If you have any further questions, do not hesitate to contact us. We are here to support you throughout your journey.