Medical abortion: The abortion pill by post
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This service is a safe and legal way to end a pregnancy at an early gestation without needing to attend a clinic for treatment. You should contact BPAS on our bookings and information line 03457 30 40 30 (or if you are from Northern Ireland call 0300 500 8086) to book a telephone consultation and full medical assessment with a trained nurse or midwife who will assess your suitability for treatment. Most women are eligible for NHS funded treatment and we can discuss whether this applies to you when you call. If treatment is suitable and safe, you will receive abortion pills by post a few days later, or we can book you for an alternative treatment in clinic.
Medical assessment
You will have your consultation and medical assessment over the telephone and have opted for remote abortion pill treatment (pills by post).
Consent
We will explain the known risks and complications of your treatment during your telephone assessment. The risks and complications of this treatment are shown below.
Risks and complications of the abortion pill
Significant unavoidable or frequently occurring risks
These are usually easy to treat and rarely have any long-term health effects:
- You may see a recognisable pregnancy
- Unpredictable time to complete the procedure (variable)
- Side effects of drugs such as nausea, vomiting, diarrhoea, headache, dizziness, fever/chills (common)
- Retained products of conception - where the pregnancy is no longer growing but some of the pregnancy tissue is left behind in the womb (2 in 100)
- Infection (2 in 1,000)
- Unpredictable, irregular or prolonged bleeding after the abortion (variable)
- Pain during the procedure (common)
- Pregnancy being significantly later than realised (less than 1 in 1,000). Rarely if a much later pregnancy was not suspected, this may mean the abortion fails, there is more pain or bleeding, or in extreme circumstances a live birth
These may require transfer to hospital or surgical procedures, and may have serious long-term health effects:
- Continuing pregnancy (less than 1 in 100)
- Haemorrhage – very heavy bleeding (2 in 1,000)
- Undiagnosed ectopic pregnancy (1 in 7,000)
- Psychological problems (variable)
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Extra procedures that may be necessary
- Surgical abortion or uterine aspiration (3 in 100)
- Blood transfusion
- Laparoscopy or laparotomy – operation to look inside the abdomen
- Hysterectomy – surgical removal of the womb (2 in 100,000)
Death is very rarely linked to abortion treatment (less than 1 in 100,000 for all abortions).
Treatment
You will receive your treatment package direct from the pharmacy from 1 to 3 days from your telephone consultation (sometimes longer with Bank Holidays). If your package is delayed in the post for a few days you should still take the tablets as directed once they arrive. The package is plain with no indication of its contents, it will be tracked but not signed for. Your pack will contain:
- Medabon pack containing 1 tablet of mifepristone (step 1) and 4 tablets of misoprostol (step 2)
- 2 plastic wrapped misoprostol tablets (step 3)
- Pregnancy test (step 4)
- Codeine (only provided if medically suitable)
- Progestogen only contraceptive pills (if requested and suitable)
Click here to see what your package will look like (contents and medication brand names may vary)
About medical abortion: The abortion pill
The abortion pill involves taking two medicines, mifepristone and misoprostol.
The first medicine, mifepristone, ends the pregnancy. It works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.
The second medicine, misoprostol, makes the womb contract causing cramping, bleeding and loss of the pregnancy similar to a miscarriage.
How to take mifepristone and misoprostol
The timing when you administer your medication is important:
- Step 1 - You will swallow the first medicine (mifepristone) with water
- Step 2 - 1 to 2 days later you will take the second medicine (misoprostol)
- Step 3 - 3 to 4 hours after the first dose of misoprostol, you will take another dose
- You will then pass the pregnancy at home.
How to take mifepristone and misoprostol
Step 1 – Mifepristone
Swallow the mifepristone tablet with water.
You may have nausea or vomiting after swallowing the mifepristone. If you do vomit, you should still use the misoprostol as outlined below. Please telephone if you have any concerns or if you vomit within 30 minutes of swallowing the mifepristone.
Most women do not have bleeding or pain until they take the second medication (misoprostol). Bleeding can occur after taking mifepristone but it is usually light. If bleeding does happen, you should still use the misoprostol. Contact us if you have any concerns.
Step 2 and 3 – Misoprostol
Misoprostol tablets are placed in the vagina or between the cheek and gum. See below for more detail.
Misoprostol (the second medication) causes strong, painful cramps and heavy bleeding.
Bleeding and cramping usually start within 2 to 4 hours after using the tablets. Bleeding and pain are often greatest when the pregnancy is being expelled. Most women pass the pregnancy within 4 hours - timings vary, but it is OK if this happens sooner or later. Almost all women miscarry within a few days.
You may be given codeine to help you manage the pain and you can also use pain relief from supermarkets and pharmacies. Please refer to the ‘Pain Control’ section on this page, for information about managing your pain.
Instructions for using misoprostol (second medication)
You have been sent 6 tablets of misoprostol.
Step 2 – misoprostol
Use 4 tablets placed either in your vagina or between your cheek and gum.
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Into the vagina
Insert 4 tablets as high as possible in the vagina; the exact location is not important only that they do not fall out. You can do this while lying down, squatting or standing with one leg up - whatever is most comfortable for you.
OR
Into the mouth between cheek and gum
Place 4 misoprostol tablets into the mouth between the upper cheek and gum and allow the tablets to dissolve for 30 minutes. If the tablets have not completely dissolved within 30 minutes, you may swallow what is left with water.
Some clients describe the taste of misoprostol as unpleasant and the texture as chalky. Placing the tablets between the cheek and gum is associated with higher rates of nausea, vomiting and diarrhoea.
Step 3 – repeat misoprostol
3 to 4 hours after the first misoprostol tablets, use the 2 remaining tablets by either placing them in your vagina or between your cheek and gum.
Passing the pregnancy (and bleeding)
Use sanitary towels to monitor your bleeding during abortion pill treatment. The amount and type of bleeding can vary for each person and each abortion. It is normal to experience light, moderate, or heavy bleeding during a medical abortion. Not everyone
will pass blood clots during a medical abortion, but for those who do, the clots should be no larger than a lemon. It is NOT normal to have no bleeding/scant bleeding or flooding (see the image below), therefore you should telephone BPAS on 0300 333 68 28
for advice if:
will pass blood clots during a medical abortion, but for those who do, the clots should be no larger than a lemon. It is NOT normal to have no bleeding/scant bleeding or flooding (see the image below), therefore you should telephone BPAS on 0300 333 68 28
for advice if:
- 24 hours after taking the misoprostol, you do not bleed at all, have spotting/only see blood on a tissue when wiping (see Scant image 1)
- You experience heavy bleeding soaking 2 maxi size sanitary pads for 2 hours in a row (see Heavy image 4)
Online casino black jack. Call 999 if:
- You experience extremely heavy bleeding (see Flooding image 5) and feel unwell
Bleeding and cramping usually start 2-4 hours after taking misoprostol but sometimes it can take up to a few days for this to happen. You may see other tissue when you pass the pregnancy. This is larger and more recognisable at higher gestations, but in most cases the fetus cannot be seen without magnification.
Once the pregnancy passes, the amount of bleeding and cramping should noticeably reduce. It is likely you will feel cramping on and off for a week or so and this should be easily managed with ibuprofen or paracetamol. Most women have light bleeding for about 2 weeks, but you may have spotting up to your next period. High limit slots youtube. Sometimes you may have a short episode of pain with a gush of blood or a clot several weeks after the abortion - contact us if this continues.
Side effects
For most women, early medical abortion is like an early miscarriage. It is normal to have bleeding and cramping. You might also:
- feel dizzy
- feel nauseous, vomit and/or have diarrhoea (more likely when misoprostol is placed between the mouth and gum)
- have a headache
- have temporary hot flushes or sweats
If symptoms continue after 24 hours of taking the second medicine, please get in contact with us.
Pregnancy remains
You will pass the pregnancy at home or another place of your choosing. You can decide how you wish to dispose of the pregnancy remains. They can be flushed down the lavatory or wrapped in tissue, placed in a small plastic bag and put in the dustbin.
If you have any other questions about the disposal of the pregnancy remains see pregnancy remains for more information.
Pain control
During an early medical abortion, most women will have a strong cramping, similar to period pains. There are many ways to lessen the pain:
- wear comfortable clothes
- stay in a familiar and relaxing place
- apply a heating pad or hot water bottle to your lower stomach
- use a pain medicine like ibuprofen and codeine
How to get pain medicine
You can buy ibuprofen tablets in 200mg or 400mg strengths and your pack may also contain codeine in 15mg or 30mg strengths. Codeine is not suitable for anyone under 12 years of age.
How to use these medicines
Ibuprofen is for mild to moderate pain. Codeine is for moderate to severe pain. Paracetamol can be used for mild to moderate pain by those who cannot take ibuprofen.
You can start with ibuprofen (or paracetamol) adding codeine when you need stronger pain relief. Or you can just start with codeine. Or alternate the medicines depending on how you feel.
What dose you should take and how often you can take it
Ibuprofen: Do not take more than 2.4g (2400mg) in 24 hours. Take 600mg to 800mg by mouth every 8 hours as needed.
Paracetamol 500mg: Do not take more than 8 tablets in 24 hours. You can take up to 2 tablets by mouth every 4 to 6 hours as needed.
Codeine 30mg: Do not take more than 8 tablets in 24 hours. Take 1 or 2 tablets by mouth every 4 hours as needed. If you are aged between 12 and 18 years, take 1 or 2 tablets by mouth every 6 hours as needed.
Codeine 15mg: Do not take more than 16 tablets in 24 hours. Take 2 or 4 tablets by mouth every 4 hours as needed. If you are aged between 12 and 18 years, take 2 or 4 tablets by mouth every 6 hours as needed.
All aboard game. Please note: Do not drive or operate machinery whilst taking codeine.
If you have tried these options, but still have pain, please call the Aftercare Line on 0300 333 68 28 (or +44 1789 508 210) for advice.
After treatment
Follow-up instructions
The abortion pill is very effective and usually uncomplicated, but it is important to make sure it has worked. Having some cramping and bleeding does not guarantee that your treatment was successful. Misoprostol may cause serious birth defects if the pregnancy continues. If the abortion pill does not work for you, you should contact us to discuss your options.
- You will NOT be contacted by BPAS to find out if your treatment has worked
- You need to complete the ‘self-assessment checklist’ below to ensure your treatment has worked and that you are no longer pregnant
- 3 weeks after starting your treatment, you should use the pregnancy test we sent you, with the first urine you passed when you woke up in the morning. (see below)
Self-assessment checklist
I will contact BPAS if I experience any of the following signs that my treatment has not worked:
- I did not bleed (or had only spotting, or only saw blood on a tissue when wiping) within 24 hours of taking misoprostol tablets
- I had less than 4 days of bleeding
- By the end of week 1, I still ‘feel’ pregnant or have symptoms of pregnancy such as sore breasts, sickness, tummy growing, etc.
- 3 weeks after treatment, I performed the BPAS urine pregnancy test (using the first urine passed when I woke) and the test was positive, invalid, or I was not sure of the result
- My next period has not come by 4 weeks after treatment (even if the pregnancy test was negative)
Telephone BPAS immediately on 0300 333 68 28 (or +44 1789 508 210) if you experience any signs listed above.
Pregnancy test instructions
The pregnancy test we sent with your medication should be used 3 weeks after you swallow the first medication (mifepristone). The pregnancy test should be performed using the first urine you pass after waking in the morning.
This is a diagram of your pregnancy test:
- Remove all packaging
- Remove the cap from the test
- As you urinate, hold the absorbent tip of the test in the urine stream or collect some urine in a clean pot and dip the tip into the urine for 5 to 10 seconds
- Wait 5 to 10 minutes
- Read the pregnancy test
Recovery
Our Aftercare Line is open 24 hours a day, 7 days a week. If you have any questions or are unsure about anything, please call 0300 333 68 28 (or +44 1789 508 210) for help.
What to expect after treatment
Recovery after an uncomplicated abortion usually happens fairly quickly, but it is different for every woman. There are some things to expect, which are normal, and other signs and symptoms that are not. It’s important that you know about both.
Most women recover quickly after an abortion. How much pain and bleeding you experience afterwards can vary.
Feelings
After an abortion, most women feel relieved, but some may also feel sad or guilty.
If you feel you need to talk to someone, you can call us on 03457 30 40 30 (or +44 1789 508 211) to make an appointment for post-abortion counselling. This is a free service for women who have had treatment at BPAS.
Physical symptoms as your body recovers
Symptoms of nausea, vomiting and tiredness usually stop within 3 days of an abortion. Sore breasts may last 7 to 10 days. Take ibuprofen or paracetamol if necessary for the pain.
Important/unexpected or unusual symptoms after treatment
Contact our Aftercare Line immediately on 0300 333 68 28 (or +44 1789 508 210) if:
- you have heavy vaginal bleeding and have soaked through 2 or more large maxi pads an hour, for the last 2 hours
- it is more than 24 hours since you took your misoprostol and you still feel sick, have abdominal discomfort, diarrhoea, nausea, vomiting or weakness
- you have abdominal pain or discomfort that is not helped by medication, rest, a hot water bottle, or a heating pad
- you have a fever of 38°C or higher
- you have an unpleasant smelling discharge from your vagina
- if treated without a scan (or your scan only showed a gestation sac and no yolk sac)
- no or minimal bleeding 24 hours after using misoprostol
- lower abdominal pain worse on one side
- lightheadedness, dizziness or feeling faint
- shoulder tip pain
- if you were treated following a scan showing a pregnancy in your uterus and you have no or minimal bleeding 5 to 7 days after using misoprostol
- if you have a positive pregnancy test or other sign listed on the self-assessment checklist
Telephone 999 for an ambulance if you experience any of the following:
- loss of consciousness
- severe allergic reaction
- acute confused state
- concern for a heart attack or stroke
- chest pain
- slurred speech
- breathing difficulties
- fits that aren’t stopping
- you experience extremely heavy bleeding and feel unwell
More information
Other questions you may have
Does having an abortion increase my chance of getting breast cancer?
No, there is no proven association with breast cancer and abortion.
Can I continue breastfeeding during a medical abortion?
Both mifepristone and misoprostol pass into the breast milk but the amounts are small and should not cause any adverse effects in breastfed infants. Breastfeeding may continue uninterrupted following mifepristone and misoprostol. If breastfeeding an
infant under 6 months’ of age, express and discard milk whilst taking codeine and for the first feed after the last dose of codeine.
infant under 6 months’ of age, express and discard milk whilst taking codeine and for the first feed after the last dose of codeine.
Will having an abortion cause problems with future pregnancies?
If your abortion is uncomplicated there should be no issues with future pregnancies as a result of the abortion.
There are no proven associations between abortion and future infertility, ectopic pregnancy or placenta praevia.
Having an abortion may be associated with future pregnancies ending before the due date. This risk appears to increase when someone has had more than one abortion.
How will I feel afterwards?
Every woman is different so they feel, experience and cope in a way individual to them. There is no evidence to suggest that you will experience any mental health issues as a result of an abortion. However, if you have a history of mental health problems you may still have those problems whether you choose to have the abortion or not.
What about travel after treatment?
Travel is not ideal in the first 24 hours after using misoprostol. You may experience symptoms whilst in transit. You will need to know how to access emergency services in case of a complication.
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What about contraception and STI Screening?
Routine STI screening is recommended for all women having an abortion. Almost all methods of contraception can be started on the same day as medical abortion or the day after. If you choose intrauterine contraception (IUD or coil) this can be inserted as soon as the abortion is complete. If you live in England, Scotland or Wales, you can see your GP or local contraception and sexual health service to obtain contraception after treatment.
To locate your nearest NHS contraception or service or STI clinic visit the following websites:
England www.nhs.uk/service-search
Northern Ireland www.informingchoicesni.org
Scotland www.sexualhealthscotland.co.uk/get-help/sexual-health-service-finder
Wales www.nhsdirect.wales.nhs.uk/LocalServices
Feedback and complaints
If you want to provide any feedback about the service you have received, please email [email protected]
After treatment we will email you with a link to complete our satisfaction survey, if you agreed that we may do so.
There may be times you want to feedback formally or raise a complaint with us. Find out more about BPAS complaints and feedback here.
To raise a complaint you can:
- speak to a member of staff
- call 0345 365 50 50 (or +44 1789 508 211) and ask to speak to the Client Engagement Manager. If you are deaf or hard of hearing and use a textphone you can call 0345 365 1450 (or +44 1789 416 584)
- write to the Client Engagement Manager, British Pregnancy Advisory Service, 20 Timothys Bridge Rd, Stratford Enterprise Park, Stratford-upon-Avon, CV37 9BF, or email [email protected]
Definition of Chills
Chills or rigor refers to the involuntary, continuous contractions of skeletal muscles with paroxysms of excessive shivering and teeth chattering.
When the body attempts to produce heat to increase its temperature from within, the muscles contract and relax rapidly. In this way, the body is able to compensate and maintain the homeostasis with regards to temperature.
Chills relates to a feeling of being cold without a supposed cause. Echofon 1 8 7. It normally occurs as a response to exposure to cold. Goose bumps show on the skin when it is cold and during times of stress. However goose bumps are not the same with chills.
The mechanism of goose bumps is when the arrector pili muscle on the dermis contract, causing the hair to lie perpendicular to the skin [1, 2, 3].
What Causes Chills?
Being exposed to cold weather is a common and logical cause for chills without fever. Because of the low temperature, the body compensates by producing heat inside the body through continuous muscle contraction and relaxation [4].
Causes of Chills without Fever
Having chills without fever may coincide with certain medical conditions such as the following [5, 6, 7]:
Influenza (Flu)
This commonly happens among children whose immune system is not yet sufficiently exposed to microorganisms so their body is not yet immune to several types of influenza virus. At first, the person may have chills without the fever yet. 1-2 days later, the fever starts to occur, i.e. when the virus becomes active.
Acute Bronchitis
Acute bronchitis refers to inflammation of the bronchi most commonly due to bacterial or viral infection. The bronchi swell because of the infection, causing chest pain, breathing problems, cough, and chills with or without fever. Chills without fever can also be seen in other respiratory tract infections.
Malnutrition
Default folder x 5 2 1 for mac crack download. This happens when you are not getting enough nutrients that should be able to cater the needs of the body. There is a wide group of causes for malnutrition. Medical conditions, poor diet, and problems with absorption and digestion are the three main ones. Weight loss, dizziness, fatigue, and chills without fever are the main symptoms that seem to be present in the generality of the cases.
Having deficiencies in vitamin B, specifically vitamin B12, is bound to suffer from chills. The series of events that happens upon malnutrition depends entirely on the cause. Treatment includes stabilization of the underlying medical state which causes the malnutrition or replacing the missing nutrients.
Iron Deficiency Anemia
This is a condition characterized by low hemoglobin levels in the blood. The person feels cold even when if the weather is hot. Chills and fatigue also occur with the cold sensations. The hemoglobin in our red blood cells transports oxygen throughout our body.
The blood in itself provides warmth so with iron deficiency anemia, there is less transport of blood to the different parts of the body, especially on the distal parts like hands and feet, hence feeling cold especially on those areas.
Food Poisoning
Sudden chills without fever can occur due to food poisoning. Though some patients get fever and chills due to food illnesses, others do not experience an increase temperature of the body. They may also experience diarrhea, vomiting, and abdominal cramps aside from uncontrollable shivering or shaking.
Urinary Tract Infection
Iswift objective c to swift converter 4 2. Persons suffering from urinary tract infection experience dysuria (painful urination) and a malodorous urine. Chills may occur periodically without fever in instances where the UTI is not that severe. If the infection ascends to the kidneys (pyelonephritis), a person may experience chills eventually with a fever.
Hypoglycemia
Hypoglycemia or low blood sugar level can also cause infrequent chills with diaphoresis (excessive sweating), headache, dizziness, and tachycardia (increased heart rate). A person who is diabetic and having insulin administrations are more likely to have hypoglycemia.
A rapid drop in blood sugar is also caused by an accidental take of excessive dose of insulin. Carefully following the schedule of medications but not eating regularly develops higher chances of hypoglycemia in patients with diabetes. Being an alcoholic, low carbohydrate diet and extreme exercises are other causes of hypoglycemia.
Drugs or Medications
If the prescription is incorrect or an individual is using them in an abusive manner, chills may occur as a side effect of some prescribed drugs. When you are besieged with uncontrollable muscle spasms, there will be chills in periodical sessions. These chills will be accompanied by vomiting, nausea, allergic reaction, insomnia, heart problems, drowsiness, and drug dependence.
Hypothyroidism
Thyroid is a small gland found in a person’s neck. It releases thyroid hormones to regulate your metabolism. When there is lacking production of the thyroid hormone, hypothyroidism occurs. One manifestation is chilling without fever.
It will result to chills because with this condition, you are more sensitive to cold. Some symptoms include depression, fatigue, constipation, joint pain, pale skin, heavy, weight gain, and brittle fingernails and hair. More symptoms may appear as the condition develops. Subsequent manifestations include decrease in sensation, slow speech, puffiness in the hands, feet and face, thickening of the skin, and thinning of the eyebrows.
Psychiatric Disorders
The sensation of coldness is not only experienced by a person with poor physical health. Panic disorders, anxiety problems, and other psychiatric diseases can have cold sensations regardless of the external environment. Chills without fever is a common response to anxiety.
Treatment
Medical Treatment
Chills without fever is not a disease per se. It is a [9].
- Antibiotics/antibacterial for bacterial infections: Intravenous administration is recommended in more serious cases.
- Antiviral drugs for viral infections. However, antiviral drugs are not really necessary because influenza goes away on its own even without treatment. The patient is rather recommended to drink plenty of warm fluids and have a bed rest.
- Improve your diet by carefully planning what and what not to eat. Take vitamin supplements as necessary.
- Seeking emergency call is necessary in cases of food poisoning.
- Intravenous administration of fluids prevents dehydration.
- Levothyroxine is the treatment of choice for hypothyroidism.
- Iron supplements can correct the symptoms of iron deficiency anemia.
- Physiological counseling, relaxation, and breathing techniques are recommended for anxiety or stress-related disorders.
Home Remedies
If your chills is not that severe, it may be controlled by having these home remedies [10]
- Getting enough rest can comfort the chills. 8-9 hours is recommended to sleep at night.
- Do not skip your meal. Eat regularly and make sure not to go hours without getting any form of nutrition for the body. Keep some snacks with you in case of hunger.
- Exercises like brisk walking and quick swimming help in controlling the chills.
- Getting a vitamin B supplement can be a big help in the body. It can reduce your chills and boost your energy.
- Drinking warm water every now and then can help in soothing your body and reducing chills. This helps is to keep the body hydrated very well, and maintaining also the heat in your body.
- Relax through a soothing warm bath.
References:
- Chills without Fever are Caused by Different Conditions. Available from:
- http://hubpages.com/health/Chills-without-Fever-are-Caused-by-Different-Conditions
- Rapid Assessment: A Flowchart Guide to Evaluating Signs and Symptoms by Lippincott Williams and Wilkins
- Chills. Available from:
- http://www.nytimes.com/health/guides/symptoms/chills/overview.html
- Chills without fever. Available from:
- http://ic.steadyhealth.com/chills-without-fever
- Chills without fever. Available from:
- http://www.buzzle.com/articles/chills-without-fever.html
- Chills without fever. Available from:
- http://www.medguidance.com/thread/Chills-Without-Fever.html
- Causes and Treatment for Uncontrollable Shivering. Available from:
- http://www.newhealthadvisor.com/Uncontrollable-Shivering.html
- Healthtap available from:
- https://www.healthtap.com/topics/chills-without-fever-during-pregnancy
- Chills without fever. Available from:
- http://mddk.com/chills-without-fever.html
- How to treat chills without fever. Available from:
- http://basicfirstaid.ca/how-to-treat-chills-without-fever/
Related posts:
Published by Dr. Raj MD under Diseases and Conditions.
Article was last reviewed on August 6th, 2018.
Article was last reviewed on August 6th, 2018.