How to use abortion pills if you have no access to an abortion clinic in the USA

 

If you live in the U.S., abortion is legal in every state. However, it is a crime to induce an abortion if you did not get the medicines (mifepristone, misoprostol) from a doctor, nurse practitioner, physician assistant or nurse midwife who is authorized to provide these medicines. It is also a crime to help a woman to get the abortion pills if you are not a licensed medical clinician. The penalty for this depends on which state you live in, but can carry serious fines and prison sentences. The contents of this webpage are for informational purposes only.

Photo by Kristof Borkowski from flickr

Click aquí para encontrar informacíon en español.

If you're located in Hawaii, New York, Oregon, or Washington state, you may be able to receive abortion pills by mail through the TelAbortion Study. Please visit www.telabortion.org for further information about this study.

How Can I Have a Safe Abortion with Pills?

In countries where abortion is legal, two medicines, mifepristone and misoprostol, are available from doctors and are 95-98% effective in safely ending an unwanted pregnancy up to 12 weeks. The service is provided in clinics and is extremely safe.


Misoprostol alone is also very safe and is 80-85% effective in ending an early unwanted pregnancy (up to 12 weeks). In Mexico and many other countries in Latin America and the Caribbean, misoprostol is available over the counter (without a prescription) in pharmacies. It is generally used for ulcers and for arthritis.

Where can I get Misoprostol?

In many states along the Mexican border, misoprostol, also called cytotec, is sold in flea markets, bodegas and in the black market.  

In Mexico and other countries in Latin America, prescriptions are not required for most medicines available in pharmacies. Therefore it is possible to buy misoprostol. In many cases, the pharmacist will not ask why you want to buy the medicine. If the pharmacist asks, you can say that it is for your mother’s ulcers or for your grandmother’s arthritis. If a pharmacy will not sell the misoprostol to you, you can try a different pharmacy.

There are many Internet sites that claim to sell misoprostol or mifepristone. The majority of these are scams; they do not send genuine medicines. 

In Mexico, how is Misoprostol sold?

In Mexico, misoprostol is available in most larger pharmacies. It is sold under several names, and the price for each brand varies. There are two large chains of pharmacies. In Farmacias Similares, misoprostol is sold under the brand name Cyrux. In Farmacias del Ahorro, it is sold as Misoprostol.

The cost for a box or bottle of 28 pills ranges from US $35 to $127, depending on the brand.

Misoprostol – 420 pesos, $35 US
Cyrux – 500 pesos, $42 US
Tomisprol – 890 pesos, $75
Cytotec – 1500 pesos, $127

Make sure to buy a sealed box or package.

What if I don’t speak Spanish?

In many pharmacies, if you write down the name of the medicine that you want to buy, they will help you.

How many misoprostol pills do I need?

If you are less than 12 weeks pregnant, you will need 12 tablets of 200 mcg each. In Mexico you usually will need to buy the full box of 28 tablets; pharmacists usually are not allowed to open the prepacked box. You might also be able to find Mifepristone in some pharmacies

It is very important that you know how many weeks pregnant you are. Have you taken a pregnancy test to confirm your pregnancy? If you cannot have an ultrasound, calculate the duration of pregnancy by counting the number of days since the first day of your last menstrual period. You can do this method till 12 weeks of pregnancy.

Try to get 12 tablets of Misoprostol in a local pharmacy or from a trusted source. Misoprostol has many different brand names, to find the brand name available in your country please go to http://www.womenonwaves.org/en/map/country.

The use of Misoprostol alone is more than 90% effective. The information is based on research by the World Health Organization.  Please send an email to info @womenonweb.org when you are more than 12 weeks pregnant. In this case the risk of complications increases and the amount and use of misoprostol is different.

You should not use the medicines if:

  • someone is forcing you to end your pregnancy.
  • you are not sure about wanting to end your pregnancy.
  • you have an allergy to Misoprostol or prostaglandins
  • you have one of the following diseases: Chronic adrenal failure, severe liver failure Hemorrhagic disorders or bleeding disorders/diseases, Inherited porphyries. (It is highly unlikely that you have one of these diseases and do not know it yet.)
  • you have an ectopic pregnancy (a pregnancy outside the womb).
  • you cannot get to a hospital or first aid center within an hour.
  • you are alone. You should ask a partner, friend or other trusted person to stay with you while you use the medicines.

When you are in a bad medical condition, such as severe anemia, recently had abdominal operations that did not heal well, had previous deliveries with heavy complications like bleeding, caesarian, please first ask for advice of a (our) medical doctor.

If you have is an intrauterine device (IUD), it is better to have it removed before using the medicines. When the doctor does not want to take it out, you can do a medical abortion anyway, as it has not been proved to give more complications.

In many countries the pharmacy will ask for a prescription from a doctor, but sometimes you can get it without prescription if you are persistent and say it is for an ulcer (Cytotec), or for your grandmother’s arthritis (Arthrotec or Oxaprost, which also contains a painkiller diclofenac)

Don’t stop after the first “no”!

How to use Misoprostol?

Avoid drinking alcohol or eating heavy meals on the day you take the misoprostol, the days afterwards you can eat and drink as you like.

You will need 12 tablets with 200 mcg of Misoprostol each.

Follow these steps:

  • Put 4 pills of Misoprostol (200 mcg) under your tongue and keep the tablets there for at least 30 minutes,. You can swallow your saliva, but avoid eating or drinking while the tablets are dissolving. After 30 minutes, you can spit out any remaining bits of pill (especially when you used the medicines called oxaprost or arthotec).
  • 3 hours later put 4 pills of Misoprostol (200 mcg) under your tongue and keep the tablets there for at least 30 minutes,.
  • 3 hours later put 4 pills of Misoprostol (200 mcg) under your tongue and keep the tablets there for at least 30 minutes,

It is important to use the second and third doses of misoprostol even if you are already bleeding and think the abortion already occurred. These doses will help make sure the process is complete and make it less likely that you will need any sort of medical attention.

If a woman uses Arthrotec to induce an abortion, she should let the 4 tablets dissolve under her tongue until the outer mantle is dissolved (half an hour). She should spit out the inner hard tablet. The inner tablet is diclofenac, a painkiller and it is better not to swallow the inner tablets.

 

4 misoprostol pills under the tongue

photo by Benjamin Sadkowski

 

What to expect?

Usually bleeding starts after 4-6 hours after the first dose of misoprostol, but it can start as early as after one hour but sometimes only after 12-24 hours. You may experience pain, cramping, bleeding that is heavier than a menstruation, with blood clots. The longer the length of the pregnancy, the stronger the cramps and bleeding will be.

Women can also have nausea, vomiting, diarrhea, and chills as normal effects of the misoprostol.

As the abortion completes, the cramps and the bleeding will gradually diminish.

It is normal for the bleeding to get lighter and to slowly diminish over a period of 1-4 weeks, or even longer. The first menstruation should come 4-6 weeks after the abortion, though it can take even longer. You should use menstrual pads, do not use tampons.

After 3 weeks, take a pregnancy test to confirm that the pregnancy has ended.

If you did not bleed, or only had very little bleeding after using the medicines or the pregnancy test is still positive after 3 weeks, please go to local doctor to get an ultrasound. It is possible that:

  • If you did not have chills, cramps, fever, pain or nausea, you probably used pills that were not misoprostol but fake. 
  • Misoprostol alone is approximately 90 % effective and does not always cause an abortion. If you are sure that you have real misoprostol, you can try again after 3 days.
  • The pills have been taken in a wrong way.
  • You have an ectopic pregnancy, which is a pregnancy outside of the uterus. Misoprostol will not work in this case and you should see a doctor IMMEDIATELY. A sign for this is increasing pain in one side of the lower abdomen. Please readhttps://www.womenonweb.org/en/page/525/in-collection/6903/what-is-an-ectopic-pregnancy-and-how-do-you-know-you-have-one. The diagnosis can only be done by ultrasound.

When you have an ongoing or ectopic pregnancy, the pregnancy signs (if you had those before) like nausea, swollen breasts etc, will remain.

 

Signs of a complication

If you have any of the following signs of a complication you should immediately go to the doctor:

  • Heavy bleeding (bleeding that fills more than 2 regular maxi pads per hour, for 2 hours or more. It is bleeding that is like having a faucet open, but with no pressure); ); in case of heavy bleeding, you should immediately take 2 extra tablets of Misoprostol under the tongue and go to the hospital at once. Swallow them or spit them out before you enter the hospital.
  • Fever 39º at any point, or 38º that continues for more than 24 hours;
  • Strong or persistent pain that does not go away within a few days after the abortion and even if you take painkillers.
  • Abnormal vaginal discharge (abnormal in colour, texture, and/or odour)

If you go to the hospital, you can tell the doctors you think you had a miscarriage. The symptoms and treatment are the same for miscarriage or abortion, and doctors know how to handle a miscarriage.

  

Painkillers

Women often feel cramps after using the misoprostol. You can use painkillers such as Ibuprofen, Diclofenac, (these are the most effective) or Paracetamol. Most women find that they can manage the pain when they use painkillers. 
Please read the patient instructions of the package of painkillers you obtained for the maximum doses you can use. 

Some of the brands that have misoprostol (like Artrotec or Oxaprost) are actually a combination of misoprosol with the painkiller diclofenac. Arthrotec is available as either Arthrotec 50 or Arthrotec 75. These numbers refer to the amount of Diclofenac in each pill. The amount of misoprostol is the same - 200 mcg. Each pill is made up of a small tablet of diclofenac covered by a thick coating that is the misoprostol. If you break the pill apart you can see this clearly. The misoprostol is a bit softer and will dissolve or break more easily than the diclofenac. When you used the first dose of Arthrotec or diclofenac you can swallow the remains of 1 of the 4 tablets (which is the small pill of diclofenac) after the misoprostol dissolved and spit out the remains of the other 3.

  

How to get misoprostol

In some countries women can get Misoprostol at their local pharmacies and use it alone. But if you can get help from Women on Web it is better to do a medical abortion with Mifepristone and Misoprostol. It is much more likely she will have a successful abortion than if she uses Misoprostol alone (99% effective with both medicines compared to only 90% with Misoprostol alone).

Some brand names for Misoprostol are Cytotec, Arthrotec, Oxaprost, Cyprostol, Prostokos and Misotrol. Sometimes it is sold over the counter without a prescription, or sometimes a prescription is required. It is less likely that one would need a prescription for Arthrotec. A woman can of course also make her own prescription (see example below)

Misoprostol is used to prevent gastric ulcers.
Cytotec, Cyprostol, Mibetec, Misotrol, and Prostokos are brand names for Misoprostol. 


Arthrotec and Oxaprost contain Misoprostol and a painkiller called Diclofenac. It is used for pain in the joints, or arthritis. Arthrotec is generally more expensive than Cytotec.

- Cytotec (200µg Misoprostol) 
- Arthrotec or Artrotec 50 or 75 (200µg Misoprostol)
- Cyprostol 
- Misotrol (Chili) 
- Prostokos (25µg Misoprostol) (Brazil)
- Vagiprost (25µg Misoprostol) (Egypt) 
- Oxaprost 50 or 75 (200µg Misoprostol) (Argentina)
- Misotac (Egypt, Ghana, Sudan, Tanzania, Uganda, Zambia)
- Mizoprostol (Nigeria
- Misive (Spain)
- Misofar (Spain)
- Isovent (Kenya, Nepal) 
- Kontrac (India, Democratic Republic Congo) 
- Cytopan (Pakistan) 
- Noprostol (Indonesia)
- Gustrul (Indonesia)
- Asotec (Bangladesh)
- Cyrux (Mexico)
- Cytil (colombia) 
- Misoprolen (Peru)
- Artrotec (Venezuela, Hong Kong, Australia)
(even more brands are : Mibetec, Cytomis, Miclofenac, Misoclo, Misofen, Arthrofen, Misogon, Alsoben, Misel, Sintec, Gastrotec, Cystol, Gastec, Cirotec, Gistol, Misoplus, Zitotec, Prestakind, Misoprost, Cytolog, GMisoprostol, Mirolut, Gymiso)

To obtain one of these medicines, one could, for example, say that your grandmother has rheumatoid arthritis so severely she can not go to the pharmacy herself, and that you do not have money to pay for a doctor to get the prescriptions for the tablets.

If there are problems to get the medicines in one pharmacy, try another pharmacy, or a male friend or partner might have fewer problems obtaining them. Or perhaps you can find a doctor willing to prescribe them. Usually one can expect more luck at the smaller pharmacies that do not belong to a chain.

Sometimes Cytotec can also be bought on the black market (places where you can also buy Marijuana). However try to make sure that is really is Misoprostol and not fake pills or some other medicine! See the picture on this page for an example of genuine pills. 

The woman should buy at least 12 pills of 200 mcg Misoprostol. One pill of Cytotec or Arthrotec should contain 200 micrograms of Misoprostol. Look for the dosage of Misoprostol on the package, usually the tablets contain 200 mcg but other dosages do exist. If the pills do not contain 200 micrograms of Misoprostol, recalculate the number of pills so that the same total amount of Misoprostol is used. 

 

For the future

Get good contraception to prevent a new unwanted pregnancy.
An IUD can be inserted by a doctor as soon as the bleeding has finished and a pregnancy test is negative or when an ultrasound shows an empty womb.
Oral contraceptives can be taken once the bleeding is finished as well, but they will not be completely safe during the first month. Use extra contraceptives such as condoms for extra protection during the first month.

If you have any questions about this method or experiences you want to share, send email to info@womenonweb.org

I have read all of the instructions at www.womenonwaves.org . But what if after taking the tablets I need to see a doctor or go to a hospital?

Misoprostol causes a miscarriage. The symptoms of a miscarriage and an abortion with pills are EXACTLY the same and the treatment is EXACTLY the same. You do not need to say that you took the medicines. If you took the medicines as instructed at www.womenonwaves.org, they dissolve and there is no test that can tell a doctor or nurse that you took medicines. In every hospital in the world, doctors know how to treat a miscarriage or a complication from a miscarriage.

It is important to remember that in many states in the U.S., causing an abortion by yourself is a crime. Any person that knows you used the medicines by yourself might feel obliged to report you.

If you have any questions about this information, please contact info@womenonweb.org.