Medical Miscarriage management
Please note, we are currently not offering medical miscarriage management in clinic. We continue to offer medical management at home for pregnancies under 10 weeks.
Depending on your symptoms, you may be given either two different types of medication, mifepristone and misoprostol or you may be given just misoprostol. Your healthcare professional will explain which regimen you will be offered.
If you have been told that you have been prescribed both medicines, you will be given mifepristone first.
Mifepristone is sometimes given before misoprostol as the combination of the medicines will work together to complete the miscarriage. Misoprostol is a medicine which allows the cervix (the entrance of the womb) to open and causes the uterus to cramp so the pregnancy will pass.
The misoprostol tablets are placed under the tongue or into your vagina, it’s up to you. If the pregnancy is less than 10 weeks, you can take these tablets home with you, so you can be in the comfort of your own surroundings to miscarry.
If the pregnancy is over 10 weeks you will need to come into a BPAS centre to receive the medication and to be monitored until the pregnancy has passed. This may mean an overnight stay so bring the items you will need.
If you choose to take the tablets by mouth you will be given 3 tablets. You will need to place the tablets under your tongue and leave them in place to dissolve for 30 minutes. You may then need to swallow the remainder of any pills.
If you choose to have the tablets placed in your vagina you will be given 4 tablets. You can place them in the vagina or if you prefer your healthcare professional can insert them for you. If your blood group is Rhesus-negative you will also have an Anti-D injection.
You will be given antibiotics to take.
However you choose to take the misoprostol tablets they will cause you to have cramps and bleeding. This usually starts about 2 hours after you have taken the tablets but can start sooner. The cramping is usually worse than period cramps and is bad enough that you will need pain medication. We will give you pain control medicine and also instructions on how to take medicines you can buy at the pharmacy.
If this treatment has not worked you may be advised to have a surgical treatment to complete the miscarriage.
You will stay at the centre until the pregnancy has passed, so bring an overnight bag.
Please note, we are currently not offering medical miscarriage management in clinic.
Essential things to bring:
- prescribed medicines including inhalers
- stick on sanitary towels
- extra underwear
- slippers and nightshirt or t-shirt
- toileteries and a towel
A nurse will be in attendance and your progress will be monitored. You can rest in bed or be up and about as you wish. The misoprostol will be repeated every 3 hours until the miscarriage is complete.
Many women will only require 1 or 2 doses of the misoprostol to enable the pregnancy to be passed. You may see large blood clots or the pregnancy but the nurse will try to make sure that you see very little, however, sometimes this is not possible as events can be rapid.
Sometimes the placenta does not come out at the same time as the pregnancy. In this case, you may need more misoprostol or need to be taken to the operating theatre. On rare occasions you will need to be transferred to a local NHS hospital for further treatment.
You will not need a follow up appointment if you have had medical miscarriage management at a BPAS clinic.
There are many ways to lessen the pain
During a medical procedure, most women will have strong cramping, similar to period pains. What you can do:
- wear comfortable clothes
- stay in a familiar and relaxing place
- apply a heating pad or hot water bottle to your lower stomach
- use pain medicine like ibuprofen or codeine
Once the cramping and bleeding begins you may see large blood clots of tissue as the pregnancy passes and you will probably need pain medication.
Most women pass the pregnancy within 4 hours after taking the medication. For others it can be quicker or take longer. Every woman is different but most women pass the pregnancy within a few days.
It’s normal to have some bleeding or spotting for up to 2-3 weeks following the miscarriage. For some women light spotting can continue until the next period. You should use sanitary pads as it makes it easier to keep track of your bleeding.
It is normal for you to have bleeding and cramping. You may also:
- Feel dizzy
- Feel nauseous or vomit
- Have a headache
- Have diarrhoea
- Have temporary flushes or sweats
You may feel more at ease if you have someone with you while the pregnancy passes.
You should start to feel better each day after the pregnancy has been passed. Some mild abdominal cramping is normal and can be managed with painkillers such as ibuprofen.
Please let us know if you are breastfeeding so we can work out the best plan together.
If you are breastfeeding, a little of the misoprostol will be present in the breast milk after you take it. In rare cases, the medication may cause your infant to have diarrhoea. To reduce any risk you can choose to wait 6 hours between taking the misoprostol and breastfeeding.
Miscarriage follow-up instructions
You should start to feel better each day after the pregnancy has been passed.
Medical management in the clinic or at home
Please note, we are currently not offering medical miscarriage management in clinic.
In the clinic
If you choose surgical management or have medical management in the clinic where we can be sure the pregnancy has passed, you will not need a follow-up appointment.
You will be told what is expected as you recover and how to contact us if you have any problems.
At home
If you choose medical management, any pain or bleeding should have lessened or stopped completely within 7-14 days. This usually means that the treatment has been successful.
However, if the pain or bleeding have not started or are continuing or getting worse, this could signal a problem and you should contact us for a check-up. You will be given a home pregnancy test to take 3 weeks after the misoprostol.
If the test is positive, you will need to contact us for an appointment.
Miscarriage recovery
Most women bleed for around 1-2 weeks after treatment for miscarriage or if they have chosen expectant management. It is best to use sanitary towels during this time. You should expect the bleeding to be like a normal menstrual period, but you may pass some small blood clots. Your bleeding should lessen over time, but you may have some spotting until your next period.
If your bleeding soaks 2 or more sanitary towels per hour for 2 hours in a row, then you should contact the clinic or Aftercare Line urgently for advice. If you cannot call, go to A&E.
Most women experience cramping on and off for about a week after the procedure. Take ibuprofen and paracetamol if needed. These can be bought over the counter without a prescription, from pharmacies, supermarkets and other shops.
There are 2 strengths of ibuprofen tablets - follow the directions for the one you have. Always read the patient information leaflet that comes with these medicines and take them as directed.
You can take paracetamol and ibuprofen together if the recommended dose of either medicine alone is not controlling your pain.
If the medicines do not control your pain - call the clinic or Aftercare Line on 0300 333 68 28 (or +44 01789 508 210)
You may experience a variety of emotions regarding the miscarriage and this is normal. You may feel like talking to someone if these feelings remain for a long time. The Miscarriage Association and Relate can provide information about counselling.
If you have any of the below symptoms, you should phone the BPAS clinic where you had your treatment, or the Aftercare Line on 0300 333 68 28 (or +44 1789 508 210) immediately. Alternatively, you should go to A&E.
If you have pregnancy symptoms such as nausea or fatigue, these will go away within a few days of treatment. If you lost a pregnancy after 12 weeks, your breasts may feel firm and tender and leak milk after your procedure. Your breasts will return to normal after 3-4 days of swelling. You will feel more comfortable if you wear a supportive bra and apply cold ice packs to your breasts. Take ibuprofen or paracetamol if necessary for the pain.
Unexpected or unusual symptoms
- heavy bleeding that soaks through 2 sanitary pads an hour for 2 hours or more in a row
- abdominal tenderness, pain or discomfort which is not helped by medication, rest, a hot water bottle or heating pad
- a fever of 38°C or higher
- an unpleasant smelling discharge from your vagina
- no bleeding at all after 24 hours of taking the medication
- a general feeling of being unwell or still feeling pregnant
Bathing
You can have a bath or shower as normal. Take care if you have a bath in the 24 hours after a general anaesthetic - make sure someone is around to keep an eye on you in case you still feel drowsy.
Work and other activities
Most women are fit and well enough to return to normal activities within a day or two. Rest until you feel able to return to your usual routine.
Sex
You may resume sexual activity when you feel ready. You can get pregnant almost immediately following miscarriage, so it is important to use contraception if you do not want to get pregnant.
Travel
It's best not to travel within 24 hours of treatment. If you must travel, make sure you know how to get emergency treatment at your destination in case of complication. Please be aware that, if you are having medical management and choose to travel soon after taking the second medication (misoprostol), you could start to have cramps and bleed heavily whilst you are travelling.
Your next period should come about 4 weeks after miscarriage. If it hasn't or you are concerned, contact us. Remember that any bleeding immediately after treatment is not a period.
Important
Serious complications may have warning signs.
Contact your BPAS clinic or our Aftercare helpline 0300 333 68 28 straight away if you have:
- heavy bleeding that soaks through 2 sanitary pads an hour for 2 hours or more in a row
- abdominal pain or discomfort which is not helped by medication, rest, a hot water bottle or heating pad
- a fever of 38°C or higher
- an unpleasant smelling discharge from your vagina
- no bleeding at all after 24 hours of taking medication (medical management)
How we can help ?
We are an independent healthcare charity which for more than 50 years, has been advocating and caring for women and couples who decide to end a pregnancy.
