Abortion with Pills and Telemedicine Services
Medical abortion, also known as abortion with pills, is a process whereby a pregnancy is terminated by taking medicines. The pregnancy is then expelled by the body like a natural miscarriage. Abortion with pills is the most common method of abortion used by women in Malta. This page summarises the facts about medical abortion, and answers some frequently asked questions.
The most commonly used abortion pills are Mifepristone and Misoprostol and according to World Health Organisation guidance these could be safely used at home up to 12 weeks of pregnancy. These medicines are over 98% effective at terminating a pregnancy.
An abortion with pills with Mifepristone and Misoprostol is usually carried out as follows. If you only have Misoprostol, click here.
The first abortion pill, Mifepristone, is taken at a dose of 200mg. The Mifepristone tablet is swallowed. Nausea is a common side effect. It is rare for the miscarriage to start after Mifepristone, but you may get some cramps and spotting before you take the second abortion pill.
The second abortion pill, Misoprostol, is taken 24 hours later at a dose of 800mcg. Depending on the dose in each tablet*, this usually means four Misoprostol 200mcg tablets are used at once. Misoprostol tablets are placed under the tongue for 30 minutes, where they dissolve. Misoprostol can also be placed inside the vagina. Cramps and bleeding should start in a few minutes to a few hours after Misoprostol is used. You may pass a fluffy white sac which is the pregnancy sac, but it is rare to see a formed embryo.
If three hours after taking Misoprostol there is not much bleeding, a second dose of Misoprostol should be taken, which usually means placing another two or four Misoprostol 200mcg tablets under the tongue for 30 minutes or inside the vagina. For pregnancies of over 9 weeks, a second dose of Misoprostol should always be used.
* Misoprostol tablets may come in strengths of 400mcg each. If you have Misoprostol 400mcg tablets, the number of tablets used in each step should be halved.
It is normal for bleeding to be heavier than a normal period and with clots. However, if the bleeding is too severe, if the pain is too great, or in case of a fever or a smelly vaginal discharge, one will need to seek medical help.
You can also watch this informative video by Doctors for Choice on how abortion pills are used (in English):
If you only have Misoprostol:
It is possible to have an abortion using only Misoprostol, although ideally this should be used with Mifepristone as written above. Women on Web and Women Help Women always send packages containing both Mifepristone and Misoprostol. However, we are aware of women in Malta who have obtained only Misoprostol. The protocol for an abortion with only Misoprostol is as follows:
Misoprostol is taken at a dose of 800mcg. This usually means four Misoprostol 200mcg tablets are used at once. Misoprostol tablets are placed under the tongue for 30 minutes, where they dissolve. Misoprostol can also be placed inside the vagina. Misoprostol should be moistened before being placed in the vagina.
After three hours, another dose of Misoprostol 800mcg is taken.
After another three hours, another dose of Misoprostol 800mcg is taken. More doses of Misoprostol may be taken if needed until the abortion starts.
In total, at least 12 tablets of Misoprostol 200mcg are needed for a Misoprostol-only abortion. The success rate of a Misoprostol-only abortion is approximately 84%. Bleeding should start within 7 hours after taking the first dose of Misoprostol. If there is little or no bleeding by 72 hours, it means the abortion was not successful.
How to reduce pain during the abortion:
Abortion pills start a miscarriage, and the pain during a miscarriage is typically more than that of a normal period, and is felt as cramps (it comes and goes). The same medicines that are used to reduce the pain of periods are also effective at reducing pain during an abortion. These include medicines of the NSAID class such as Ibuprofen (Nurofen), Mefenamic acid (Ponstan or Alfoxan), and Diclofenac (Catafast). If you do not have any of these or you cannot use these types of medicines for health reasons, you can use Paracetamol (Pandaol) instead.
You can take the first dose of painkillers about an hour before Misoprostol, and then repeat the dose every few hours until the pain subsides. By five hours after using Misoprostol the pain would usually have reduced a lot, but it is normal to have cramps for a number of days after the abortion.
If you need medical assistance:
Less than 5% of people who use abortion pills in the first 12 weeks of pregnancy will need medical assistance. However, if you develop a lot of bleeding (for example, you fill more than four maxi pads in two hours), or you have too much pain that does respond to painkillers, or you develop a fever or a smelly vaginal discharge you will need to seek medical help as soon as possible. If it is an emergency, go to hospital. If it can wait a bit, you can see a gynaecologist in a clinic. If you cannot be sure whether the professional you are seeing is pro-choice, you do not have to say you used abortion pills. You can say you are having a miscarriage.
There is a small chance (less than 1 in 20 cases) that a pregnancy may continue after taking abortion pills. To confirm that the abortion pills have worked, you can take a pregnancy test two weeks after taking pills. If it is negative, the abortion has been successful. If it is positive, you should re-take the pregnancy test after another week. An ultrasound can also determine whether the pregnancy has continued. If the abortion with pills has been unsuccessful, another course of Mifepristone and Misoprostol can be taken if you are still less than 12 weeks pregnant. A surgical abortion is also an option.
How to get abortion pills
It is a known fact that Women on Web and Women Help Women send abortion pills to women in Malta.
These are reputable organisations that offer online telemedicine services and are known to send authentic pills. Both of these organisations send kits containing Mifepristone and Misoprostol, which are the medicines recommended by the World Health Organisation for medical abortion.
These organisations take care to ask you questions to make sure it is safe for you to use abortion pills. They ask for a donation of around EUR 90 to cover the costs of the pills and postage. The pills usually arrive in one to three weeks. Please remember that using abortion pills in Malta is illegal. You can find more information on how to order abortion pills on Safe Abortion Malta.
Avoid other sites on the internet that claim to sell abortion pills. Many of them are scams and ask for large sums of money. If you are in doubt about whether a site is an authentic abortion pill provider, contact us.
Abortion pills for future use
Women on Web also provide abortion pills to people who are not pregnant in case they need to use them in the future. You can find more information about this service here.
Frequently Asked Questions
Abortion is illegal in Malta. Can I get in trouble if I have an abortion?
Taking pills to end a pregnancy is illegal in Malta. We are not aware of any women who have been taken to court recently for having an abortion. However, this could happen if you get caught. If you would like legal advice from pro-choice lawyers, you can contact the Women's Rights Foundation.
Abortion pills have other medical uses. For example, Mifepristone is used to treat certain types of cancer, and Misoprostol is used to treat stomach ulcers.
If you have an abortion abroad in a country where it is legal (which is almost all other EU states), then you cannot be prosecuted in Malta.
Can abortion pills be used at home?
Yes, abortion pills can be used at home with pregnancies of up to 12 weeks, according to the World Health Organisation.
The risks of a medical abortion are the same as those of a miscarriage. About 15% of all pregnancies end in a miscarriage, most of which do not happen in a hospital. Most women will deal with early miscarriages themselves and only seek medical attention in case of problems, such as prolonged heavy bleeding or fever. A medical abortion resembles a miscarriage and can occur safely at home.
How effective are abortion pills?
Mifepristone and Misoprostol successfully terminate the pregnancy in 99.5% of cases. In 97% of cases, the woman's body eliminates all the pregnancy remains naturally.
It is normal to see bleeding with clots for 1-3 weeks after an abortion. If you have extreme pain, prolonged heavy bleeding, smelly vaginal discharge or fever, it might be a sign that you have a complication and should get medical help.
How long do abortion pills take to arrive in Malta?
Abortion pills from Women on Web and Women help Women generally arrive in one to two weeks. However, delivery times vary because the organisations often use different methods of postage. If the pills do not arrive or are late, please contact the organisation you ordered them from.
Can I use painkillers during an abortion with pills?
Yes. Cramping pains are to be expected during an abortion and Ibuprofen (Nurofen) is the most effective painkiller. Paracetamol (Panadol) can also be used but may be less effective.
Nausea is also common during abortion and tablets like Motilium can help.
Will I see an embryo come out after an abortion with pills?
Most probably not. You will see blood and tissue (clots) but it is very unlikely that you will see an embryo. For abortions done in the first 8 weeks of pregnancy, the embryo usually is too small to be seen. Beyond 8 weeks, an embryo or parts of it may be seen, although these are usually obscured by blood and tissue.
I have taken abortion pills and I need to see a doctor. Can they find out I used abortion pills?
Not unless you tell them. There is no test they can do to check whether you took abortion pills, unless they find the pills themselves. Women on Web advise that Misoprostol is put under the tongue instead of inside the vagina, so that no residue of the pills can be found.
If you have taken abortion pills and you think you need medical help, for example you feel very weak, have bled too much, or have a fever, you should seek help immediately.
What happens if I vomit after taking Mifepristone or Misoprostol?
If you vomit in the first 90 minutes after swallowing Mifepristone, it may be less effective. However, as advised by Women Help Women, you can still continue with the abortion and take Misoprostol the next day.
If you vomit 90 minutes or more after swallowing Mifepristone, then it has already been absorbed and you do not need to worry.
Since Misoprostol is held under the tongue for 30 minutes and you do not have to swallow it, vomiting is less likely to be a problem. However, if you do vomit during those 30 minutes you should take another dose of Misoprostol. Putting Misoprostol inside the vagina is also an option.
Nausea is very common during the abortion process. You can take medicines like Motilium to help with this.
What happens if I forget to take Misoprostol after Mifepristone?
Misoprostol can be used as late as 72 hours (3 days) after Mifepristone. If you do not take Misoprostol at all after taking Mifepristone, you could have one of three outcomes:
1. You could have a complete abortion anyway.
2. You could have a missed abortion (an unviable fetus that remains in the uterus) and this will have to be removed with a minor surgical procedure.
3. Your pregnancy could continue.
There is no evidence that the effects of Mifepristone can be reversed using Progesterone or any other drug.
How do I know if the abortion pills worked?
A few hours after taking Misoprostol you should start to see blood, which should be at least as heavy as a period. Since the pregnancy hormones take a while to come down after an abortion, a pregnancy test may remain positive for up to three weeks after an abortion.
You could have a pregnancy test at 2 weeks after taking abortion pills: If it is negative, then the abortion definitely happened. If it is positive at 2 weeks, it does not necessarily mean the abortion did not work - you should take another test a week later (3 weeks after the abortion pills). If it is still positive at 3 weeks, then the abortion may have been unsuccessful and you may have to repeat the process or opt for a surgical abortion.
An ultrasound can also be used to tell whether an abortion has been successful.
When should I start using contraception after an abortion with pills?
You should start using contraception straight away, because ovulation can happen soon after an abortion. If you use the contraceptive pill, you can start a new pack the day after taking Misoprostol. If you start the pill more than three days after taking Misoprostol, you should use a condom during the first 9 days.
Will an abortion affect my fertility?
No, an abortion will not affect your ability to have children in the future. However, if you develop a complication you will need to seek help immediately to prevent damage to the uterus.
Can an embryo or fetus feel pain when aborted?
No. According to research by the Royal College of Obstetricians and Gynaecologists (RCOG), a fetus does not have the necessary brain connections to feel pain and is unconscious before 24 weeks. Abortion with pills at home are performed in the first 12 weeks of gestation.
The RCOG research can be accessed here.
When should I NOT use abortion pills?
You should not use abortion pills if:
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Someone is forcing you to end your pregnancy against your will.
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You are not sure about wanting to end your pregnancy.
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The first day of your last menstrual period was more than 12 weeks ago.
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You have an allergy to Mifepristone, Misoprostol, or prostaglandins (this is very rare).
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You have one of the following diseases: Chronic adrenal failure, Hemorrhagic disorders or bleeding disorders/diseases, Inherited porphyrias. (These diseases are very rare.)
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You have an ectopic pregnancy (a pregnancy outside the womb).
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You are alone. You should ask a partner, friend or other trusted person to stay with you while you use the medicines.
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You are under the influence of alcohol or drugs.
Do you have an unwanted or unplanned pregnancy and wish to speak to someone? Do you want to discuss all pregnancy options, including abortion, with someone who is pro-choice? Call us or use the chat at the bottom right of the screen.