Medical Termination

A mTOP is when medication is used to end a pregnancy. It is available up until 9 weeks gestation (63 days from the first day of your last period).

Two medications are used for a mTOP: first you take one mifepristone tablet and then 36 to 48 hours later, you take four misoprostol tablets. These medications are provided in a combination pack called MS-2 Step.

Mifepristone acts by blocking the effects of progesterone, a hormone that is needed for pregnancy to continue. Misoprostol causes contractions of the uterus and relaxation of the cervix, which helps to remove the pregnancy implanted in the lining of the uterus. Both mifepristone and misoprostol work together to end a pregnancy; it is important that you take both medications.

Step 1: Green Box (mifepristone 200mg).
Swallow this tablet with water on an empty stomach (two hours before or two hours after a meal).

Step 2: Purple Box (misoprostol 200μg) This step is taken 36 to 48 hours after Step 1.
Take the suggested pain medication, as discussed with your health professional, 30 minutes beforehand. Then, place the four misoprostol tablets between your cheek and gum and allow them to dissolve. Do not swallow these. Bleeding usually starts 30 minutes to 2 hours after taking misoprostol and may continue for about 6 hours before reducing. It is important to take it easy and remain in a quiet and comfortable location, close to a bathroom.

MS-2 step is considered a safe and effective medication for medical termination of pregnancy.

A mTOP is 99% effective in ending pregnancies. In the rare instances where it is not effective (1%) or not fully effective (4%), further medication or surgical termination may be necessary. Continuing a pregnancy after mTOP carries risks of foetal malformations due to misoprostol. Follow-up care is essential to ensure your safety and to check that the medication has worked.

You can take this medication if:

• You are pregnant and it has been less than 63 days since the first day of your last menstrual period (up to two months ago).
• You have easy access to emergency medical care (within a 2 hour drive) for the next 14 days.

You can’t take this medication if:

• Your period was more than 63 days ago.
• Your pregnancy is not inside your uterus. (ectopic pregnancy).
• You are allergic to the medications or are taking medication that would interact with MS-2 Step (eg. steroids).
• You have a medical condition that would make the procedure unsafe. (eg. IUD in place, pelvic infection, chronic adrenal failure, haemorrhagic disorders).
• You want to continue your pregnancy.

Your health professional will discuss this method with you and may arrange blood tests and an ultrasound to confirm your suitability. If appropriate,
they may give you a prescription and this script will usually need to be taken to a pharmacy to obtain the MS-2 Step medicine. This is also an opportunity to arrange any pain relief that may be needed.

MS-2 Step is listed on the Pharmaceutical Benefits Scheme (PBS) so for eligible people the price is fixed between pharmacies. If you do not have a Medicare card, the price can vary. If a pharmacy does not have the medication, you could try another, or contact the 1800 4 CHOICE helpline (1800 424 642).

After taking Step 1, you may experience some bleeding after 1 or 2 days. This bleeding is usually light to moderate and can be managed while carrying out normal activities. After taking Step 2, it is recommended to rest in a quiet and comfortable location for at least 3-6 hours. Bleeding is expected within 4 hours of taking the medication. This medication can cause cramping, ranging from mild period pains to severe cramping and pain. Most people find that these symptoms can be managed with pain relieving medication. The pregnancy is typically expelled within 6 hours of taking Step 2, though sometimes it may take longer. As a result, bleeding during this initial time may be heavier than usual. Bleeding usually lasts 10-16 days but can continue for up to 6 weeks.

After taking the medication, people usually experience symptoms such as nausea, cramping and bleeding. Your healthcare professional can discuss additional medication options to make these more comfortable for you. Other side effects may include:

• Headaches
• Dizziness
• Stomach upset including vomiting
• Breast tenderness
• Hot flashes and rashes

These are usually mild and don’t last long but if they worry you or last more than 24 hours after taking Step 2, you should contact your health professional. Rare complications can occur, which your health professional can discuss with you. These include excessive bleeding, severe pain and infection. There is no evidence to suggest that abortion affects future fertility or future pregnancies.

To reduce the risk of infection, after taking Step 2 you must avoid placing anything inside the vagina for seven days. This means you should:

• not use tampons or menstrual cups. (It is ok to use sanitary pads or period underwear).
• not swim.
• not have baths. (Have showers instead).
• not have penetrative sex.

If you experience any side effects that worry you or last more than 24 hours after taking Step 2, you should contact your health professional or the Sexual Health Helpline on 9227 6178.

You should contact your doctor straight away if:

• You don’t take Step 2 within 48 hours of taking Step 1.
• You do not have any bleeding after taking Step 2

It is also important that you attend a follow up appointment with your doctor after 1-2 weeks to ensure the medication has worked. Home pregnancy tests cannot be relied upon, as they can remain positive for many days after a pregnancy has ended. This follow-up is also a good time to discuss contraception with your doctor, as you can become pregnant again very soon after having an abortion.

Seek urgent medical attention (Call 000 or go to the nearest hospital emergency department) if you:

• Have heavy vaginal bleeding; filling 2 pads an hour for 2 hours in a row. (Call 000 or go to the nearest hospital emergency department).
• Have severe pain.
• You have a serious reaction to any of the medications.
• Experience signs of infection like weakness, persistent fevers, chills or abnormal discharge other than blood