Bleeding Before Step 2: When It’s Safe to Continue & When to Seek Help

It’s common to experience some bleeding after taking Step 1 (mifepristone) but before taking Step 2 (misoprostol) in the medical abortion process. Around 1 in 5 people will notice bleeding during this time. While this can feel unexpected, in most cases, it is completely normal, and it is essential to continue with Step 2 as planned as long as your pain and bleeding levels remain within safe guidelines.

Why Does Bleeding Happen Before Step 2?

Mifepristone works by blocking progesterone, the hormone that supports pregnancy. As progesterone levels drop, the uterus starts shedding its lining, which can lead to early bleeding. If safe to do so, it is essential to continue with Step 2 (misoprostol) as planned, to ensure the process is complete.

When It’s NOT Safe to Continue

To ensure you are safe and supported, please answer the following important safety questions. If you answer YES to any of these, STOP and seek urgent medical attention immediately:

1️⃣ Are you experiencing an altered level of consciousness?

2️⃣ Are you experiencing consistent dizziness or have you fainted?

3️⃣ Are you experiencing difficulty breathing or shortness of breath?

4️⃣ Are you experiencing chest pain or a rapid heart rate?

5️⃣ Are you experiencing cool, pale, or clammy skin?

If you are experiencing any of the following, seek immediate medical care and NO NOT TAKE Step 2 (misoprostol).

🚨 Severe Bleeding:

• Soaking 4 or more maxi pads in 2 hours
• Soaking 10 or more maxi pads in 10 hours
• Passing clots the size of a tennis ball or larger

🚨 Severe Pain That Doesn’t Improve:

• Severe pain lasting more than 2 hours even after taking paracetamol and ibuprofen

These symptoms may indicate excessive blood loss, incomplete abortion, or another medical emergency. If any of these apply to you, STOP and seek urgent medical care immediately.

When It’s Safe to Continue

If your bleeding is similar to or slightly heavier than a normal period, and your pain is manageable with paracetamol & ibuprofen, you are safe to proceed with Step 2 at the scheduled time.

Next Steps

If you are not experiencing any concerning symptoms, you can continue as planned and take Step 2 (misoprostol) at the scheduled time (24-48hrs after Step 1 (mifepristone). If you are unsure about your symptoms or need reassurance, reach out for support—we’re here to guide you through every step of the process.

Your safety is the priority—if you're ever in doubt, don’t hesitate to ask for help. 💙

The information provided on this website by Aunty Jane in any format or medium, are for general information purposes only and are not intended as medical advice or as a substitute for consultation with a qualified healthcare professional. The information made available by Aunty Jane do not provide personalised medical advice, diagnosis, or treatment.  To the extent permitted by law, Aunty Jane disclaims all liability for any outcomes resulting from reliance on the information provided. For specific medical concerns, please consult a qualified healthcare professional.