MS-2 Step (medical abortion medicine)
9-minute read
If you have taken MS-2 Step and you have heavy vaginal bleeding (filling more than 2 pads per hour), go to your nearest hospital emergency department immediately or call triple zero (000) and ask for an ambulance.
Key facts
- MS-2 Step is a medicine used in medical abortion (termination) of pregnancy up to 63 days after your last menstrual period.
- It includes 2 medicines used together — mifepristone and misoprostol.
- Mifepristone stops the pregnancy from continuing and misoprostol causes your uterus to push it out.
- You will experience bleeding and abdominal pain while MS-2 Step works.
- Sometimes, if MS-2 Step doesn't work, you may need surgery to end the pregnancy.
What is MS-2 Step?
MS-2 Step is the name of the medicine used for medical abortion.
MS-2 Step has 2 medicines — mifepristone and misoprostol. It's important to take both medicines exactly as directed.
How does MS-2 Step work?
Mifepristone blocks the effects of the hormone progesterone. This causes your pregnancy to stop developing and to detach from the lining of the uterus.
Misoprostol causes the muscle in the uterus to contract and the cervix to open. This helps push out the contents of the uterus.
What is MS-2 Step used for?
MS-2 Step is approved in Australia for medical abortion (termination) of pregnancy up to 63 days (9 weeks) after the start of your last menstrual period.
You should not take MS-2 Step if you:
- are unsure about how many weeks you are pregnant
- have an intra-uterine device (IUD) in your uterus
- have a pregnancy that is not inside the uterus (ectopic pregnancy)
- have a bleeding problem or severe asthma
- have a problem with your adrenal gland
- are taking steroid medicines or blood thinners
- are unable to easily access emergency medical care for the next 14 days
Tell your doctor about any health conditions you have or other medicines you take, including any supplements you buy without a prescription. Some medicines can affect how MS-2 Step works.
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What forms of MS-2 Step are available?
MS-2 Step is available as a package containing one tablet of mifepristone and 4 tablets of misoprostol.
How do I get access to MS-2 Step?
Any family doctor (GP), as well as some other trained healthcare professionals such as nurse practitioners and midwives, can prescribe MS-2 Step. You can also get a prescription from a healthcare professional over telehealth services. Any pharmacy can sell you MS-2 Step with a prescription.
Depending on your location, you can find a service and health professional near you.
How much does MS-2 Step cost?
MS-2 Step is listed on the Pharmaceutical Benefits Scheme (PBS). This means that the government covers part of the cost of this medicine. For the latest information on how much this medicine may cost you, visit the PBS website.
MSI Australia has a cost estimator to help you understand the out-of-pocket costs you may have.
What are the possible side effects or risks of MS-2 Step?
Like all medicines, MS-2 Step can have side effects. These can include:
If you have a skin reaction after taking MS-2 Step, you may be allergic to the medicine. Seek medical help immediately.
If you vomit up to 1 hour after taking mifepristone in Step 1, let your doctor know. They will give you another prescription for MS-2 Step, as well as medicine to reduce your nausea.
Serious complications of medical abortion are rare, but include:
- very heavy bleeding (haemorrhage)
- infections
- incomplete abortion
- continuing pregnancy
How do I take MS-2 Step?
If you forget to take the step 2 tablets (misoprostol) and it is more than 48 hours after you have taken step 1 (mifepristone), contact your doctor immediately.
To take MS-2 Step:
- Step 1 — Take one mifepristone tablet by swallowing it with a glass of water. Take this medicine on an empty stomach, either 2 hours before or 2 hours after a meal.
- Step 2 — Take 4 misoprostol tablets at the same time, 36 to 48 hours after the mifepristone. Hold the tablets in your mouth between the cheek and gum for 30 minutes before swallowing any tablet fragments with water. They should be taken on an empty stomach, either 2 hours before or 2 hours after a meal.
You should avoid drinking grapefruit juice around the time that you are taking MS-2 Step, as it can interfere with the way the medicine works.
What can I expect after taking MS-2 Step?
Step 1 — After taking mifepristone, you can usually continue with your normal activities. Vaginal bleeding usually starts 1 to 2 days after taking the mifepristone tablet.
Step 2 — After taking the misoprostol tablets, you should stay at home and rest for at least 3 hours. Vaginal bleeding usually starts within 4 hours and lasts on average for 10 to 16 days. If bleeding does not occur, contact your doctor straight away.
Cramping and abdominal pain may also occur and can be mild or severe.
You should stay within a 2 hour drive of a hospital for 14 days after starting MS-2 Step in case you have heavy bleeding or complications.
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When should I see my doctor?
If you have taken MS-2 Step and you have heavy vaginal bleeding, go to your nearest hospital emergency department immediately, or call triple zero (000) and ask for an ambulance.
Your bleeding is heavy if you:
- are filling more than 2 pads per hour
- have bleeding that lasts more than 2 weeks or are passing large clots the size of your fist
You should also see a doctor urgently if you:
- have severe pain
- feel weak
- have nausea, vomiting or diarrhoea more than 24 hours after taking the misoprostol tablets
- have fevers or chills
- have difficulty breathing or swelling of your lips or tongue
- have vaginal discharge that smells unpleasant or looks unusual
You should arrange a follow-up appointment with your doctor 14 to 21 days after your first dose of MS-2 Step. It is very important to have a follow-up appointment after taking MS-2 Step to check that the termination was complete.
What should I do if MS-2 Step doesn't work?
If treatment with MS-2 Step doesn't work, your doctor can arrange another method to help terminate your pregnancy, such as surgery.
Your doctor will discuss the options that are best for your situation.
FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.
Resources and support
Australia has safe and supportive abortion and family planning clinics that give advice. Visit:
You can also find a clinic in your state or territory:
- Sexual Health and Family Planning ACT
- Pregnancy Choices (NSW)
- Family Planning NT
- Children by Choice (Queensland)
- Unplanned pregnancy services (SA)
- Family Planning Tasmania
- 1800MyOptions (Victoria)
- Sexual Health Quarters (WA)
You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.
Languages other than English
- Children by Choice offers information about accessing abortion in several community languages.
- Find general information about abortion and information about medical abortion in many languages.
- Watch a video about abortion available in many community languages.
Information for Aboriginal and/or Torres Strait Islander peoples
- Family Planning NSW has a booklet about pregnancy options.