Mifepristone and misoprostol for abortion
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How It Works
Mifepristone and misoprostol use is a two-step method.
- First, your doctor gives you a dose of mifepristone tablets by mouth. Mifepristone causes the placenta to separate from the endometrium. It also softens the cervix and increases uterine contractions to allow the uterine contents to pass. For reference, see a picture of the reproductive organs.
- Second, you take tablets of misoprostol by mouth or insert them vaginally, usually within 48 hours of mifepristone. Depending on the dose, this could be as soon as 6 hours after the mifepristone.1 Some doctors may give misoprostol buccally (dissolved between the gums and cheek). Misoprostol causes uterine contractions so that your body passes the uterine contents. Some clinics may have you stay for 4 hours after misoprostol is given, because if serious side effects occur, they usually occur in this time period and can then be treated. The pregnancy may end in the clinic or later at home. Some doctors allow their patients to take misoprostol at home and then the pregnancy ends (like a miscarriage) at home.
Many doctors are only giving misoprostol by mouth. This is because of recent reports of a very rare, fatal infection that affected a few women after they used vaginal misoprostol.2
A medical abortion usually requires at least two visits to your doctor over several weeks. For the first visit, one medicine is taken during the visit and a second medicine is given to be taken at home. The second visit is a follow-up appointment, usually scheduled about 2 weeks after the first visit, to make sure the pregnancy has ended and no complications are present. If a medical abortion is not successful, a surgical abortion is then done to complete the process because misoprostol can cause fetal abnormalities.
You can take pain medicine by mouth for this medical procedure.
Why It Is Used
A medical abortion with mifepristone offers women an early-pregnancy abortion option that doesn't involve surgery.
A medical abortion is only done in the first 9 weeks of pregnancy.1
How Well It Works
Medical abortions can be done through 9 weeks of pregnancy. Up to 7 weeks, the combination of mifepristone (orally) and misoprostol (orally) is about 92% effective.1 As the length of pregnancy increases, the effectiveness of mifepristone and misoprostol decreases slightly.
Within 4 hours of taking the second medicine (misoprostol), many women have vaginal bleeding and cramping, and the pregnancy is terminated.3 Most pregnancies end within the first 24 hours after the misoprostol dose. If not, then typically a second dose of misoprostol is given.
Misoprostol is slightly more effective when taken vaginally than when taken by mouth.1 Some studies show that vaginal misoprostol works more quickly and has fewer side effects than when taken by mouth. But many doctors are only giving misoprostol by mouth. This is because of recent reports of a very rare, fatal infection that affected a few women after they used vaginal misoprostol.
Some doctors may give misoprostol buccally (dissolved between the gums and cheek). One study found that taking misoprostol buccally works as well as when it is given vaginally.4
This method of abortion causes symptoms similar to a miscarriage (such as severe cramping and vaginal bleeding) as tissue and clots pass from the uterus. Symptoms may include:
- Chills or hot flushes (sweating and feeling overly hot).
Side effects may increase as the length of pregnancy increases and in women having their first pregnancy.
The U.S. Food and Drug Administration (FDA) has reported that a few women have died from a severe infection (sepsis) after having an abortion using mifepristone and vaginal misoprostol. Signs of serious infection include weakness, nausea, and diarrhea with or without belly pain. This deadly infection may not cause a fever. Call your doctor or go to the hospital if you have any of these signs of a serious infection after having a medical abortion.
Signs of complications
Less than 1% of women who have an abortion have serious problems afterward.5
Call your doctor immediately if you have any of these symptoms after an abortion:
- Severe bleeding. Both medical and surgical
abortions usually cause bleeding that is different from a normal menstrual
period. Severe bleeding can mean:
- Passing clots that are bigger than a golf ball, lasting 2 or more hours.
- Soaking more than 2 large pads in an hour, for 2 hours in a row.
- Bleeding heavily for 12 hours in a row.
- Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
- Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat.
- Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours.
- Vomiting lasting more than 4 to 6 hours.
- Sudden abdominal swelling or rapid heart rate.
- Vaginal discharge that has increased in amount or smells bad.
- Pain, swelling, or redness in the genital area.
Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:
- Bleeding (not spotting) for longer than 2 weeks.
- New, unexplained symptoms that may be caused by medicines used in your treatment.
- No menstrual period within 6 weeks after the procedure.
- Signs and symptoms of depression. Hormonal changes after a pregnancy can cause depression that requires treatment.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Choosing a medical or surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.
Mifepristone should not be used for women with any of the following conditions:3
- Suspected ectopic pregnancy
- Undiagnosed ovarian mass
- Intrauterine device (IUD) in place
- Long-term corticosteroid use
- Adrenal failure
- Severe anemia
- Bleeding disorders or use of blood thinners (anticoagulants)
- Severe asthma (methotrexate may be used)
- Liver or kidney disease
- Heart disease or uncontrolled high blood pressure (hypertension)
- Respiratory diseases
- Allergy to mifepristone
- Inherited skin diseases
Avoid alcohol and aspirin while using mifepristone and misoprostol for a medical abortion.
A medical abortion does not require surgery but must be done in the first 9 weeks of pregnancy. If a medical abortion fails, a surgical abortion must be done as follow-up to prevent a fetus from developing abnormally.
After a medical abortion
Expect that you may experience different emotional reactions after an abortion.
Depression can be triggered when pregnancy hormones change after an abortion. If you have more than 2 weeks of depression symptoms, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your doctor about treatment.
Do not have sexual intercourse for at least 1 week, or longer, as advised by your doctor.
When you start having intercourse again, use birth control, and use condoms to prevent infection. For immediately effective birth control, you can use a barrier method (such as a diaphragm, cervical cap, or condom). An intrauterine device (IUD) is effective immediately after it is placed in the uterus. If you start hormone birth control pills, patches, or injections right after the procedure, be sure to use a backup method until the hormone medicine becomes effective. For more information, see the topic Birth Control.
Your next regular period may come at any time within 6 weeks after the abortion. Be sure to contact your doctor if you do not have a period in 6 weeks.
The distributor of mifepristone provides an information Web site and a toll-free telephone number.
- American College of Obstetricians and Gynecologists (2005, reaffirmed 2007). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882.
- U.S. Food and Drug Administration (2006). FDA Public Health Advisory: Sepsis and Medical Abortion Update. Available online: http://www.fda.gov/cder/drug/advisory/mifeprex200603.htm.
- Holmquist S, Gilliam M (2008). Induced abortion. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 586–603. Philadelphia: Lippincott Williams and Wilkins.
- Middleton T, et al. (2005). Randomized trial of mifepristone and buccal or vaginal misoprostol for abortion through 56 days of last menstrual period. Contraception, 72(5): 328–332.
- Guttmacher Institute (2008). In Brief: Facts on Induced Abortion in the United States. Available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.
Last Updated: September 29, 2008
Author: Healthwise Medical Writer