Mifepristone and misoprostol for abortion
Examples
Generic Name Brand Name mifepristone Mifeprex, RU-486 misoprostol Cytotec How It Works
Mifepristone and misoprostol use is a two-step method.
- First, your health professional 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 an illustration 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 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 health professionals allow their patients to take misoprostol at home and then the pregnancy ends (like a miscarriage) at home.
Note: 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.
A medical abortion usually requires three visits to your health professional over 3 weeks. Medicines are given at the first and second visits. The third visit is a follow-up appointment, usually scheduled within 10 to 15 days after the second 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.2
You can take pain medicine by mouth for this medical procedure.
Why It Is Used
A medical abortion uses medicine prescribed by a health professional to end a pregnancy. It does not require surgery. For women with an intrauterine device (IUD), medical abortion can be used after the IUD has been removed.
A medical abortion is most effective within the first 9 weeks of pregnancy.3
How Well It Works
A medical abortion with 200 mg mifepristone and 800 mg misoprostol is effective 95% to 99% of the time among women 9 weeks pregnant or less.1 As the length of pregnancy increases, the effectiveness of mifepristone and misoprostol decreases slightly.
Within 4 hours of taking the second medicine (misoprostol), about 50% of 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, a second dose of misoprostol is typically given.
Misoprostol is slightly more effective when taken vaginally than when taken by mouth.3 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.
Side Effects
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.
- Nausea.
- Vomiting.
- Diarrhea.
- Headache.
- Dizziness.
- Chills or hot flushes (sweating and feeling overly hot).
- Shivering.
- Fatigue.
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 health professional 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 all women who have an abortion have serious problems afterward.4
Call your health professional 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 sanitary 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 health professional 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 postpartum 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
Mifepristone (RU-486) has been widely used in Europe and is more effective than methotrexate. It may be used for emergency contraception within 72 hours of unprotected sex and is also being studied for other gynecological uses.
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 to be most effective. If a medical abortion fails (2% of the time among women 9 weeks pregnant or less5, 6), 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.
Postpartum depression can be triggered by changing pregnancy hormones after an abortion. If you have more than 2 weeks of postpartum depression symptoms, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your health professional about treatment. Keep track of your symptoms with a postpartum depression checklist
(What is a PDF document?).
Do not have sexual intercourse for at least 1 week, or longer, as advised by your health professional.
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 health professional if you do not have a period in 6 weeks.
The distributor of mifepristone provides an information Web site and toll-free telephone number.
- http://www.earlyoptionpill.com
- 1-877-432-7596
Complete the new medication information form (PDF)
| Author: | Healthwise Medical Writer | Last Updated: October 6, 2006 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Lori A. Boardman, MD, ScM - Obstetrics and Gynecology | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |