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
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)
(What is a PDF document?)
to help you understand this medication.