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Mifepristone and misoprostol use is a two-step method.
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.
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
Medical abortions can be done through 9 weeks of pregnancy. Up to 7 weeks, the combination of mifepristone (orally) and misoprostol (orally) is effective in about 92 out of 100 cases.1
Within 4 hours of taking the second medicine (misoprostol), many women have vaginal bleeding and cramping, and the pregnancy is terminated.2 Most pregnancies end within the first 24 hours after the misoprostol dose. If not, then typically a second dose of misoprostol is given.
Misoprostol can be given orally, buccally (dissolved between the gums and cheek), or vaginally. Misoprostol is slightly more effective when given vaginally than when taken by mouth.1 But many doctors are only giving misoprostol by mouth because of reports of a rare, fatal infection that affected a few women after using vaginal misoprostol. Some studies have shown that taking misoprostol buccally works as well as when it is given vaginally or orally.3, 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:
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.5 Signs of serious infection include weakness, nausea, and diarrhea with or without belly pain. This rare 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.
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
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 who have any of the following conditions:2
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.
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 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 within 6 weeks.
- American College of Obstetricians and Gynecologists (2005, reaffirmed 2009). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882.
- 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.
- Winikoff B, et al. (2008). Two distinct oral routes of misoprostol in mifepristone medical abortion: A randomized controlled trial. Obstetrics and Gynecology, 112(6): 1303–1310.
- U.S. Food and Drug Administration (2006). Public health advisory: Sepsis and medical abortion with mifepristone (Mifeprex). Available online: http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051298.htm.
Last Revised: August 31, 2012
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