Misoprostol for Abortion
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How It Works
- Softens and opens (dilates) the cervix.
- Causes uterine contractions.
- Starts (induces) labor.
Why It Is Used
Misoprostol is a prostaglandin medicine used to terminate a pregnancy by starting labor. It is more effective when used in combination with methotrexate or mifepristone than when used alone. This is an unlabeled use of misoprostol.
Misoprostol is also used to prevent stomach ulcers (labeled use) and for induction of labor for childbirth (unlabeled use).
Misoprostol may also be used to:
- Complete a spontaneous missed abortion (incomplete miscarriage).
- Start labor in second-trimester abortions.
- Start labor in third-trimester abortions. Third-trimester abortions are not done unless the fetus has died or has severe medical problems and will not survive.
- Dilate the cervix 3 to 4 hours before a surgical abortion procedure.
- Soften the cervix for induction of labor.
- Soften the cervix for special gynecologic tests.
How Well It Works
Misoprostol used alone may terminate a pregnancy. But it is more often used with other medicines, such as mifepristone or methotrexate, in first-trimester abortions.
Misoprostol alone, moistened and used vaginally, is effective in over 90 out of 100 cases in terminating first-trimester pregnancies of less than 8 weeks.1
Misoprostol can be given orally, buccally (dissolved between the gums and cheek), or vaginally. Misoprostol is slightly more effective when taken 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.2, 3
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).
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.4 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.
Signs of complications
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 belly 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 belly 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 past health, how many weeks pregnant you are, what options are available where you live, and your personal preferences.
Misoprostol is not used in women who have an allergy to misoprostol or other prostaglandins.
Misoprostol can cause fetal abnormalities, so a follow-up surgical abortion will be done if the medical abortion did not work.
The use of misoprostol for medical abortion is an unlabeled use. Misoprostol is approved (labeled) for preventing and treating stomach ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAIDs) on a long-term schedule.
Misoprostol does not have any known drug interactions.
- 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.
- 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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