Medical abortion is a procedure that is available during the early weeks of the first trimester of pregnancy. This procedure requires the use of a combination of drugs to terminate the pregnancy. Several drugs are currently used to perform medical abortion.
A medical abortion using methotrexate (MTX) followed by misoprostol is effective up to the end of the seventh week of pregnancy. A dose of methotrexate is given either orally or by injection at the first visit with the doctor. The second step to this procedure requires the use of misoprostol five to seven days later. A few hours or a few days later you will begin experiencing contractions and the fetus will be aborted from your body. Seven days after the administration of misoprostol you will be examined to ensure that the procedure is complete and no complications have occurred.
Methotrexate is a drug that is typically used for the treatment of cancer and rheumatoid arthritis because it fights the rapid growth of cells in the body. When used to assist in an abortion, the drug will cause the fetus and placenta to separate from the lining of the uterus in preparation for the misoprostol administration. MTX is not successful in about 10 percent of cases. When the medical abortion does not work, a surgical procedure is carried out to remove the fetus from your uterus.
Mifepristone is also used in combination with misprostol to carry out a medical abortion. It is often called RU-486 or the abortion pill. This combination of drugs can be used during the first seven to nine weeks of the pregnancy. RU-486 is not recommended for women with certain pregnancy complications such as ectopic pregnancy, ovarian mass, IUD, corticosteroid use, adrenal failure, anemia, bleeding disorders, use of blood thinners, asthma, heart disease, liver or kidney problems, or high blood pressure.
Mifepristone is administered orally during the first office visit. The drug works by blocking progesterone from the uterine lining, leading to the death of the fetus. The cervix begins to soften and the uterus contracts. The body can respond by contracting and expelling the fetus. When it does not, the doctor may give you misoprostol tablets either orally or vaginally 36 to 48 hours later. As with MTX, you will experience contractions a few hours or a few days later that will cause the fetus to be aborted from the body. RU-486 is unsuccessful in 8 to 10 percent of cases.
Following methotrexate or mifepristone, you will return to the doctor to receive misoprostol tablets either orally or vaginally. This drug is responsible for causing contractions to expel the fetus after the first drug helped dislodge it from the uterine lining. Using only misoprostol can cause contractions but it is not as likely that the fetus will actually be expelled by the body.
Side effects of either type of medical abortion tend to be the same and are the result of the combination of drugs used. Such side effects include cramping, nausea, vomiting, diarrhea, heavy bleeding and infection.
- Bulletin of the World Health Organization: Comparative Effectiveness, Safety and Acceptability of Medical Abortion at Home and in a Clinic -- A Systematic Review
- Iranian Journal of Pharmaceutical Research: Misoprostol Alone or in Combination with Methotrexate for Termination of Pregnancy at First Trimester
- Reviews in Obstetrics and Gynecology: Uses of Misoprostol in Obstetrics and Gynecology