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The Three M's of Medical Abortion — Mifepristone, Methotrexate and Misoprostol
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The Three M's of Medical Abortion — Mifepristone, Methotrexate and Misoprostol

 
What is medical abortion? Quite simply, it is the ending of a pregnancy using drugs rather than surgery. A conventional abortion is considered a type of surgery. Although various herbal preparations that claim to cause an abortion have long been part of folk medicine in many cultures around the world, it is only in the last 20 years that modern science has developed abortion drugs that are reliable and effective.

While there are now several medical abortion drugs, as well as different ways of administering them, all of the approaches have one thing in common: they make use of one or more of three drugs: mifepristone, methotrexate and misoprostol.

The Three Medical Abortion Drugs

Mifepristone, A.K.A. RU-486
Around the year 1980, researchers at the French company, Roussel Uclaf, discovered a drug that interferes with the body's ability to utilize the hormone progesterone. They called it RU (for Roussel Uclaf) 486.

Progesterone is a key player in the body's early preparations for pregnancy, helping to prepare the wall of the uterus for the implantation of the embryo, or rapidly dividing fertilized egg. If the body does not provide sufficient amounts of progesterone, the embryo cannot be implanted in the uterus. When this occurs, the uterus expels the embryo by a series of muscular contractions and the pregnancy is terminated.

As they investigated the use of mifepristone as an abortion drug, early researchers found that the drug's success rate in causing abortion was no better than 80%. But when they combined mifepristone with other drugs, such as misoprostol that further stimulate uterine contractions, the success rate rose to almost 90%. This combination, a technique which is called the "French Protocol," has been widely and successfully used in France, Sweden, China and the United States.(1)(2)

The dose of mifepristone used in the French Protocol is 600 mg. Recent studies, however, have suggested that much lower doses can be just as effective and may be safer. In the U.S., the most common protocols are two variations on the French Protocol called the Population Council, or PC, Protocol and the Abortion Rights Movement, or ARM, Protocol. These are named for two large-scale studies of medical abortion that were done in the United States.

A key benefit of these protocols is that they can be done very early in pregnancy. This is also an important limitation because medical abortion drugs do not work as well after the seventh week of pregnancy when other hormones and mechanisms, including the growth of the placenta (the organ formed in the uterus during pregnancy), support the pregnancy. The seventh week is up to the 49th day after the first day of the last menstrual period.(3)

Methotrexate
Methotrexate is not new; it was approved as an anticancer drug in the U.S. in 1953. It has also been used in treating other diseases, including rheumatoid arthritis and psoriasis. Methotrexate works by interfering with the development of rapidly dividing cells in the human body.

In 1982, researchers discovered that methotrexate was an effective treatment for ectopic pregnancy. Ectopic pregnancy is a dangerous condition in which a fertilized human egg implants in the wrong place, usually in one of the two fallopian tubes that transport eggs from the ovaries to the uterus. While an ectopic pregnancy cannot produce a baby, it can threaten the health, fertility and even the life of the woman.

Before methetrexate, the only treatment for an ectopic pregnancy was surgery. The surgery, unfortunately, often results in fertility problems because the fallopian tube, sometimes also an ovary or, in the worst cases, the entire uterus may need to be removed. Methotrexate doesn't interfere with progesterone but, instead, prevents the growth of the rapidly dividing cells of the developing placenta. The drug has proven to have the same effect on normal pregnancies in the uterus.

Once researchers saw the potential of methotrexate as a medical abortion drug, they tried it in combination with misoprostol, usually given as a vaginal suppository. They found that the methotrexate/misoprotol combination had a 90% success rate, which was comparable to that achieved with mifepristone/misopristol.(4)

Misoprostol
Misoprostol is a drug with many uses; for one, it is given to people who are taking certain anti-inflammatory drugs in order to prevent stomach ulcers. Because it can also cause uterine contractions, it has become a second component of medical abortion along with either methotrexate or mifepristone.

In the French Protocol, misoprostol is given in pill form (400 mcg) 48 hours after a woman has taken mifepristone. It is sometimes prescribed as a vaginal suppository (800 mcg) because this route can be safer and more effective, especially with pregnancies that are farther along.5 The use of misoprostol by itself for medical abortion has been studied, particularly in Brazil, where abortion is illegal and misoprostol is the easiest of the three medical abortion drugs to acquire. These studies have found that although misoprostol is about as effective as both two-drug combinations, there are many more unpleasant side effects.(4)(6)

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Readers Comments
(53) Comments have been made

Lawal Taiwo
pls i need ur help how can i abort seven week pregnat
Posted Mon, Mar. 24, 2014 at 5:22 am EDT
 
Orchid
where will i get mifepristone in Ghana pls am 2wks pregnant and a student
Posted Fri, Mar. 7, 2014 at 1:10 am EST
 
naa
i abort my first pregency and bcz i dnt wnt to gt pregant i start taking pills to prevent pregency. I dd nt menstrate bf taking the pill. I recently check and i tested positive which means am pregant. And i dnt to kp the baby. What shld i do.
Posted Tue, Mar. 4, 2014 at 9:17 am EST
 
Moses Adeola
Pls Can I Get Dis Drug In Nigeria
Posted Sun, Mar. 2, 2014 at 5:08 am EST
 
kavya
Does misoprostol will help in terminating 3 mönths of pregnancy.
Posted Fri, Feb. 28, 2014 at 1:16 pm EST
 
The Doctor Editor
WE WELCOME COMMENTS AND READER DISCUSSION, BUT PLEASE KNOW THAT WE CANNOT ADVISE YOU MEDICALLY. YOU NEED TO SEE A DOCTOR TO RECEIVE THE RIGHT INFORMATION FOR YOUR SITUATION. You may also want to take a look at our article on Emergency Contraception: http://www.thedoctorwillseeyounow.com/content/womens_health/art2089.html.
Posted Wed, Feb. 26, 2014 at 9:52 am EST
 
Chi
I had surgical abortion and after one week i started having fast heart beat, waist pain. Plss which drugs will i take
Posted Wed, Feb. 26, 2014 at 4:22 am EST
 
mandy
I need help.. Am 10 weeks 3days pregnant...I took abortion pills,is it works....or hv to go for clinic for cleaning....bleeding gets start from last 3days...plz help me
Posted Tue, Feb. 25, 2014 at 4:10 am EST
 
merriam
Hw does its effectiveness,for hw many days can d abortion works
Posted Tue, Feb. 18, 2014 at 6:11 am EST
 
jane
Am 2 weeks pregnant and am 18 I don't want 2 keep de baby cox of my studies . Need ur help
Posted Sun, Feb. 16, 2014 at 5:23 pm EST
 
hannibell
am 1month pregnant and i dnt want to have a child now beouse my boyfriend is married to anyother woman, i dnt thing i can take of the child becouse i dnt have a good job, what should i do
Posted Fri, Feb. 14, 2014 at 9:53 am EST
 
mass
mifpristone Onely one tablet taking after that she is bleeding one week its success abortion or not? What im do next?
Posted Wed, Feb. 12, 2014 at 8:19 pm EST
 
Ajani taiwo
Is misoprostol powerful more mifeprostone
Posted Sun, Feb. 9, 2014 at 11:40 pm EST
 
ada
Am some weeks pregnant i dont need the baby now please how can i end it
Posted Sun, Feb. 9, 2014 at 12:20 pm EST
 
kari
I did take the first and today I need to take the other 4 pills and now I just want to keep my baby I feel like not taking this pills im bleeding with the first pill I took now I regret it
Posted Thu, Jan. 30, 2014 at 8:01 am EST
 
bgp
I am 19 years old.how abort my 3 months pregnant
Posted Mon, Jan. 27, 2014 at 8:11 am EST
 
Ifeoma
Am 5 wks pergant whc drug can i use to abort it
Posted Sun, Jan. 26, 2014 at 10:28 am EST
 
No Name
I am three weeks pregnant and completely unable to raise a child right now. I am only 18 years old and I plan to enroll into college in just a few months along with my boyfriend of three years. Even though having a child is something I desperately want, right now is just not the best time. I am strongly considering the abortion pill and plan to call planned parenthood first thing in the morning to schedule an appointment. I have no idea how this works and I am extremely nervous, BUT this is just something I have to do.
Posted Tue, Jan. 21, 2014 at 3:23 am EST
 
Eniola
Please i m one week pregnant, how can i terminate it.
Posted Tue, Jan. 14, 2014 at 8:08 am EST
 
lydia
l am some weeks pregnant and how can i terminate this pregnancy
Posted Fri, Jan. 10, 2014 at 9:23 am EST
 
baby
I am three weeks pregnant how can I terminate it?
Posted Sun, Jan. 5, 2014 at 8:57 am EST
 
NANCY
Am one mounth pregnant how can i use mifepristone and misoprostol to terminate the pregnancy?
Posted Mon, Dec. 23, 2013 at 10:02 am EST
 
nma
am two weeks pregnant please where can i find misoprostol in nigeria precisely in owerri
Posted Fri, Dec. 20, 2013 at 1:25 am EST
 
Ada
Am 2month pragnat which drug wil i take
Posted Wed, Dec. 18, 2013 at 10:13 am EST
 
Ada
Am 2month pragnat which drug wil i take
Posted Wed, Dec. 18, 2013 at 10:00 am EST
 
NKIRU
CAN I SEE THESE DRUG S IN NIGERIA
Posted Sun, Dec. 15, 2013 at 3:06 am EST
 
nelly
I am two weeks and some dpregnantayz
Posted Thu, Nov. 28, 2013 at 12:29 am EST
 
Becky
Am 2weeks pregnant is the drug MISOPROSTOL around in nigeria and how do i use it to abort a 2weeks pregnant?
Posted Fri, Nov. 8, 2013 at 9:30 am EST
 
Ébéré
Am one month and pregnat,which drug wil i use to abort the baby
Posted Thu, Nov. 7, 2013 at 5:14 am EST
 
Ebý
am six weeks pregnat which drug wil use
Posted Thu, Nov. 7, 2013 at 4:57 am EST
 
Lizzie
Am 2 weeks nd some dayz pregnant, which drug shld i take?
Posted Sun, Oct. 27, 2013 at 4:56 am EDT
 
dorcas
I'm 5weeks pregnant, how can I use this drug, MISOPROSTOL
Posted Tue, Oct. 22, 2013 at 8:29 pm EDT
 
jodywood
Mifepristone and misoprostol are connected because together they are used to produce medical abortions for women who are less than eight weeks pregnant. The drugs are not identical and perform different actions. Misoprostol has wider applications and may be used in place of prostaglandins to create cervix softening prior to birth. It can also help prevent stomach ulcers that are caused when people take non-steroidal anti-inflammatory drugs (NSAIDS). Know more here internationaldrugmart.com/misoprostol-mifepristone.html
Posted Wed, Oct. 9, 2013 at 1:35 am EDT
 
Om
M 3weeks pregant which drugs wil i take
Posted Fri, Sep. 20, 2013 at 1:17 pm EDT
 
RichardJohn
Women were finding it necessary to travel hundreds, to thousands of miles to a practitioner competent in performing early and late trimester abortions. He subsequently opened four additional centers in Florida. All specialize in non-surgical, medical and surgical abortion methods. Dr. Pendergraft constantly strives to assure that abortions are performed compassionately, safely and during times that are convenient to patients. The center provides services during a wide variety of times, seven days a week. www.womenscenter.com/abortion_methods.html
Posted Sun, Aug. 25, 2013 at 4:04 am EDT
 
golden
Am 4wiks nd sum days pregnant hw do i use dix drugs wult d drug damage my womb
Posted Wed, Aug. 21, 2013 at 2:58 am EDT
 
Valerie
help! am 1week and 1day pregnant wat d best drug 2 take
Posted Tue, May. 21, 2013 at 11:06 pm EDT
 
baby
Pls, I am 3 weeks pregnant, and I do not want to have the baby. How can I get my hands on abortion pills becos I really don't want this baby.
Posted Mon, May. 13, 2013 at 2:37 pm EDT
 
Chy
Am 1mnth nd 1wk pregnant i took misoprostol 2 nd insert 2 bt after dat only notice cramping whc lasted throught the night.then after dat i didnt see any blood wat am i going 2 do next bcos d pains is 2 much 4 me i cnt kp dis pregnancy.pls hlp me.
Posted Tue, Apr. 2, 2013 at 6:39 am EDT
 
Prudence
I used six tablets of misoprostol four which I swallowed and inserted two virginally. All I got was cramps and little sporty blood , purging and dat was all. The next day I swallowed another four tablet but nothing happened. Could it be that I bought a fake one because I have used it before and it worked. I don't know where to get mifepristone no pharmacist store seems to have it around here. I am so scared. I am about two weeks pregnant.
Posted Thu, Aug. 16, 2012 at 9:55 am EDT
 
seif
what is the best combination at what dose does it abort a 2months pregnancy?
Posted Wed, May. 9, 2012 at 4:36 am EDT
 
Anonymous
yes dis drug is here in nigeria infact i have made us of it on two occasion i bougth it here in kaduna state and a freind of mine bought and used it in delta state(asaba)
Posted Mon, Apr. 2, 2012 at 4:10 pm EDT
 
folly
am just two weeks pregnant and am scared of taking pills cos dey said it depends on body
Posted Sat, Mar. 31, 2012 at 6:31 am EDT
 
chioma bibian ilodi
i hav taken so many drugs for abortion bt it seem is not working and drugs u people recommended here is no were to be found in our side (Onitsha) so wot next i my to do now pls help me
Posted Thu, Mar. 15, 2012 at 2:09 pm EDT
 
Stacy
Can we get these pills in nigeria presently
Posted Fri, Mar. 2, 2012 at 1:00 pm EST
 
Rita Nelson
Can we get this pills in Nigeria
Posted Sat, Feb. 4, 2012 at 12:26 am EST
 
Ann
Am 2weeks pregnant and i want to abort it so can i use the drugs prescribe here?
Posted Wed, Jan. 4, 2012 at 10:41 am EST
 
Theresa Damian
Can I get this drug in Nigeria?
Posted Sat, Mar. 5, 2011 at 1:37 pm EST
 
Kennieade4real@yahoo.com
I'm one and half month pregnant which drug should i use cuz its early for me to have baby
Posted Wed, Feb. 16, 2011 at 10:02 pm EST
 
gurugirl777
My friend just had a medical abortion. It did not work. If she wants to keep her baby, what are the chances of it being healthy? She was about 7 weeks when she took the pills. now she is about 10 weeks. She found out at her follow up appointment that she was still pregnant.
Posted Mon, Jan. 3, 2011 at 1:47 pm EST
 
Layla
Iam feeling non stop pain such as fever,stomach pain,vomiting,lost of apetite and body swollen.for that reason i wanna terminte it.
Posted Fri, Feb. 26, 2010 at 6:17 pm EST
 
Jerryc@in.com
Am 6wks now which of the drugs should i take cos am confused
Posted Fri, Feb. 19, 2010 at 5:12 pm EST
 
melissataylor1977@yahoo.com
i am 14wks and i just found out the baby has swelling of the brain and spine possibly a sign of down-syndrome. am i too late to terminate my pregnacy by using the pill or anything other than the surgical procedure? thank you for any information you can provide for me
Posted Sat, Feb. 6, 2010 at 1:00 am EST










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