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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

 
Among the side effects of misoprostol are diarrhea, nausea and vomiting. Some women also get hot flashes or episodes of fever. Possibly because it enters the bloodstream more gradually, misoprostol seems to have fewer side effects when given as a suppository than by mouth.(5)

Medical Abortion Drugs and Birth Defects
Any medical abortion drug carries with it two main risks: one, that it will not work; and two, that if an unsuccessful medical abortion is not followed up by a traditional surgical abortion, the abortion drug or combination of drugs may harm the fetus.

Based on what we know today, of the three drugs we have mentioned, misoprostol is the most likely to cause birth defects. Limb and cranial abnormalities have been reported in babies born to women who remained pregnant after using misoprostol. Obviously, the newer the drug the less information is available. For instance, there is little or no evidence that mifepristone can cause any particular problem. Although in the high doses used in cancer treatment methotrexate poses a clear risk to a developing fetus, we do not know if the low dose of methotrexate used for medical abortion has a similar effect.(4)

It should be remembered, however, that most of the scientific data on these drugs come from studies in which women have agreed in advance to undergo a surgical abortion if medical abortion drugs fail. For this reason, it is difficult to collect enough data to determine whether these drugs will cause birth defects.

Medical Reasons Not to Have a Medical Abortion
There are a number of medical reasons why a woman might not be able to take the medical abortion drugs. The contraindications to these drugs should be discussed one-on-one between a woman and her own doctor. The most common medical conditions are long-term corticosteroid therapy, chronic adrenal failure, a disease called porphyria, conditions that cause internal bleeding or anticoagulant medication, as well as any indication of an allergy to one of the medications. If a woman has an IUD, it must be removed before taking the medications.(7)

For many women, medical abortion is desirable because it enables them to avoid a surgical procedure. However, because of the possible birth defect risk discussed above, all patients are required to agree that they will have a surgical abortion if the medical abortion fails.

The Steps of a Medical Abortion Procedure

Mifepristone/Misoprostol
On her first visit, following examination, counseling and signed permission, a woman undergoing a medical abortion takes mifepristone (600 mg). This generally causes few noticeable symptoms. (A small percentage of women, however, usually less than 5%, will have an abortion at this point.) Two days later, she takes misoprostol in pill form (400 mcg). Note that this is the PC regimen.

In the ARM version, the woman takes mifepristone by mouth (200 mg) and two days later takes misoprostol (800 mcg) as a suppository. In both of these regimens, two-thirds of women develop cramps and bleeding and complete the abortion in the next four hours. After 24 hours, the success rate nears 90%.(8)

The heaviest bleeding occurs on the day misoprostol is taken. For most women, bleeding and spotting continue for about two weeks. Uterine cramps also occur and vary from extremely severe to very mild. Women usually describe the bleeding and cramps as resembling a heavier than normal menstrual period.(5)(9)

Women having a medical abortion are normally given pain killers such as ibuprofen, acetaminophen or a stronger analgesic containing codeine.

Methotrexate/Misoprostol
The basics of a medical abortion with methotrexate are very similar to that using mifepristone, except that it takes longer. Methotrexate is given by injection (75-100 mg). At least two days later, a misoprostol suppository is given. At this point, about 60% of women abort within 24 hours. Twenty to 30% of patients do not complete their abortion for another three to three and half weeks, and the bleeding lasts longer than with mifepristone.(4)

Follow-up Visit
In all regimens, women are asked to return after 14-20 days for an examination to determine whether the abortion has occurred. While the overall success rate for medical abortion is around 90%, studies have shown that the greater the experience of the center providing the abortion, the lower the failure rate. (3)(10)(11)

Medical Abortion in the United States Today
Surveys show that medical abortion is well accepted — many phyisicans, for example, indicate they are willing to provide this option to their patients.(12) When women are asked why they chose medical over surgical abortion and whether they found the procedure acceptable, most say they wanted to avoid a surgical procedure, felt a medical procedure was more natural and more private, and allowed them to feel more in control. When the option of taking the misoprostol at home, rather in the clinic, was available, women who took their medication at home liked the increased sense of privacy and convenience, as well as having friends and family members nearby.

The political picture is less clear. In the United States, pro-life forces have focused on trying to restrict the use of mifepristone (RU-486). This is largely because the two other medical abortion drugs have been approved for other uses and are, therefore, already available. The PC and the ARM studies demonstrated the safety and efficacy of mifepristone and, despite the opposition, the drug was approved by the FDA in September of 2000.

The FDA has, however, put limits on the use of RU-486 — the medication is not sold in pharmacies but is provided directly to physicians' offices. Opponents of medical abortion continue to pursue the battle on two fronts. Upon his appointment as Health and Human Services Secretary, Tommy Thompson suggested that he might direct the FDA to reopen the approval process for RU-486.

Although Secretary Thompson has since backed away from his comment in his public statements, the possibility remains that the Bush Administration may further restrict the availability of medical abortion. Meanwhile, the U.S. Congress is debating a bill that would allow RU-486 to be prescribed only by the small minority of doctors who currently perform surgical abortions and only at clinics within an hour's drive of an hospital emergency room.

For More Information
To learn more about the practical considerations of medical abortion, click on our interview with Planned Parenthood's Jini Tanenhaus.
May 1, 2001
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Readers Comments
(62) Comments have been made

Paul
I regret it too
Posted Tue, Jul. 29, 2014 at 6:55 am EDT
 
Fatima
Am 3 month pregant
Posted Fri, Jul. 18, 2014 at 11:16 am EDT
 
chika
How can I take it(mifepristone)
Posted Thu, Jul. 17, 2014 at 9:01 am EDT
 
Pere
Am a month pregnant,hw can i abort the baby successful wihout causing damages to my womb and body.
Posted Thu, Jun. 5, 2014 at 11:14 am EDT
 
Blessing
Am 19yrs, and i didnt see my menses last mnth, pls want type of drug sud i tak 2 terminate the pregnancy.
Posted Thu, Jun. 5, 2014 at 12:39 am EDT
 
ashmi
Delay my periods 2months....what tablet take
Posted Sat, May. 31, 2014 at 4:51 pm EDT
 
nassy
how can I take it
Posted Sun, May. 18, 2014 at 9:28 am EDT
 
temiloluwa
I av a month pregnancy pls what can I use to abort it that will not be amful to my life
Posted Thu, May. 15, 2014 at 4:26 am EDT
 
Victoria
How can i abort pregant of 2months
Posted Mon, Apr. 21, 2014 at 5:45 pm EDT
 
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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