How It Works
Mifepristone and misoprostol use is a
- First, your doctor gives you a dose of
mifepristone tablets by mouth. Mifepristone causes the
placenta to separate from the
endometrium. It also softens the
cervix and increases uterine contractions to allow the
uterine contents to pass. For reference, see a
picture of the reproductive organs .
- Second, you take tablets of
misoprostol by mouth or insert them vaginally, usually within 48 hours of
mifepristone. Depending on the dose and how it is given, this could be as soon as 6 hours after the
mifepristone.1 Some doctors may give misoprostol
buccally (dissolved between the gums and cheek). Misoprostol causes uterine
contractions so that your body passes the uterine contents. Many doctors allow their
patients to take misoprostol at home and then the pregnancy ends (like a
miscarriage) at home.
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.
Why It Is Used
A medical abortion with mifepristone
offers women an early-pregnancy abortion option that doesn't involve
A medical abortion is only done in the first 9 weeks of
How Well It Works
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
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
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
- 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 abdomen
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
- Sudden abdominal swelling or rapid heart
Vaginal discharge that has increased in amount or smells
- 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
- Bleeding (not spotting) for longer than 2
- New, unexplained symptoms that may be caused by medicines
used in your treatment.
- No menstrual period within 6 weeks after
- 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 medical history, how many weeks
pregnant you are, what options are available where you live, and your personal
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.
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
After a medical abortion
Expect that you may
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.
have sexual intercourse for at least 1 week, or longer, as advised by your
When you start having intercourse again, use birth
control, and use condoms to prevent infection. For more information, see
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.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
American College of Obstetricians and Gynecologists
(2005, reaffirmed 2009). Medical management of abortion. ACOG Practice Bulletin
No. 67. Obstetrics and Gynecology, 106(4):
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
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):
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.
Primary Medical Reviewer
||Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer
||Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology
Specialist Medical Reviewer
||Kirtly Jones, MD - Obstetrics and Gynecology
Current as of
||August 31, 2012