Examples
| methotrexate |
|
| misoprostol |
Cytotec |
How It Works
Methotrexate and misoprostol use is a
two-step method.
- First, methotrexate tablets are taken by mouth
or an injection of methotrexate is given by your doctor. Methotrexate
interferes with the growth of the
placenta, which allows it to separate from the
endometrium. This is an
unlabeled use of methotrexate. For reference, see a
picture of the
reproductive organs.
- Second, tablets of
misoprostol are taken by mouth or inserted vaginally, usually 5 to 7 days
later. Some doctors may give misoprostol buccally (dissolved between the gums
and cheek). This medicine causes uterine contractions so that your body passes
the uterine contents. The pregnancy usually ends at home within a day or two
when the tissue from the uterus is passed.
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 and is usually scheduled about 2
weeks after the first visit to make sure the abortion is complete and no
complications are present. If a medical abortion is unsuccessful, a surgical
abortion must be done to complete the process. (A fetus may not develop
normally after exposure to methotrexate or misoprostol.)
You may
also take pain medicine by mouth for this procedure.
Why It Is Used
A medical abortion with methotrexate
offers women an early-pregnancy abortion option that doesn't involve
surgery.
Methotrexate is also used for treatment of an
ectopic pregnancy.
How Well It Works
A medical abortion with methotrexate
and misoprostol is effective in over 90 out of 100 cases. Medical abortions can be
done through 9 weeks of pregnancy. And when completed before 7 weeks, injected
methotrexate is effective in 92 to 96 out of 100 cases.1
Misoprostol can be given orally, buccally (dissolved between the gums and cheek), or vaginally. 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. Experts do not know for sure if these deaths were related to the use of vaginal misoprostol.2
Methotrexate
and misoprostol can take up to 4 weeks to be effective, which is longer than
other abortion methods.1
Side Effects
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:
- Nausea.
- Vomiting.
- Diarrhea.
- Headache.
- Dizziness.
- Chills
or hot flushes (sweating and feeling overly
hot).
- Shivering.
- Fatigue.
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 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 that lasts more than 4 to 6
hours
- Sudden abdominal (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 medical history, how many weeks
pregnant you are, what options are available where you live, and your personal
preferences.
Methotrexate for medical abortions has not been
evaluated in women who have the following medical conditions:
Avoid alcohol and aspirin while
using methotrexate and misoprostol for a medical abortion.
Avoid folic acid supplements.
Folic acid (folate)
can interfere with the action of methotrexate during a medical
abortion.
Methotrexate can be used by women who have
asthma.
A medical abortion does not
require surgery. But if methotrexate fails, a
vacuum aspiration must be done as follow-up. If the
abortion is not completed, complications can include abnormal development of
the fetus.
After a medical abortion
Expect that you may
experience a wide range of
emotional reactions after an abortion.
Depression
can be triggered when pregnancy hormones
change after an abortion. If you have more than 2 weeks of symptoms of
depression, such as fatigue, sleep or appetite change, or feelings of sadness,
emptiness, anxiety, or irritability, see your doctor about treatment.
Do not have sexual intercourse for at least 1 week or longer, as advised
by your doctor.
When you start having intercourse again, use
birth control, and use condoms to prevent infection. For more information, see
the topic
Birth Control.
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 in 6 weeks.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
-
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.
-
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.
Credits
|
By
|
Healthwise Staff |
|
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 |
|
Last Revised
|
August 31, 2012 |