Methotrexate and misoprostol use is a
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.)
also take pain medicine by mouth for this procedure.
A medical abortion with methotrexate
offers women an early-pregnancy abortion option that doesn't involve
Methotrexate is also used for treatment of an
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
and misoprostol can take up to 4 weeks to be effective, which is longer than
other abortion methods.1
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
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
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
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
Methotrexate can be used by women who have
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
Expect that you may
experience a wide range of
emotional reactions after an abortion.
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
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.
American College of Obstetricians and Gynecologists
(2005, reaffirmed 2009). Medical management of abortion. ACOG Practice Bulletin
No. 67. Obstetrics and Gynecology, 106(4):
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.
August 31, 2012
Sarah Marshall, MD - Family Medicine
& Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology & Kirtly Jones, MD - Obstetrics and Gynecology
How this information was developed to help you make better health decisions.
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