Medical abortion procedures are available for terminating a pregnancy during the early weeks of the first trimester. For women seeking a medical abortion procedure, a sonogram is recommended to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating.
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Types of Medical Abortion Procedures
Methotrexate & Misoprostol (MTX)
MTX is a medical abortion procedure used up to the first 7 weeks (49 days of pregnancy). This procedure is not as commonly used as in the past because of the availability of mifepristone.
- Methotrexate is given orally or by injection during the first office visit.
- Antibiotics are also given in order to prevent infection.
- Misoprostol tablets are given orally or inserted vaginally about 3 to 7 days later. This can be done at home.
- This procedure will usually trigger contractions and expel the fetus. The process may take a few hours or as long as a few days.
- A physical exam is given a week later to ensure that the abortion procedure is complete and to check for complications.
- Methotrexate is primarily used in the treatment of cancer and rheumatoid arthritis because it attacks the most rapidly growing cells in the body. In the case of abortion, it causes the fetus and placenta to separate from the lining of the uterus. Using the drug for this purpose is not approved by the FDA.
The side effects and risks of Methotrexate & Misoprostol include the following:
- Cramping, nausea, diarrhea, heavy bleeding, fever
- The procedure is unsuccessful approximately 5% of the time with the potential of requiring an additional surgical abortion procedure to complete the termination.
- It is not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease, or who use an intrauterine device (IUD).
Mifepristone (Mifeprex) and Misoprostol
Mifepristone (Mifeprex) and misoprostol is a medical abortion procedure used up to the first 7 to 9 weeks of pregnancy. It is also referred to as RU-486 or the abortion pill.
- A physical exam is first given in order to determine eligibility for this type of medical abortion procedure. You are not eligible if you have any of the following: ectopic pregnancy, ovarian mass, IUD, corticosteroid use, adrenal failure, anemia, bleeding disorders or use of blood thinners, asthma, liver or kidney problems, heart disease, or high blood pressure. You will be given antibiotics to prevent infection.
- Mifepristone is given orally during your first office visit. Mifepristone blocks progesterone from the uterine lining, causing the lining to break down, preventing the ability to continue a pregnancy.
- Misoprostol tablets are taken orally or inserted vaginally about 36 to 72 hours after taking the mifepristone. The tablets will cause contractions and expel the fetus. This process may take a few hours or as long as a few days.
- A physical exam is given two weeks later to ensure the abortion was complete and to check for complications.
The side effects and risks of Mifepristone & Misoprostol include the following:
- Cramping, nausea, vomiting diarrhea, heavy bleeding, infection
- The procedure is unsuccessful approximately 8-10% of the time with the potential of requiring an additional surgical abortion procedure to complete the termination.
- It is not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease or use an intrauterine device (IUD).
Want to Know More?
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Compiled using information from the following sources:
1. “Induced Abortion.” The American College of Obstetricians and Gynecologists. 2001.
2. Pymar HC, Creinin MD (2000). Alternatives to mifepristone regimens for medical abortion. American Journal of Obstetrics and
Gynecology, 183 (2): s54-s64.
3. Paul M, et al. (1999). A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.
4. Creinin MD, et al. (2001). Medical management of abortion. American Journal of Obstetrics and Gynecology Practice Bulletin, no. 26, pg.1-13.
5. Goldberg ab, et al. (2001). Misoprostol and pregnancy. New England Journal of Medicine, 344 (1): 3845.
Medication Abortion – Facts and information for healthcare professionals
6. Planned Parenthood