What are the Pros and Cons of Misoprostol for Abortion?

Donna Johnson

Misoprostol is a drug that may also be used to induce labor in pregnant patients, or, together with mifepristone, to bring about a medical abortion, one induced solely with medication. The drug is usually prescribed to people who are taking other medications that may cause stomach ulcers, to prevent the ulcers from forming. Using misoprostol for abortion allows a woman to avoid an invasive clinical abortion, a surgical procedure with various risks, and possibly go through the process in the privacy of her own home. Misoprostol side effects are possible, however, and the drug may only be used for an abortion before the ninth week of pregnancy, with the success rate declining after that time.

Misoprostol may be used with mifepristone to cause a medical abortion.
Misoprostol may be used with mifepristone to cause a medical abortion.

Before prescribing misoprostol for abortion, the patient's doctor will perform an ultrasound, typically transvaginal due to the early stage of pregnancy. The ultrasound images allow the doctor to estimate the gestational age of the embryo and confirm the patient is within the allowed time frame to use the abortion pill. When the patient is verified eligible for a medical abortion, the doctor will give her an oral dose of mifepristone to be taken in the office. This drug separates the placenta from the uterine lining, brings about uterine cramping, and softens the cervix in preparation for termination of the pregnancy. At this point, the patient may begin to experience vaginal bleeding and discomfort from the cramps.

Most women will complete the medical abortion within 8 hours of taking misoprostol.
Most women will complete the medical abortion within 8 hours of taking misoprostol.

Anywhere from six hours to three days after taking mifepristone, depending on dosage, the patient may take misoprostol. Most doctors prescribe the drug to be taken orally. Although misoprostol for abortion may also be administered vaginally, reports of very rare but fatal infections associated with this method have decreased its use. Within eight hours of taking misoprostol, most women will complete the medical abortion. During this time, uterine contractions will increase to expel the pregnancy, as will vaginal bleeding, including the passage of clots.

Approximately two weeks after using misoprostol for abortion, the patient must visit her doctor for a follow-up examination. During this exam, her doctor will confirm whether the medical abortion was successful. If not, the patient will have to undergo a clinical abortion to complete the process. Approximately 92 percent of women who use the abortion pill prior to seven weeks' gestation will successfully terminate the pregnancy. The success rate declines to 83 percent from seven to eight weeks' gestation, and to 77 percent for patients at eight to nine weeks' gestation.

Side effects vary by patient but are typically mild, such as nausea, vomiting, chills, and fatigue. Less than one percent of patients will experience serious side effects such as severe bleeding, prolonged vomiting, or intolerable pain. If any of these symptoms are present, an infection may be present, and the patient should contact her doctor right away.

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