Medical abortions may be provided very early in pregnancy. They are most effective up to about 9 weeks LMP depending on the medications being used. There are two combinations of medications that are used to provide medical abortions - mifepristone and misoprostol, or methotrexate and misoprostol.
Mifepristone (the "abortion pill", Mifeprex, or RU-486) is a medication that was developed and tested specifically as an abortion-inducing agent. It was first licensed in France in 1988. Since then it has been used safely by millions of women worldwide. It was approved for use in the U.S. in September 2000.
Mifepristone is taken in the form of a pill. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy. Without this hormone, the pregnancy detaches from the uterine wall, the cervix (opening of the uterus or womb) softens, and some uterine cramping can begin.
Methotrexate has been used in the U.S. since 1953 when it was approved by the FDA to treat certain types of cancer. Since that time, medical researchers have discovered other important uses for the drug, including ending unintended pregnancies. Methotrexate has been studied and used as a safe method of medical abortion since the early 1990s.
Methotrexate is usually given to a pregnant woman in the form of an injection, or shot, although it also can be taken orally. It stops the implantation of the embryo that occurs during the first several weeks after conception.
Within a few days after taking either mifepristone or methotrexate, a second drug, misoprostol, is taken. Misoprostol tablets, which are usually inserted in the vagina or taken orally, cause the uterus to contract and empty.
- You will take the first medication (either mifepristone or methotrexate) at the facility. It is not unusual to have some bleeding after the first medication but the procedure is not complete.
- Within the next few days you will take the misoprostol as directed by the facility. Within a few hours of taking the medication, you will probably start to have strong cramps and bleeding, similar to a heavy period. Pain medicine or a heating pad can help with the cramps. You may also have nausea, vomiting, diarrhea, fever, chills, or feel tired. These symptoms usually last a short time and stop on their own. The facility will give you instructions for your aftercare. If you have questions or concerns related to your recovery you should call the number provided to you by the facility.
- It is important for you to return to the facility for a follow-up to make sure that the abortion is complete. At this visit you will have a pelvic examination, a pregnancy test, or ultrasound. In the rare case that your abortion is incomplete, you may need to take an additional dose of misoprostol or simply wait and return for another visit in a week or two. If the pregnancy is still growing, however, you will need a surgical abortion.
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