Instructions for Medical Abortion using Mifepristone and Misoprostol
These instructions are provided for informational purposes only and in no way to promote or encourage performing a medical abortion on your own!
Mifepristone and Misoprostol dosages
All dosages in our MTP (Medical Termination of Pregnancy) complex are under the latest WHO recommendations (link to the official recommendations of the World Health Organization for safe abortion).
The World Health Organization recommends the following dosages:
For the first stage: Mifepristone – 200 mg
In our online pharmacy, Abortion Pills kits include 1 tablet of Mifepristone 200mg
For the second stage: Misoprostol – 400 mcg
Our MTP kits contain Misoprostol: 4 tabs of 200 mcg, a total of 800 mcg.
Please note that the indicated dosages are relevant only for our products from the world’s leading manufacturers, the quality of which we guarantee!
Procedure for Taking Medication for Medical Abortion
The procedure for taking drugs consists of two stages.
Before the procedure, it is necessary to do an ultrasound of the pelvic organs to determine the gestational age and the location of the fetal egg (excluding the possibility of ectopic pregnancy).
To start the medical abortion procedure, the patient must take 200 mg of Mifepristone orally with water (at least 150 ml).
In most cases, after taking the first drug (Mifepristone), a woman subjectively does not feel anything. THIS IS NORMAL! The main effect begins in the second stage – after taking Misoprostol.
And only in some cases can minor spotting and aching pains in the lower abdomen begin. This is also normal but much rarer.
The way Mifepristone works
Mifepristone is a progesterone blocker (this is the primary hormone that maintains pregnancy). The main effect of the drug in medical abortion is to stop the development of pregnancy. Mifepristone also significantly increases the sensitivity of uterine cells to prostaglandins (for example, to Misoprostol).
After 36–48 hours from the moment of taking Mifepristone, it is necessary to take the second drug from the complex – Misoprostol (Cytotec) in the following dosage: 4 tablets of 200 mcg.
There are three ways to take Misoprostol:
- place under the tongue (sublingually);
- vaginal (deep into the posterior fornix of the vagina) and
- buccal (place the tablet in the space between the cheek and gum) Source.
The effectiveness is the same for all methods, but we strongly recommend that you dissolve one tablet under the tongue first and the second after 40–60 minutes. This significantly reduces the likelihood of vomiting, and the duration of the effect increases.
The way Misoprostol (Cytotec) works
Misoprostol, combined with the action of Mifepristone, stimulates the contractile activity of the uterus, which leads to cramping pains in the lower abdomen, as well as the appearance (much more often) or an increase (if it appeared during the first stage) of bleeding. With these processes, the ovum is separated from the walls of the uterus and excreted through the genital tract.
After taking the medication
Usually, spotting is observed over the next 3–5 days (usually a little more abundant than during menstruation). The average spotting duration (with decreasing intensity) is 12–14 days.
After 10–14 days from the onset of bloody discharge, it is necessary to conduct a control ultrasound examination of the pelvic organs. Minor spotting should not be a reason to delay an ultrasound.
A brief overview of the possible complications of medical abortion. Solutions
While using Mifepristone and Misoprostol, the following symptoms may be observed:
- General discomfort;
- Fever up to 37.5 degrees C (99.5°F)
Usually, these symptoms are mild and disappear without medical intervention.
If vomiting occurs within one hour after taking Mifepristone, then the medication should be retaken at the exact dosage. If Misoprostol is administered correctly (dissolved under the tongue), then vomiting does not affect the effect of Misoprostol, and repeated administration of the drug will not be required.
If the patient has a pronounced early pregnancy toxicosis (vomiting of pregnant women), then before using the complex for medical abortion, it is necessary to inject 2.0 ml of Cerucal intramuscularly 30 minutes after that, eat some food (a small amount), and then take the drug.
Pain during medical abortion can have varying intensity and depends on the duration of pregnancy (pain increases with increased gestational period), as well as on the individual pain threshold. Usually, the pain is tolerable and does not require additional interventions. According to women, the pain is somewhat more muscular than during menstruation.
Pain usually disappears after 1–3 days after the release of the fetal egg. To eliminate severe pain, it is allowed to use antispasmodics, for example, No-spa. It may be taken from the very beginning of the procedure.
It should be noted that from non-steroidal anti-inflammatory drugs (NSAIDs), Ibuprofen can be used and is recommended. Read more about Pain during MTP.
In most cases, the amount of bloody discharge slightly exceeds the usual amount of menstrual blood loss; moreover, the longer the gestational period, the more significant the volume. If the pregnancy does not exceed 10 weeks of gestational age, then despite the possible abundant bleeding, there is no need for additional treatment. Read more about Bleeding during MA.
If this complication is detected, then vacuum aspiration is necessary to remove the remnants of the fetal egg. Read more about Incomplete Abortion.
Rehabilitation after medical abortion
Medical termination of pregnancy completely eliminates mechanical damage to the uterus, but does not exclude the development of possible functional disorders as a result of hormonal stress. To prevent the development of such a pathology, all patients who have undergone medical abortion are recommended to take monophasic combined oral contraceptives (for example, Regulon) for two menstrual cycles. It is advised to start taking contraceptives from the fifth day from the onset of menstrual-like discharge during medical abortion.
This page describes the use of Mifepristone and Misoprostol (Cytotec) for medical abortion (MTP) in early pregnancy.
Dr. Kopp Kallner. M.D. in Obstetrics & Gynecology, Columbia University Medical School.