The Ins and Outs of Misoprostol

What is Misoprostol and what is it used for?

Misoprostol is in a class of medication called prostaglandins and is used for a variety of indications in the practice of obstetrics and gynecology. These include abortion, medical management of miscarriage, induction of labor, cervical ripening before a surgical procedure, and the treatment of postpartum bleeding (1; 2; 3; 4). For abortion specifically, misoprostol can be used to abort pregnancies up to 24 weeks (5).
Because it is widely used in the medical field for the prevention and treatment of many conditions, misoprostol is on the World Health Organization (WHO) model list of essential medicines. Misoprostol is an important medicine as it provides access to medical abortion care, which is critical to achieving safe and effective abortions. WHO outlines at-home protocols for using misoprostol at home, some of which will be reviewed in this article (4;6). We will discuss the ins and outs of misoprostol for use in medical abortions.

The history of misoprostol

Misoprostol was first developed in the US in 1973 to treat peptic ulcers, which it did by preventing harsh gastric secretions; but, it had known major side effects on a pregnant uterus. As misoprostol was first developed to treat peptic ulcers, this has made it most readily available in countries with legal restrictions.
In the 1980s, French researchers developed mifepristone, also known as RU-486, a pill that could be taken in sequence with misoprostol to induce an abortion. France legalized this regimen in 1988, and China, Great Britain, and Sweden soon followed suit. As mifepristone is only used for abortion, it’s been more difficult to access in legally restricted countries.

How is misoprostol used?

Misoprostol can be used alone or in combination with mifepristone to cause an abortion. If used with mifepristone, mifepristone is taken first and followed by misoprostol one to two days after4. Misoprostol tablets can be administered under the tongue (2;7). Typically, you would take multiple tablets of misoprostol at once. Depending on where you are in the pregnancy, you may have to repeat this process after a few hours (4).

Can you insert misoprostol vaginally?

The most effective way to use mifepristone is by swallowing it. Misoprostol can be used effectively in three different ways: sublingual, buccal, and vaginal.
Although using misoprostol pills sublingually, buccally or vaginally are equally effective, it is not recommended to use them vaginally if your geographic location has laws or restrictions against abortion. This is because sometimes misoprostol can leave traces that can be visible to health staff if you need medical care. Using misoprostol sublingually or buccally does not leave visible traces of the pills (1).

How many tablets of misoprostol should be used?

The number of tablets you use and the number of doses you take will depend on how far along you are in your pregnancy. If you are between 10-13 weeks pregnant, it is strongly recommended that you use 12 pills of misoprostol. However, we understand that it could be difficult to obtain the 12 pills, depending on your personal circumstances. In this case, you can find more information and alternatives here.

How long does it take misoprostol to dissolve?

Misoprostol takes about 30 minutes to dissolve in the mouth, also referred to as sublingually or buccally, after which any remaining medication should be swallowed with water.

How does misoprostol work in the body?

As mentioned, misoprostol is commonly used in combination with mifepristone for medical abortion. Mifepristone is consumed first as it helps to stop pregnancy by blocking the hormone called progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy stops progressing.
After mifepristone blocks progesterone, it creates an ideal environment for misoprostol to act. Misoprostol acts directly in the uterus to induce uterine contractions that lead to expulsion of products of conception.

How long do you experience cramping after taking misoprostol?

Cramping, moderate pain, and moderate to heavy bleeding, and possibly passage of blood clots, are common symptoms of the abortion process. Usually the most intense bleeding and cramping will occur within the first 48 hours after using misoprostol, but you may experience bleeding on and off for several days or weeks (13).
The symptoms are similar to a menstrual period or a miscarriage. Heavy bleeding and strong cramps usually last between one and four hours (9).
If you are using mifepristone, this medication does not usually cause any symptoms. Most of the symptoms will only occur after using the misoprostol. Misoprostol can cause temporary side effects, such as fever, chills, diarrhea, nausea, vomiting, and headaches. If you do not experience any of these, it is perfectly normal. If you do, these will disappear in the next 24 hours or less.

What are the contraindications of using misoprostol?

If you have been using long-term steroids (such as Prednisone or dexamethasone), you can have an abortion with misoprostol only.
There are situations where it is not recommended to use both misoprostol and mifepristone when having an abortion with pills. You can find these contraindications here.
If you have an IUD inserted, you may use misoprostol as it’s not really a contraindication; however, you need to take some precautions beforehand. Having a medical abortion using misoprostol when you have an IUD may incurr higher risks than normal. Its always safer to have the IUD removed before using misoprostol for an abortion. This means that if you are in this situation, you should be aware of the risks involved. You can get more information from our counselors here.

Conclusion

Misoprostol is a safe and effective medication that you can self-administer to induce an abortion at home. It is commonly taken after mifepristone, another medicine used for abortions, but can also be taken alone.
Misoprostol can be taken in various ways, and how many tablets you use and how frequently you take them will depend on how far along you are in your pregnancy. After taking misoprostol, it is normal to experience cramping, bleeding, and moderate pain. The bleeding symptoms can last several days to a few weeks, while the other side effects of misoprostol typically resolve within 24 hours. If you want to know more about having an abortion with pills using Misoprostol only, please check our resources section or get in touch with our counselors.