Disclaimer: THIS IS NOT MEDICAL ADVICE
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).
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 at least 24 hours but no more than 48 hours after. Misoprostol pills are recommended to be administered under the tongue. Typically, you would take multiple pills of misoprostol at once. Depending on where you are in the pregnancy, you may have to repeat this process four hours later.
Can you insert misoprostol vaginally?
Misoprostol can be used effectively in three different ways: sublingual, buccal, and vaginal, and mifepristone is taken by swallowing the pill.
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 pills of misoprostol should be used?
The amount of misoprostol recommended for a complete and successful abortion depends on whether you're using misoprostol after using mifepristone and weeks of gestation.
If you’re using mifepristone and misoprostol for pregnancies up to nine weeks, four pills of misoprostol would usually be enough. However, if there’s an absence of bleeding after 24 hours after using the misoprostol, you can use four additional pills.
If you’re using mifepristone and misoprostol for pregnancies between 9 to 13 weeks, it’s recommended to use two doses of four pills of misoprostol (eight in total). You can use four misoprostol pills, wait for four hours, and use another four misoprostol pills.
If you’re using misoprostol alone for up to 13 weeks of pregnancy, you’ll need 12 misoprostol pills. They are used in subsequent doses of four pills every three hour-interval.
For pregnancies beyond 13 weeks, you can get in touch with the safe2choose counselors for support. You can also find more information and alternatives here.
How long does it take misoprostol to dissolve?
The amount of time needed for the misoprostol to dissolve depends on the brand; some dissolve better and/or quicker than others. However, regardless of whether or not the pills have completely dissolved, as long as the pills are held for 30 minutes in the chosen route, that’s enough time for them to be absorbed into the body. If you’re administering the pills orally, you can swallow the rest of the pills with water for 30 minutes.
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.
The symptoms are similar to a menstrual period or a miscarriage.
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?
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 incur higher risks than normal. It's 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.
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.
