Disclaimer: This information is provided for educational purposes and does not replace medical advice from a healthcare provider.
What Is Misoprostol and Why It Is an Essential Medicine
Misoprostol as a prostaglandin medication
Misoprostol is in a class of medication called prostaglandins and is used for a variety of indications in the practice of obstetrics and gynecology.
Medical uses in 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).
Why Misoprostol is on the WHO essential medicines list
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.
To better understand why Misoprostol is so widely used today, it helps to look at how it was originally developed.
The History and Development of Misoprostol
Original use for peptic ulcers
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.
Discovery of its effects on pregnancy
Misoprostol’s effects on pregnancy were identified through decades of research on prostaglandins, substances known to influence uterine activity. In the 1930s, scientists first observed that prostaglandins could trigger uterine contractions, and later research clarified their chemical structure and medical potential. Misoprostol itself was synthesized in the early 1970s as a prostaglandin E1 analog and was initially approved in the late 1980s to treat stomach ulcers. Over time, clinicians recognized that the same properties that protect the stomach also stimulate the uterus, leading to its widespread use in reproductive health for medical abortion, labor induction, and managing postpartum bleeding.
Combination with Mifepristone and global adoption
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 Misoprostol Is Used for Abortion
Using Misoprostol alone versus with Mifepristone
Misoprostol can be used alone or in combination with mifepristone to cause an abortion.
Timing between Mifepristone and Misoprostol
If used with mifepristone, mifepristone is taken first and followed by misoprostol at least 24 hours but no more than 48 hours after.
How Misoprostol works 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.
Once you understand how Misoprostol works for abortion, the next step is knowing how to use it safely.
How to Take Misoprostol Safely
Routes of administration: sublingual, buccal, and vaginal
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.
Misoprostol can be used effectively in three different ways: sublingual, buccal, and vaginal, and mifepristone is taken by swallowing the pill.
Choosing a route based on safety, privacy, and legal context
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 are needed based on gestational age
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.
You should contact a counselor or healthcare provider if you have concerns about symptoms, the effectiveness of the medication, or your gestational age. 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.
What to Expect After Taking Misoprostol
Cramping, bleeding, and abortion symptoms
Cramping, moderate pain, and moderate to heavy bleeding, and possibly passage of blood clots, are common symptoms of the abortion process.
How long side effects last
Side effects after taking misoprostol vary, but most are temporary and short-lived. The strongest cramping and heaviest bleeding usually happen within the first one to two days, often peaking for several hours as the pregnancy tissue passes, and then easing into milder, on-and-off cramps for a day or two.
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.
When bleeding and pain are considered normal
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.
Conclusion
Misoprostol is a widely used and effective medication, and understanding how it works, what to expect, and when to seek support can help people navigate the abortion process with greater confidence and safety. 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.
