Medical Abortions

Medical abortion procedures are available to terminate a pregnancy during the early weeks of the first trimester. Before seeking a medical abortion procedure, it is recommended that you obtain a sonogram to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating or gestation.

Some people ask about the abortion pill when thinking about medical abortions. You can call the Helpline toll-free at 1-866-942-6466 to discuss the differences between medical and surgical abortions and to find free sonogram services.

MTX: Methotrexate & Misoprostol:

MTX a medical abortion procedure used up to the first seven weeks of pregnancy.

• Methotrexate is given orally or by injection during the first office visit.
• Misoprostol tablets are given orally or inserted vaginally during the second office visit which occurs 5 to 7 days later.
• You will return home where the misoprostol will start contractions and expel the fetus. This may occur within a few hours or up to a few days.
• A physical exam is given 7 days later to ensure that the abortion procedure is complete and that no complications are apparent.
• Methotrexate is primarily used in the treatment of cancer and rheumatoid arthritis because it attacks the most rapidly growing cells in the body. In the case of an abortion, it causes the fetus and placenta to separate from the lining of the uterus. The use of this drug for this purpose is not approved by the FDA.

The side effects and risks of Methotrexate & Misoprostol include the following:

• The procedure is unsuccessful approximately 10% of the time, thus requiring an additional surgical abortion procedure to complete the termination.
• Cramping, nausea, diarrhea, heavy bleeding, fever
• Not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease, or use an intrauterine device (IUD).

RU-486: Mifepristone (Mifeprex) and Misoprostol:

Mifepristone (Mifeprex) and Misoprostol is a medical abortion procedure used up to the first seven to nine weeks of pregnancy. It is also referred to as RU-486 or the abortion pill.

• A physical exam is given to determine if you are eligible for this medical abortion procedure. You are not eligible if you have any of the following: ectopic pregnancy, ovarian mass, IUD, corticosteroid use, adrenal failure, anemia, bleeding disorders or use of blood thinners, asthma, liver or kidney problems, heart disease, or high blood pressure.
• Mifepristone is given orally during your first office visit. Mifepristone blocks progesterone from the uterine lining, causing the fetus to die. This alone, may cause contractions to expel the fetus.
• Misoprostol tablets are given orally or inserted vaginally during the second office visit which occurs 36 to 48 hours later.
• You will return home where the misoprostol will start contractions and expel the fetus. This may occur within a few hours or in some cases up to two weeks after taking the misoprostol.
• A physical exam is given two weeks later to ensure the abortion was complete and that there are no immediate complications.

The side effects and risks of Mifepristone & Misoprostol include the following:

• The procedure is unsuccessful approximately 8-10% of the time, thus requiring an additional surgical abortion procedure to complete the termination.
• Cramping, nausea, vomiting diarrhea, heavy bleeding, infection
• Not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease, or use an intrauterine device (IUD).

“Induced Abortion.” The American College of Obstetricians and Gynecologists. 2001.

Pymar HC, Creinin MD (2000). Alternatives to mifepristone regimens for medical abortion. American Journal of Obstetrics and Gynecology, 183 (2): s54-s64.

Paul M, et al. (1999). A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.

Creinin MD, et al. (2001). Medical management of abortion. American Journal of Obstetrics and Gynecology Practice Bulletin, no. 26, pg.1-13.

Goldberg ab, et al. (2001). Misoprostol and pregnancy. New England Journal of Medicine, 344 (1): 3845.

Spitz IM, et al. (1998). Early pregnancy termination with mifepristone and misoprostol in the U.S. New England Journal of Medicine, 338 (18): 1241-1247.

Last updated: 02/2020