Methotrexate and misoprostol use is a two-step method.
A medical abortion usually requires at least two visits to your doctor over several weeks. For the first visit, one medicine is taken during the visit and a second medicine is given to be taken at home. The second visit is a follow-up appointment and is usually scheduled about 2 weeks after the first visit to make sure the abortion is complete and no complications are present. If a medical abortion is unsuccessful, a surgical abortion must be done to complete the process. (A fetus may not develop normally after exposure to methotrexate or misoprostol.)
You may also take pain medicine by mouth for this procedure.
A medical abortion with methotrexate offers women an early-pregnancy abortion option that doesn't involve surgery.
Methotrexate is also used for treatment of an ectopic pregnancy.
A medical abortion with methotrexate and misoprostol is effective over 90% of the time. Medical abortions can be done through 9 weeks of pregnancy. And when completed before 7 weeks, injected methotrexate is effective in 92% to 96% of cases.1
Misoprostol can be given orally, buccally (dissolved between the gums and cheek), or vaginally. Many doctors are only giving misoprostol by mouth because of reports of a rare, fatal infection that affected a few women after using vaginal misoprostol. Experts do not know for sure if these deaths were related to the use of vaginal misoprostol.2
Methotrexate and misoprostol can take up to 4 weeks to be effective, which is longer than other abortion methods.1
This method of abortion causes symptoms similar to a miscarriage (such as severe cramping and vaginal bleeding) as tissue and clots pass from the uterus. Symptoms may include:
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
Choosing a medical or surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.
Methotrexate for medical abortions has not been evaluated in women with the following medical conditions:
Avoid alcohol and ASA while using methotrexate and misoprostol for a medical abortion.
Avoid folic acid supplements. Folic acid (folate) can interfere with the action of methotrexate during a medical abortion.
Methotrexate can be used by women who have asthma.
A medical abortion does not require surgery, but if methotrexate fails, a vacuum aspiration must be done as follow-up. If the abortion is not completed, complications can include abnormal development of the fetus.
Expect that you may experience a wide range of emotional reactions after an abortion.
Depression can be triggered when pregnancy hormones change after an abortion. If you have more than 2 weeks of symptoms of depression, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your doctor about treatment.
Do not have sexual intercourse for at least 1 week or longer, as advised by your doctor.
When you start having intercourse again, use birth control, and use condoms to prevent infection. For immediately effective birth control, you can use a barrier method (such as a diaphragm, cervical cap, or condom). Diaphragms are no longer widely available in Canada. The spermicidal jelly required to ensure a seal at the cervix is no longer available. An intrauterine device (IUD) is effective immediately after it is placed in the uterus. If you start hormone birth control pills, patches, or injections right after the procedure, be sure to use a backup method until the hormone medicine becomes effective. For more information, see the topic Birth Control.
Your next regular period may come at any time within 6 weeks after the abortion. Be sure to contact your doctor if you do not have a period in 6 weeks.
- American College of Obstetricians and Gynecologists (2005, reaffirmed 2009). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882.
- U.S. Food and Drug Administration (2006). Public health advisory: Sepsis and medical abortion with mifepristone (Mifeprex). Available online: http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051298.htm.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology|
|Specialist Medical Reviewer||Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology|
|Last Revised||August 12, 2011|
Last Revised: April 12, 2012
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.