Patient Information for Medical Abortion with Mifeprex (Mifepristone) and Misoprostol at the Downtown Women's Center

Phone: (503) 224-3435 (800) 742-9202 Monday-Friday 9-5, Saturday 8-2

After-hours emergency number: (503) 294-1953

Most patients who choose to end their early pregnancies with a medical abortion are satisfied with the process. For most women (95% or more) the process is predictable and successful. The first medication, Mifeprex, is taken at the clinic on the first day. This is the medication that inactivates the hormone progesterone, which the pregnancy needs to continue. Either one or two days later (the time can vary somewhat depending on your schedule), a second drug is taken buccally (held between the cheek and gum until it dissolves). The second drug, misoprostol, begins the expulsion of pregnancy tissue sometime in the next 1-8 hours. It causes more cramping and bleeding than most women have during their menstrual periods; it is very similar to the cramping and bleeding of a spontaneous miscarriage. Most women tolerate the discomfort and bleeding quite well. Having a support person with you during the procedure is essential, and a follow-up clinic visit to ensure that the pregnancy has passed is also necessary. When the process is uncomplicated, the total bleeding is fairly minimal and is no more than that expected with a surgical abortion.

In a small number of cases (about 5%) the process is not so straightforward. We want all women who choose this method to understand what complications can occur and how to recognize them and deal with them before they decide that this is the right method of abortion for them. At this point we are not able to offer medical abortions to patients who do not speak fluent English.

Medical abortion is different from surgical abortion in many ways, but one of the most significant is that women undergo the process for the most part in the privacy of their own homes. The procedure is safe and effective when used at home, if you are willing to be responsible in following the instructions and calling us if any problems occur.

Problems that can occur:

1. Bleeding too much. The likelihood that you will need to be seen urgently in a hospital or emergency room for bleeding is, at most, one woman in 100. That chance is even less if you are very early in the pregnancy. Excessive bleeding is a risk that can occur in any pregnant woman, and medical abortion is no exception. The chance that you will need a blood transfusion with this method is about 1 in 1000. YOU MUST CALL US IF YOU SOAK MORE THAN TWO MAXI PADS AN HOUR FOR TWO HOURS IN A ROW. We will need to evaluate the need for a suction procedure at that point.
   If you are undergoing this process outside the Portland area and you are bleeding more than the expected amount, call us anyway. We will be happy to facilitate your visit at a local medical facility if that seems necessary.
2. As with surgical abortion, there is a small chance (1-2%) that the method will not end your pregnancy. This is less likely the earlier you are in the pregnancy. In those few cases when the medical abortion fails and a pregnancy continues, we urge you to undergo a surgical abortion (at no extra expense). We don't know the effects of these two drugs on an ongoing pregnancy, but there is serious concern about the potentially damaging effects of the second medication, misoprostol, on the developing fetus.
3. Again, as with surgical abortion, there is a small chance that not all the tissue will pass. The incomplete abortion rate is also 1-2%. This means there is some tissue that doesn't pass and may cause ongoing bleeding. If this occurs, you may have a suction procedure to completely empty your uterus.

The average woman bleeds heavily for a short period of time after the second medication. Some bleeding is expected for 1-4 weeks afterwards. If the bleeding concerns you or is heavier than you think is normal, you are welcome to call us at any time to arrange for an extra check up appointment at your convenience.

Some good things about medical abortion:

1. In most cases, no surgery!! You can do this at home with someone you know to take care of you.
2. The chance of uterine damage (perforation) is zero when this method is successful.
3. The infection rate with medical abortion is lower than with surgical abortion.

You should not use this method if:

1. You know you are allergic to either of the drugs used-mifepristone and misoprostol.
2. You have a bleeding abnormality or take anticoagulation drugs like heparin or coumadin.
3. You have an IUD in place.
4. You have chronic adrenal failure.
5. You use steroid medications, including daily use of steroid-containing asthma inhalers.
6. You have an ectopic (tubal) pregnancy. Mifeprex will not end a pregnancy outside the uterus.

ADDITIONALLY - Even though we know quite a lot about the drug mifepristone, it has not been used in this country except in tightly controlled research settings. As a consequence, our information about drug interactions is necessarily incomplete. It may be that some drugs like Erythromycin, some seizure medications, and even St. John's Wort lessen the effectiveness of Mifeprex. Do not take any other medications with this drug unless absolutely necessary.

CONTRACEPTION: You should not have intercourse until the heavy part of the bleeding has finished (about one week). You can start contraceptive pills the first Sunday following the taking of Mifeprex, but use a back-up method like condoms or a diaphragm for the first cycle of pills.

DIRECTIONS FOR USE:

We will give you the first medicine, Mifeprex, here in the office. You and your counselor will have discussed together when and where you are planning to take the second medicine. You will receive 4 tablets of misoprostol in an envelope. At the appointed time, put the tablets in your mouth between your cheek and gum, and allow them to dissolve. After half an hour, you may swallow any remaining pill fragments with a glass of water.

Once you have placed the tablets in your mouth, you should expect to start bleeding anytime from almost immediately to 1-8 hours later. Call us if you do not bleed within 24 hours. Bleeding and cramping are normal and expected. About 40% of women get nauseated and a few throw up. This is normal, too. About 10-15% will have diarrhea.

You can take the pain medicine we have prescribed anytime. You can also take ibuprofen (Advil) to help with the cramps.

About 20% of our patients are reporting bleeding before using the second medicine. This is normal. Always go ahead and insert the vaginal tablets as planned. The blood and tissue you will pass will mostly look like blood clots. The expulsion process usually lasts no longer than a few hours, but some patients feel the cramps associated with the expulsion for 8 hours or more. Some bleeding is likely to continue, similar to a period, for 1-4 weeks.

IT IS ESSENTIAL THAT YOU COME BACK TO BE CHECKED AFTER THE PROCEDURE SO WE KNOW YOU ARE NOT PREGNANT.

The last thing we want is for you to think your pregnancy has ended if that is not the case. It can be hard to tell if the pregnancy has passed, as pregnancies in this range are mostly invisible. Again, it is essential that you return to your scheduled check up so we can check by ultrasound to see if the pregnancy tissue has passed.