Non-surgical, medically induced, abortions
using methotrexate and misoprostol
Medically induced abortions involve the use of a medication instead of
RU-486 is one medication that is used; it is described in a
This essay deals with abortions induced by a combination of methotrexate and misoprostol.
Religious and social conservatives often refer to medical abortions as "chemical
Abortions have traditionally involved surgery, clinics, hospitals,
insurance companies, instruments, anesthetics, etc. But two recent medical developments
may change this in the near future for many women:
The home-pregnancy kits that are now available are simple to use and rather reliable.
They can be purchased at relatively low cost in most drug stores. They allow accurate
detection of pregnancy at or a few days before the expected timing of the first missed period. Thus,
a woman can often detect a pregnancy within two weeks of conception
A combination of two drugs (methotrexate and misoprostol) will usually terminate the
pregnancy if given at 7 weeks or less after conception.
Methotrexate is approved by the FDA as an anti-cancer and immune
modulator drug. Misoprostol is used to prevent ulcers in patients
treated with nonsteroidal antiinflammatory drugs. In 2000-OCT, the manufacturer of misoprostol sent a circular letter which mentioned that the FDA had not
approved its use on pregnant women. 16 However, the FDA
allows physicians to employ these drugs to induce an abortion, even though that was not
their original intent. Obstetricians have used the drug since 1988 to terminate ectopic
pregnancies. (Ectopic pregnancies occur when the fertilized ovum lodges in the fallopian
tubes. They are sometimes called "tubal pregnancies." If
untreated, they are generally life threatening.) 6
An office of Planned Parenthood reports that "More that 3,000 women have
used this method in clinical trials, clinics, and doctors' offices, and there have been no
reports of significant side-effects or long-term risks." 5
A woman who has had unprotected sex can check whether she is pregnant within two weeks
of the possible conception, and terminate any pregnancy immediately with help from any
cooperating physician. One physician refers to these as "Early Medical Abortions
(6-7 weeks) Option using Methotrexate and Misoprostol." 4
Three women from Seattle who have had medical abortions describe their experience in
In late 1999-DEC, Rhode Island became the last state to pass legislation that approves of the use
of Methotrexate & Misoprostol. The treatment is thus legally
available across the country.
What a medical abortion involves:
Methotrexate has been available for almost 50 years as a treatment for tumors,
arthritis, and psoriasis. It is given by injection. Normal side effects are described as
"usually mild" and not of long duration; they can include: nausea,
diarrhea, abdominal cramping, hot flashes, or sores in the mouth. The medication stops the
development of the embryo.
Misoprostol is a commonly used prostaglandin medication for ulcers. It is inserted into
the vagina, often by the woman at home, 5 to 7 days after the injection of
number of side-effects are possible, including nausea, vomiting, diarrhea, abdominal pain,
dizziness, and/or fever and chills.
Methotrexate prevents the cells in the embryo from dividing. Misoprostol causes the
womb to contract. Cramping and bleeding will be experienced. Blood clots will be passed.
The embryo is usually expelled within a week. If the woman has determined that she is
pregnant 2 weeks after conception, and goes immediately to her doctor for the injection,
then the development of the embryo might be stopped at 2 weeks, when it is an small piece of undifferentiated tissue. At 3 weeks, it is
typically 1/12" (2 mm) long, the size of a pencil point. It most closely resembles a
worm; it is long and thin and with a segmented end. A week later, it is typically about
1/5" (5 mm) long. It looks something like a tadpole. The structure that will develop
into a head is visible, as is a noticeable tail. The embryo has structures like the gills
of a fish in the area that will later develop into a throat.
One complication of this procedure is that it is only about 95% reliable; the embryo is
sometimes not expelled, but continues to grow. Because of the nature of the medication used, it will
be almost certainly seriously deformed. Before proceeding with a medical abortion, the
woman should be willing to follow up with a surgical abortion if the chemical technique
fails. One study expresses concern that a small percentage of women may change their
mind and not follow through with a surgical abortion in the event that a medical abortion
fails. Very serious limb damage in the newborn will result. 3
Planned Parenthood reports: "The most common complication of a medical
abortion, like the most common complication of miscarriage, is heavy bleeding. A small
number of women may even need an emergency D&C to stop the bleeding. In very rare
cases, a woman may need a blood transfusion." 5
Published studies by other medical researchers have found that using methotrexate and
misoprostol in terminating pregnancies is approximately 90% effective when it is
taken up to 49
days from the first day of a woman's last menstrual period.
Results of a Clinical Trial:
Richard U. Hausknecht reported the results of a study at Mount Sinai School of
Medicine, New York, NY.
"A total of 171 of the 178 women enrolled in the study (96 percent) had
successful medical abortions. Twenty-five women (14 percent) did not have an abortion
after the first dose of misoprostol and received a second dose. Eighteen subsequently had
complete abortions, but seven required suction curettage. In all seven women who required
suction curettage, there was histologic evidence of disruption in the conceptus. No
important side effects or complications were noted."
A second study by Dr. Eric Schaff was held at the University of Rochester. They
"found that 98 of 100 women completed abortions with the Methotrexate-Misoprostol
Some advantages/disadvantages to medical abortions:
When compared to other methods, advantages include:
No surgical instruments are used. Many women consider the procedure less invasive.
No anesthetics are required.
The procedure can be done in a physician's office. This may offer the woman more privacy,
and less exposure to demonstrators,
when compared to a trip to an abortion clinic.
At least two visits to a physician are required (vs. one for an abortion by vacuum
The medication is only about 95% effective.
The duration of the procedure and its related bleeding are greater.
The woman may be distressed at seeing the expelled embryo. 8
One source predicts that the Methotrexate/Misoprostol combination will be eventually
replaced with a Mifepristone (RU486)/Misoprostol procedure when RU486 is finally made
available. The latter is faster, and has a proven safety history. "Over 200,000 women
already have successfully used the Mifepristone regimen." 9
In Canada, a series of studies across the country started in mid-2000;
both medications are being compared.
Safety concerns raised by Pro-Life groups:
An article by Sue Widemark dated 1996-SEP-7 is available on the Catholic
Information Network's web page. She concludes that Methotrexate is a "rather
dangerous drug according to the PDR (Physicians Desk Reference)." As the name
implies, the book is consulted for drug information by many physicians. She correctly
quotes the PDR: that the medication should only be used to treat "severe,
disabling, recalcitrant disease." However, she fails to note that these
precautions refer to long term treatment of cancer or severe arthritis or psoriasis. When
Methotrexate is used to induce an abortion, it is given in a single injection, and not
Dee Doughty, life resources director of Life Advocates in Houston TX said that
her group strongly opposes clinical trials of what she refers to as "M&M's."
She had two main concerns: psychological damage to women caused by the abortion, and possible
negative long-term effects that the drugs may cause. 11
Some concerns have been raised that Methotrexate might suppress the
level of folic acid in the woman's body. She might become pregnant at
a later time and her new fetus might be at risk of developing spina
bifida. We obtained an opinion from the medical director of Planned
Parenthood. He said that this concern has been well studied by several
authors and there is no evidence of adverse effects in subsequent pregnancies after methotrexate abortion.
Olivia Gans, director of American Victims of Abortion (a unit of the National
Right to Life Committee) was quoted by CNN as saying: "Methotrexate may
cause serious complications for the mother and stops the beating heart of her unborn
child...The combination of these two drugs [would have] a potentially fatal effect on
unborn children and the women who take this drug combination."
Rev. Paul Marx, founder and chairman of Human Life International, referred to
clinical trials of "chemical" abortions. He declared that "Planned Parenthood has
declared chemical warfare on the unborn...Given Planned Parenthood's eugenic philosophy
and tradition, it comes as no surprise that they would use methotrexate, the highly toxic
drug used to treat cancer, to end a life of a child and pollute its mother's body. From
the Planned Parenthood perspective, a baby IS a cancer." He referred to what he called Planned Parenthood's "callous disregard for
life, for truth and for the health and welfare of women..." Rev. Marx predicted
massive lawsuits against the abortion industry in the future.
Misuse of misoprostol outside of North America:
In some countries, like Argentina, Brazil, Colombia, Dominican
Republic, Indonesia, Nigeria, Philippines, Spain, South Africa, misoprostol is readily available on the black market. In most of these
countries, women cannot obtain legal abortions. In desperation, they
purchase the medication in order to terminate their pregnancies without
medical help. Susheela Singh of the Alan Guttmacher Institute in New York
has studied clandestine abortion practices in Latin America. She says: "It's
really the poor person's method." The drug can cost as little as US$
0.35 and can often be purchased over the counter without a prescription.
Up to 75% of clandestine abortions in Brazil involve the medication. When
misoprostol is taken in isolation, it only causes an abortion about 40% of
the time. Studies have shown that in many cases, the pregnancy continues,
and the baby is born with birth defects: fused joints, growth retardation
and Möbius syndrome (paralysis of the
Impact on the Pro-Life/Pro-Choice conflict:
This development has the potential of changing the pro-life/pro-choice debate forever.
Methotrexate/Misoprostol, and/or the Mifepristone (RU486)/Misoprostol
combination will probably become widely used in North American. Abortion will
eventually become a very private act in North America, between a woman and her physician.
It has become so in many European countries. Pregnancies can be terminated when the fetus
is only a small speck; a piece of undifferentiated tissue.
This method is almost immune to attack by pro-live advocates. They will be faced with
picketing every physician's office rather than a relatively small number of abortion
clinics. Pro-life groups will no longer be able to target those few physicians who
performed abortions in the past, because any doctor may choose to prescribe these pills.
This abortion method has the potential to drastically reduce both the number of surgical
abortions and the number of clinics that perform them.
One source indicated that a pro-life group has sent threatening faxes to
abortion researchers and have picketed their officers. 1But that seems to be the only
options open to them.