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What is it?  A methotrexate & misoprostol abortion is also referred to as an M&M or medical (non-surgical) abortion.  It is an abortion that can be done up to 7 weeks (49 days) from the first day of your last period.  It consists of a 2-step process.  The first step is taken at the abortion clinic, and the second is usually taken at home.

What happens? First, a thorough exam should be given to ensure that your pregnancy is not ectopic (or tubal) and that there is no IUD in place.  An ultrasound, blood work, and a pelvic examination will most likely be done.   If the pregnancy is confirmed and the gestational age is within the boundaries, a shot of methotrexate will be given intramuscularly (commonly in the buttocks). The measurement of the injection is based on your individual height and weight.

Methotrexate stops the growth of rapidly multiplying cells by disrupting the availability of folic acid, which is needed to build new cells.  In a pregnant woman, methotrexate goes straight to the cells of the "trophoblast" - the cells that are rapidly forming the placenta.  Once the trophoblast has been cut off from its supply of folic acid, the connection that it did have to the uterine lining loosens, and production of HCG (the hormone that tells your body not to shed its lining) stops.  The developing human will then be deprived of its blood supply and food source, and will therefore expire and float within the uterus.

Three to seven days later you are instructed to insert misoprostol suppositories into your vagina (alternatively you may take 2 pills orally).  Misoprostol produces uterine contractions and causes your cervix to dilate, and this will cause you to expel the aborted baby, placenta, and the lining of your uterus.

Normally you will not start bleeding until the misoprostol suppositories are administered (only 10% of women bleed with methotrexate alone).  Bleeding can occur between 4 hours to 21 days after the suppositories are inserted and will continue for approximately 8-16 days, with anything over 30 days warranting a call to the doctor. Some women may take 4 weeks to begin bleeding, however, and require a second dose of misoprostol.

A follow-up exam will be scheduled for approximately 7 days after the misoprostol was administered in order to confirm that the abortion has been completed.  An ultrasound or a pelvic examination should be done to verify that everything has been expelled. A blood test may also be done at this time.

What does it cost?  The cost varies from clinic to clinic, but a shot of methotrexate is approximately $10.  Misoprostol suppositories should also cost around $10.  However, you also have to factor in the cost of doctor fees and counseling services, which can put the cost at around $400-600 total.

What should I consider?

• Methotrexate abortions can be more expensive than a surgical abortion due to multiple visits.
• It is only effective during the first 7 weeks of your pregnancy, which is dated from the first day of your last period (49 days).  Some doctors may offer this option past this point, but you should know that this jeopardizes you and will not be as effective.
• There is no risk of infection from tools, uterine puncture, or cervical damage like there is with surgical abortion.
• A methotrexate abortion is a drawn-out process, taking 3-7 days to finish the regimen and sometimes up to 4 weeks to begin bleeding.  During this time, the emotional tension can get quite high.
• While it may seem easier to deal with since the majority of the abortion occurs at home, it can be more difficult to go through it without the care of medical professionals.  Some women report seeing the form of the baby after they pass it, and this can be quite difficult.
• Since the timing of the abortion is so unpredictable, it can be bothersome to begin to bleed at any moment - at work, school, etc.
• Approximately 1-2% of women have excessive bleeding that requires emergency medical attention.
• Approximately 5-10% of methotrexate abortions do not work at all in the first 7 weeks, and the pregnancy either continues unaltered or the aborted baby does not get expelled properly.  The likelihood of this happening increases to over 20% if it is taken between the 7th and 9th week of pregnancy.
• No testing has been done on long-term effects of this medication on women's health.
• The FDA has not approved methotrexate for abortion use.

What are the side effects? Side effects of methotrexate and misoprostol include nausea, vomiting, diarrhea, fever, chills, headache, dizziness, mouth sores, and uterine cramping.  Other side effects exist for methotrexate, but only for repeat doses (ie, in women treated for cancer).

What if I change my mind? Sometimes a woman gets the methotrexate shot, gets home and then doesn't want the abortion any more. The abortion clinic will most likely tell you that you need to continue.  However, this is only to protect them - not you.  You can decide to stop the abortion.  Simply throw away the misoprostol and contact a pregnancy center to help you find an OB/GYN that will examine you. The chance that the baby is still developing after the methotrexate is taken is small, but sometimes the peace of mind that comes from following your heart is more important than procedures and statistics.

Likewise, if the abortion fails and the baby is found to be developing normally at the 2-week check up, the clinic might insist that you need a surgical abortion.  This also is untrue, and the decision is still in your hands.  They cannot force you to have a surgical abortion.

The clinic will most likely warn you that birth defects will occur. Since methotrexate is not approved for abortion uses, there have been no studies done on women who continued their pregnancies after a changed mind or failed abortion.  There are some case reports of women who were treated for cancer or other illnesses who were pregnant at the same time, but these women received multiple doses instead of what is given during a methotrexate abortion.  Out of 27 births, 20 were born perfectly healthy and 7 had skeletal and/or central nervous system defects.  Misoprostol has been linked to cases of Mobius syndrome, which causes facial paralysis, but statistics say that this happens rarely.  You deserve to know the truth and have all the information concerning this procedure - let the clinic know that you are aware of the studies and statistics.  The best course of action to take if you would like to continue a pregnancy after one or both medications is to contact a pregnancy center who can give you the name of an OB who is trained in dealing with this kind of situation. You can read more about continuing a pregnancy after a failed medical abortion here.

Methotrexate &

Misoprostol