How to do an Abortion with Pills (misoprostol, cytotec)?

 

The best and safest way a woman can do an abortion herself until the 12th week of pregnancy is with the use of two medicines called Mifepristone (also known as the abortion pill, RU 486, Mifegyn, Mifeprex), and Misoprostol (also known as Cytotec, Arthrotec, Oxaprost, Cyprostol, Mibetec, Prostokos or Misotrol). If you live in a country where there is no access to safe abortion services and you would like to obtain a medical abortion with Mifepristone and Misoprostol, please go to Women on Web (www.womenonweb.org).

pills orange.jpg

Using Misoprostol (or Cytotec) alone to cause an abortion will be successful 90% of the time. If it is not effective the first time, you can try again after 3 days. The information is based on research by the World Health Organization. 

Women who live in a country where they have the possibility to have a safe and legal abortion, should go to a doctor. For abortion clinics worldwide, see www.womenonwaves.org/article-456-en.html

Some women attempt to have an abortion by placing sharp or dirty objects into the womb or by punching the belly. This is very dangerous and should never be done because there is a very high risk of wounding the insides of the woman, infection, heavy bleeding and even death.

For many women, ending a pregnancy is a difficult decision. When the woman cannot discuss the abortion or alternatives with a healthcare provider, we advise her to talk about it with a good friend or a relative. We strongly advise any young girl to talk with her parents or another adult she trusts about her situation, her decision and the abortion procedure.

Women who are sure that they want to end their pregnancy and have no other means should print and study the instructions carefully first. It is best to discuss them with a friend. A woman should never do this alone.

If you have any questions about this method or experiences you want to share, after reading the information below, send email to info@womenonweb.org

How does an abortion with Misoprostol work?

Misoprostol for medical abortion works best in the first 12 weeks of pregnancy.  After that, there is an increased risk of a complication and need for medical attention.  If you are considering using misoprostol after 12 weeks, please contact info@womenonweb.org for instructions; these instructions are for women who are 12 weeks or earlier in their pregnancy.

Misoprostol causes contractions of the womb. As a consequence, the womb expels the pregnancy. A woman can get painful cramps, vaginal blood loss that is more than a normal menstruation, nausea, vomiting and diarrhoea. There is a risk of heavy bleeding for which a woman will have to be treated by a doctor.
The chance that an abortion with Misoprostol will be successful is 90%. Misoprostol is available in pharmacies in almost all countries.

The experience and risks of an abortion caused by Misoprostol are similar to those of a spontaneous miscarriage.

Miscarriage happens spontaneously in 15-20% of all pregnancies.

The treatment of complications is the same as those of a spontaneous abortion (miscarriage). If there is a problem, a woman can always go to the hospital or any doctor. The doctor will treat her as if she had a spontaneous miscarriage. There is no way the doctor will know that the woman took medicines. 

We will now provide some important information that every woman who thinks about inducing an abortion with medicines should know.

A woman should make sure she is pregnant.

She can do a pregnancy test or have an ultrasound. 

Misoprostol should only be used if a woman is 100% sure that she wants to end the pregnancy.

A woman should try to have an ultrasound before taking Misoprostol.

An ultrasound shows whether the pregnancy is in the womb and the length (number of weeks) of a woman's pregnancy. 

Misoprostol should not be used after 12 or more weeks of pregnancy.

A pregnancy of twelve weeks means 84 days (12 weeks) after the first day of the last menstrual period. If a woman thinks she has been pregnant for more than twelve weeks, or if the ultrasound shows this, we do not advise to take Misoprostol unless the woman has medical supervision.
The medicine still works, but the risk of heavy bleeding, serious pain and complications increase the longer the pregnancy lasts.

A woman should not do the abortion alone.

While having the abortion, it is important to have someone close by; this can be the partner, a friend or a relative who knows about the abortion and who can help in case of complications. Once the bleeding starts, someone should stay in contact with the woman to be able to help in case complications occur.

Misoprostol can only be used without medical guidance when a woman has no serious illness.

Most illnesses are no problem. Some serious illnesses, such as, for instance, severe anaemia, can create problems because of the heavy blood loss involved.
Serious illnesses are sometimes a reason for a legal abortion, even in countries with restrictive laws.

Do not use alcohol or drugs during the treatment!!! The woman must be able to pay close attention to what is happening in her body.  If the cramps are very painful, she can use Ibuprofen, or a hot water bottle or heating pad, but never alcohol or drugs.

Misoprostol should not be used when there is a possibility of an ectopic (or extra-uterine) pregnancy.

An ectopic (or extra-uterine pregnancy) is not in the womb (uterus). An ectopic pregnancy can be detected by having an ultrasound. Treatment by a gynaecologist is then necessary to ensure the health of the woman. If not treated, there is a risk of heavy internal bleeding due to rupturing of the fallopian tube.
Gynaecologists treat women for this condition in all countries, even in countries where abortion is illegal. An ectopic pregnancy cannot be treated with Misoprostol.

Misoprostol should not be used if the woman has an intra uterine device (IUD).

An IUD is a contraceptive, a small coil of about 3 cm inserted by a doctor in the womb to prevent pregnancy. A Woman who has an IUD and is pregnant must have an ultrasound made because the risk of an ectopic pregnancy is higher. If the pregnancy is in the uterus, it is necessary to have the IUD removed before using doing the abortion.

Misoprostol should only be used when transportation within a few hours to a hospital is possible.

That way, if complications occur, medical aid will be near.

Misoprostol should never be used if the woman is allergic to Misoprostol or any other prostaglandin.

This is a rare condition, which a woman will be aware of if she has used these medicines and had such a reaction before. If she has never used the medicine before, she cannot have experienced an allergic reaction.

There is a possibility that the attempt to cause an abortion with Misoprostol will fail.

The chance that using Misoprostol will cause an abortion is 90%. The treatment has failed if the medicines do not cause any bleeding at all or there was bleeding but the pregnancy still continued. The woman can try to use the medicines again after a few days, but this can fail again. The failure could be due to the medicines being fake, to an ectopic pregnancy, or because 10% of the time, the medicines do not work. There is only an ongoing pregnancy in 6% of cases. 
If more than 14 days after the use of Misoprostol no abortion has occurred, and if no doctor is willing to help, there remains no other option than to travel to another country to have a legal abortion, contact women on web, or to keep the pregnancy.
There is a small increased risk of birth defects such as deformities of the hands or feet and problems with the nerves of the foetus, if the pregnancy continues after attempting abortion with these medicines. Some doctors might consider this as a reason for a legal abortion, so try to find one.

A possible sexual transmitted infection should be treated.

If there is a risk of a sexual transmitted infection (STI, also known as a sexually transmitted disease, STD) such as Chlamydia or Gonorrhoea, arrange an examination with a doctor so that the infection can be treated properly. The risk of such an infection is increased after rape (in a lot of countries a reason for a legal abortion, should pregnancy occur), or when one has had sex with an unknown person.
Having an untreated sexual transmitted infection increases the risk of an inflammation of the womb and fallopian tubes. Such an inflammation is called a pelvic inflammatory disease (PID) or salpingitis or adnexitis.

HOW TO GET MISOPROSTOL

In some countries women can get Misoprostol at their local pharmacies and use it alone. But if you can get help from Women on Web it is better to do a medical abortion with Mifepristone and Misoprostol. It is much more likely she will have a successful abortion than if she uses Misoprostol alone (98% effective with both medicines compared to only 90% with Misoprostol alone).

Some brand names for Misoprostol are Cytotec, Arthrotec, Oxaprost, Cyprostol, Prostokos and Misotrol. Sometimes it is sold over the counter without a prescription, or sometimes a prescription is required. It is less likely that one would need a prescription for Arthrotec. A woman can of course also make her own prescription (see example below)

Example prescription for Misoprostol abortion pills

Misoprostol is used to prevent gastric ulcers.
Cytotec, Cyprostol, Mibetec, Misotrol, and Prostokos are brand names for Misoprostol.
Arthrotec and Oxaprost contain Misoprostol and a painkiller called Diclofenac. It is used for pain in the joints, or arthritis. Arthrotec is generally more expensive than Cytotec.

- Cytotec (200µg Misoprostol)
- Arthrotec or Artrotec 50 or 75 (200µg Misoprostol)
- Cyprostol
- Misotrol (Chili)
- Prostokos (25µg Misoprostol) (Brazil)
- Vagiprost (25µg Misoprostol) (Egypt)
- Oxaprost 50 or 75 (200µg Misoprostol) (Argentina)
- Misotac (Egypt, Ghana, Sudan, Tanzania, Uganda, Zambia)
- Mizoprostol (Nigeria
- Misive (Spain)
- Misofar (Spain)
- Isovent (Kenya, Nepal)
- Kontrac (India, Democratic Republic Congo)
- Cytopan (Pakistan)
- Noprostol (Indonesia)
- Gustrul (Indonesia)
- Asotec (Bangladesh)
- Cyrux (Mexico)
- Cytil (colombia)
- Misoprolen (Peru)
- Artrotec (Venezuela, Hong Kong, Australia)
(even more brands: Mibetec, Cytomis, Miclofenac, Misoclo, Misofen, Arthrofen, Misogon, Alsoben, Misel, Sintec, Gastrotec, Cystol, Gastec, Cirotec, Gistol, Misoplus, Zitotec, Prestakind, Misoprost, Cytolog, GMisoprostol, Mirolut, Gymiso)

To obtain one of these medicines, one could, for example, say that your grandmother has rheumatoid arthritis so severely she can not go to the pharmacy herself, and that you do not have money to pay for a doctor to get the prescriptions for the tablets.

If there are problems to get the medicines in one pharmacy, try another pharmacy, or a male friend or partner might have fewer problems obtaining them. Or perhaps you can find a doctor willing to prescribe them. Usually one can expect more luck at the smaller pharmacies that do not belong to a chain.

Sometimes Cytotec can also be bought on the black market (places where you can also buy Marijuana). However try to make sure that is really is Misoprostol and not fake pills or some other medicine! See the picture on this page for an example of genuine pills. 

The woman should buy at least 12 pills of 200 mcg Misoprostol. One pill of Cytotec or Arthrotec should contain 200 micrograms of Misoprostol. Look for the dosage of Misoprostol on the package, usually the tablets contain 200 mcg but other dosages do exist. If the pills do not contain 200 micrograms of Misoprostol, recalculate the number of pills so that the same total amount of Misoprostol is used. 

misoprostol registration map

HOW TO USE MISOPROSTOL

In countries where abortion is illegal, Misoprostol alone can be used to cause an abortion. Incorrect use of Misoprostol can be harmful for the health of a woman!!

To cause an abortion, a woman must put 4 pills of of 200 micrograms (in total 800 mcg) Misoprostol under the tongue. Do not swallow the pills (at least until 30 minutes after putting the tablets under the tongue!!)

After 3 hours she should put another 4 pills of Misoprostol under the tongue.

After 3 hours she should put another 4 pills of Misoprostol under the tongue again for a third time. Do not swallow.

If a woman uses Arthrotec to induce an abortion, she should let the 4 tablets dissolve under her tongue until the outer mantle is dissolved (half an hour). She should spit out the inner hard tablet. The inner tablet is diclofenac, a painkiller and it is better not to swallow the inner tablets.

4 pills under the tongue

photo by Benjamin Sadkowski

The success rate is 90%.

After the first dose of Misoprostol a woman should expect bleeding and cramps. Bleeding mostly starts within four hours after using the pills, but sometimes later. Bleeding is often the first sign that the abortion starts. If the abortion continues, bleeding and cramps become more severe. Bleeding is often more and heavier than a normal menstruation, and there can be clots. The longer the pregnancy, the more heavy the cramps and the bleeding will be. If the abortion is complete, the bleeding and the cramps diminish. The moment of abortion can be noticed with a peak of heavier blood loss and more pain and cramps. Depending on the length of the pregnancy, a small pregnancy sac with some tissue around can or cannot be seen. For instance, if the woman is only five to six weeks pregnant, there will be no visible sac. At nine weeks, a woman could probably find a sac in between the blood.

If no bleeding occurs after the third dose, the abortion did not take place and the woman has to try it again after a couple of days or travel abroad to a country where it is legal or try again to find a doctor.

Ibuprofen is the most effective painkiller for cramps. You can also use other painkillers like Naproxen and Diclofenac. If you cannot obtain Ibuprofen, Paracetamol or Tylenol (acetaminophen) or Aspirin (salicylic acid) also help. For some women, additionally a hot water bottle on the belly brings relief. Please read the patient instructions of the package of painkillers you obtained for the maximum doses you can use.  

Bleeding after the abortion

Bleeding continues lightly one to three weeks after the abortion, but sometimes shorter or longer. Every woman's body is different. The normal menstrual period mostly returns after four to six weeks.

Making sure an abortion has occurred

Some women bleed without having an abortion. Therefore it is important that the woman makes sure that an abortion really occurred. It can take two to three weeks before a pregnancy test becomes negative. So if possible, have an ultrasound made about one week after the abortion to make sure that the pregnancy has ended. It is normal for some blood and tissue to be still in the uterus after 7-10 days; this will come out with the next menstrual period.  As long as there is no fever, pain, heavy bleeding or vaginal discharge, remains in the womb is not a problem. .

SIDE EFFECTS

The most common side effects are nausea, vomiting and diarrhoea. A woman can also have some fever. These are generally less severe if Misoprostol is used vaginally.

WHEN TO CONTACT A DOCTOR OR GO TO A HOSPITAL

If there is heavy bleeding

Heavy bleeding is bleeding that lasts for more than 2-3 hours and soaks more than 2-3 maxi sanitary pads per hour. Feeling dizzy or light-headed can be a sign of too much blood loss, and means that there could be a danger to the woman's health.

If the strong bleeding does not diminish after 2-3 hours, it might be a sign of an incomplete abortion (remains of the pregnancy are still in the womb), which needs medical treatment. This can happen a couple of hours after taking Misoprostol but also two weeks or longer after the abortion.

In this case a woman should go to the nearest hospital or doctor to seek help.

In countries where abortion is a crime, doctors or nurses sometimes denounce women who have attempted an abortion to the police. We recommend, if possible, to find a doctor the woman trusts.

In countries where women can be prosecuted for having an abortion, it is not necessary to tell the medical staff that one tried to induce an abortion, one can also say one had a spontaneous miscarriage. The doctor CANNOT see the difference. The treatment is also the same. A doctor will perform a dilation & curettage (D&C) or a vacuum aspiration to empty the womb. 
Doctors have the obligation to help in all cases.

If fever occurs

Chills are a normal side effect of Misoprostol as well as some elevation of body temperature. However, if the woman has a fever (> 38 degrees Celsius) for more than 24 hours, or if she has a fever of more than 39 degrees, contact a doctor, because there might be an infection as a result of an incomplete abortion that needs treatment (with antibiotics and/or vacuum aspiration).

If the Misoprostol did not work

When Misoprostol did not cause any bleeding at all or there was a little bleeding but the pregnancy still continues, this means the abortion did not happen. There is a small increased risk of birth defects such as deformities of the hands or feet and problems with the nerves of the foetus, if the pregnancy continues after attempting abortion with these medicines. Because of this low risk of Birth defects, a vacuum aspiration should be done if the woman does not have an abortion spontaneously after taking Misoprostol.

You could say that you think you had a miscarriage. In countries where women can be prosecuted for having an abortion, it is not necessary to tell the medical staff that you tried to induce an abortion, you can also say you had a spontaneous miscarriage. The doctor CANNOT see the difference.

If the abortion was incomplete, you might need a dilation & curettage (D&C) or a vacuum aspiration, during which a doctor will remove remaining tissue from the womb. 

FOR THE FUTURE

Get good contraception to prevent a new unwanted pregnancy.
An IUD can be inserted by a doctor as soon as the bleeding has finished and a pregnancy test is negative or when an ultrasound shows an empty womb.
Oral contraceptives can be taken once the bleeding is finished as well, but they will not be completely safe during the first month. Use extra contraceptives such as condoms for extra protection during the first month.

If you have any questions about this method or experiences you want to share, send email to info@womenonweb.org

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