What Is The Most Optimal Regimen For Medical Abortion?

Through the power of technology and internet, information is quickly and easily available to everyone. Similarly, women all over the world access information on medical abortion on the internet as reproductive care access is lacking, absent or too much expensive in their area.

Still, there are some doubts about the regimen that are left unanswered. Here is why the regimen given on our website is optimal as proven by research.

• What is the most recommended regimen for medical abortion?

The most recommended regimen for medical abortion is 1 pill of Mifepristone [ 200 mg] and 4 pills of Misoprostol [ 800 mcg total].

You can also take the branded versions of these drugs by taking Mifeprex and Cytolog pill.

Firstly, the 200 mg of Mifepristone is consumed orally. Then after an interval of about 24-48 hours, the 4 pills of Misoprostol of 200 mcg each are put in buccally [ in the cheek pouches] or vaginally.

It must be noted that vaginal and buccal administration of Misoprostol are both quicker in effect, but buccal administration is recommended, as there is no chance of leftover tablets residue remaining in the body with buccal route.

Why is this optimal regimen?This combination results into complete and successful medical abortion in more than 97%-98% of cases.

• Are other doses of Mifepristone possible?

Both Mifepristone [anti-progesterone] and Misoprostol [prostaglandins] given in a lone dosage may cause pregnancy cancellation. Nevertheless, the result of alone dosage is very low with a high side-effects profile, but in combination- they both work synergistically. In many cases women even buy other forms of anti-progesterone like RU486 online.

The goal is to find a regimen that has the lowest doses for both the drugs, but the highest efficacy and the lowest side-effects profile.

In many countries, Mifepristone alone is made available at 600 mg, but as per FDA, there is no medical evidence for the need of Mifepristone any greater than 200 mg- for optimal effect and followed by the most suitable type of prostaglandin.

Meanwhile, in some studies, anti-progesterone is given in 5 to 6 doses of 25 mg and given over three days for total 150 mg. This practice is widely used in China and is said to be highly effective.

However, for patient’s convenience and service delivery, a single dosage of Mifepristone [ 200 mg] is recommended.

As other doses of Mifepristone are not as effective as 200 mg, the FDA recommends this specific dosage to all patients within 10 weeks of gestation.

• Are other dosages and administration routes for Misoprostol possible?

Vaginal and buccal administrations of Misoprostol are the most effective and faster acting than any other administration route.

Oral dosage is not recommended as low efficacy and failure rates are associated with this type of route.

Meanwhile studies showed that women using Misoprostol buccal had more success rate [96%] compared to women who had a vaginal administration [88%].

In some incidences, repeated dosage of Misoprostol is used; however repeated dosage is also associated with higher risk of side effects, especially nausea.

Nevertheless, repeated dosage are required in cases the prescribed dosage remains insufficient in starting the pregnancy termination process. Many women require added dosage of 400 mcg of Misoprostol as the 800 mcg dosage proves to be insufficient.

So after three hours if the bleeding doesn’t start, two more prostaglandin pills are ingested.

• Can other prostaglandin be used to medically terminate the pregnancy?

A number of prostaglandin had been used in the past for research, sulprostone and 15- methyl prostaglandins, but none were continued because of lack of effectiveness.

In fact, many use gemeprost for the procedure, however Misoprostol is much more cost-effective as well as more stable than gemeprost in room temperature.

Gemeprost is stored in a pessary form and needs to be frozen for one and half hour before usage. Meanwhile no such thing is required for Misoprostol.

Furthermore, studies prove that more pain is associated with gemeprost usage compared to Misoprostol.

• Is the time interval between the Mifepristone and Misoprostol necessary?

The certified and most used interval between the two dosages is about 36-48 hours. This directly corresponds to when the uterus is the most sensitive to prostaglandin analogue after preparing with mifepristone. Therefore, the prostaglandin dosage can be reduced to a minimum.

This interval was also found to be the most effective in earlier studies, when they examined the uterine contractility measured in between dosages of Mifepristone and Misoprostol.

Later studies have found that the time break can be reduced to 24 hours or extended to 72 hours without compromising the efficacy of the medications.