Misoprostol alone can be used as an effective abortion method, according to a recent study published in Open JAMA Network.1
The World Health Organization recommends either mifepristone in combination with misoprostol or misoprostol alone for abortion, but clinical evidence has indicated that misoprostol alone is 80% effective, compared to 95% for combined mifepristone. with misoprostol. This has led to the combined method being preferred for abortion in many countries.
Misoprostol alone is used in areas where mifepristone cannot be used, with advantages including low cost, availability in many settings without a prescription, multiple indications, shelf stability, and ease of administration . This has led to an increase in the use of misoprostol for self-managed abortion worldwide.
Because research on misoprostol alone has focused on determining recommended dosing and administration routes, there are limited data on the effectiveness of currently approved protocols with misoprostol alone. Investigators conducted a study to determine the safety and effectiveness of misoprostol alone for abortion.
Data was obtained from callers to safe abortion hotlines, with eligible callers from July 31, 2019, to October 1, 2020, included in the analysis. Recruitment sites discussed abortion options in detail, including instructions for taking abortion medications, assessing medication eligibility, navigating the healthcare system, and determining abortion completion.
Eligibility criteria included being 13 years or older, having no contraindications to medical abortion, not currently bleeding, and contacting an inclusive support group for information on starting a medical abortion protocol. Participants completed questionnaires at baseline and 1 and 3 weeks after taking the medications.
Effectiveness was defined by the study authors as “completion of the abortion without procedural intervention.” This was the main outcome of the analysis, determined by the questions included in the follow-up questionnaires.
Safety was included as a secondary outcome, measured based on potential warning signs and adverse events. Additional outcomes included details of dosing regimen, initiation and duration of bleeding and cramping, time to expulsion, adverse events, and healthcare seeking experiences.
The final analysis included 637 participants, of which 92.8% were from Nigeria, 7.1% from Southeast Asia, and 0.2% from Argentina. Among the participants, 60.2% were aged 20 to 29 years, 97.2% had completed high school or above, and 96.9% confirmed their pregnancy with a pregnancy test.
A pregnancy duration of less than 7 weeks when taking the first dose of misoprostol was reported in 49.8% of participants, 7 to less than 9 weeks in 32.2% and 9 weeks or more in 18%. . The standard regimen of misoprostol alone, namely 800 μg of misoprostol taken 3 times, with 3 hours between each dose, was taken by 83.5% of participants.
Complete abortion at first follow-up was reported by 95.3% of participants. This rate increased to 98.6% of participants at the second follow-up. Participants using the currently approved regimen had increased effectiveness compared to those using a different regimen. All pregnancy durations had high efficacy at last follow-up.
At least some bleeding was reported in 99.4% of participants, often starting after the second or third dose. Bleeding lasting less than 7 days was reported by 76.2% of participants, and 87.3% reported 1 to 3 days of heavy bleeding. Common side effects included nausea, fever, diarrhea, and chills.
These results indicated the effectiveness of misoprostol alone for abortions. Investigators concluded that evidence-based methods of medical abortion could help ensure that people can access abortion care when needed.
This article was originally published on Contemporary OB/GYN.
