You have a choice between medical abortions with mifepristone/misoprostol (Mifegymiso) or with methotrexate and misoprostol. (see comparison chart below)
Medical Abortions with Mifepristone vs Methotrexate
Mifepristone works faster with fewer side effects and is usually the best choice. Unfortunately, for those women who do not have extended health benefits, the price is higher – $325 vs $100. If you do not have a BC Care Card, then the total price will be $725/$500.
How well do the drugs work? Both drugs work well with only about 1% failing and requiring surgery because the pregnancy is still growing. In one week 95% of women taking mifepristone are done and 80% of women taking methotrexate are done. Since methotrexate abortions take longer, about 4% of women have surgery because they don’t want to wait for a delayed reaction.
What about side effects? There are few side effects from either the methotrexate or the mifepristone, but after the misoprostol you can expect bleeding, cramping and some women get flu-like symptoms such as nausea, diarrhea, headache, fever and chills. Since you need more misoprostol after methotrexate than mifepristone, (12 pills vs 4 pills) you can expect more of those flu-like symptoms.
What will happen at the clinic? Your first visit will last about 3 hours. You need to come in to our office at least twice and possibly 3 times to be sure everything is safe, and worked well. On the first appointment, you will fill out some forms, we will collect a urine sample and you will then see the doctor, have an ultrasound and see a counselor to review the procedure. You will have some blood work done and you will get the first medication (mifepristone or methotrexate). We will also give you a package of medications to take home with you.
If the doctor has been unable to see anything on the ultrasound you may need to go to the lab for an extra blood test and we will have to book you to come back the next day.
If you live more than 2 hours away from us, please check our medical abortion at a distance page.
When and where does the abortion actually happen? At home, 24-48 hours after taking the mifepristone, you will insert misoprostol tablets into your cheeks or into your vagina. If you took methotrexate, then you will get three doses of pills to insert into your vagina. The misoprostol tablets make the uterus cramp, you will bleed heavier than a period and the pregnancy will come out.
How can we know if the abortion is completed? Your follow up visit will be about a week later and will last about 15-20 minutes. For most women, this will be their last visit. If the ultrasound shows that there is still tissue left in your uterus, you may be given more misoprostol and asked to return to our office for another ultrasound. This is called a delayed reaction and we will watch your progress until the ultrasound shows an empty uterus. If it is difficult for you to come back to our clinic, we can follow the progress of the abortion with blood tests instead of ultrasounds.
What if it doesn’t work? In about 1% of women this procedure will not work and a surgical abortion will be required. We will make the arrangements for you at a local clinic. Another 2% of women choose surgery because they are having delayed reactions to the medication and don’t want to wait. Less than 1% have complications such as infection or serious bleeding. With methotrexate, we expect 20% of women to have delayed reactions and about 4% to choose surgery.
Are there any long term effects? The medications leave your body within one week and will not affect future pregnancies or general health.
You may fill out the Medical Abortion Booking Form if you would like us to call you on our next business day.
YOU MAY CHOOSE TO USE METHOTREXATE OR MIFEPRISTONE
|Mifepristone & Misoprostol (Mifegymiso)||Methotrexate & Misoprostol|
|Cost: $325 (may be covered by your insurance)||Cost: $100 (may be covered by your insurance)|
1 week: 95% are complete
1% will fail after 1 week and need an aspiration abortion
2% will request an aspiration because they are having a delayed reaction and do not want to wait any longer.
2% will wait longer for the bleeding, may be up to 4 weeks
1 week: 80% are complete
1-2% will fail after 2 weeks and need an
4-5% will ask for an aspiration because they
are having a delayed reaction and do not want
to wait any longer.
2-3% will wait longer for the bleeding, may
be up to 4 weeks
|Mifepristone is a pill you will take in the office.||Methotrexate is given as an injection or as a
drink in orange juice.
|Misoprostol – you will be given 2 doses to take home. 24-48 hours after Mifepristone you will put the tablets in the side of your cheek or into your vagina. This can be repeated after another 24 hours if needed.||Misoprostol – You will be given 3 doses to
take home. 1 – 6 days later you will insert
the pills into your vagina over 24 hours.
|You will have cramps and bleed heavily with clots.||You will have cramps and bleed heavily with
Bleeding and cramps are normal with a possibility of nausea, diarrhea, headache, fever and chills
Bleeding and cramps are normal with a
possibility of nausea, diarrhea, headache,
fever and chills. Since there is a higher dose
of misoprostol, there is more chance of pain,
fever and diarrhea
– works faster
– fewer side effects
– used in pregnancies up to 10 weeks
– used worldwide
– lower cost
– can be used in case of suspected ectopic pregnancies
– more flexible time frame for using pills
– higher cost
– not recommended for suspected ectopic pregnancies
– may take longer for abortion to be complete
– more medication and side effects
– can only be used up to 7 weeks
|No long term effects||No long term effects|
PLEASE DO NOT FILL OUT THE QUESTIONNAIRE FORM AT THE BOTTOM ON THE LEFT UNLESS YOU HAVE BEEN ADVISED TO BY THE OFFICE AND SUPPLIED WITH A CHART #.
MEDICAL DIRECTOR: DR ELLEN WIEBE