Misoprostol for Managing Miscarriage
Misoprostol is labeled as an ulcer medication but has been found to be an effective option for miscarriage management. Using the drug for the management of missed or incomplete miscarriages is considered to be an “off-label” use by the Food and Drug Administration (FDA). However, using this medication to manage miscarriage has been well-studied and is widely recommended. Misoprostol is sometimes used in combination with an antiprogesterone drug called mifepristone (also known as Mifeprex or RU486). Another possibility is gemeprost; however, this drug may trigger more severe side effects in some cases.
Misoprostol in the First Trimester
Medical management of miscarriage is often used when the pregnancy has been identified in the uterus but it is not viable. In these cases, a miscarriage is confirmed but the bleeding has not yet started.
How It Works
If you will be taking misoprostol to manage a miscarriage, your doctor will prescribe one or more medications. These medications will cause your cervix to dilate and your uterine lining to shed. You might take these medications orally or vaginally, depending on the specific protocol. Your doctor might suggest that you take ibuprofen an hour before taking your prescribed dose of misoprostol to reduce cramps. With the vaginal application, place four of the pills in your vagina. You will need to lie down for 30 minutes while the medication is absorbed. Wear a night-time capacity sanitary napkin when you take the pills to make sure you are prepared for the bleeding the medication will cause. Miscarriage-related vaginal bleeding and cramps will usually start within one to four hours of taking misoprostol. You might have cramps for three to five hours. The bleeding is often the same as menstrual bleeding but might be more than you typically experience. Similar to a natural miscarriage, the bleeding can last for one to two weeks. You might have “starts and stops” or spotting. If bleeding does not start within 24 hours of taking your dose of misoprostol, contact your doctor or consult the instructions you were given. Often, another dosage of the pills will be recommended. Misoprostol can have side effects. Ask your doctor about how to how to manage them. Possible side effects of misoprostol include:
Cramping and painDiarrheaNausea and vomiting
When interviewed about the experience later, the majority of women who chose medical management for miscarriages reported being satisfied with their choice.
Risks of Using Medication to Manage a Miscarriage
The risks of using medication to expedite a miscarriage (rather than having a D&C) are about the same as the risks of miscarrying naturally. There’s a small chance of hemorrhage, infection, and needing a D&C later on if tissue remains in the uterus. A D&C also carries small risks. Ultimately, the choice is up to you and your doctor—except in cases where medical emergency necessitates a D&C. The length of bleeding for a medically induced miscarriage is about two weeks (the same as for a miscarriage that happens without intervention).
Second Trimester Use of Misoprostol
Doctors might prescribe misoprostol (sometimes alongside mifepristone) to induce an impending stillbirth or second-trimester miscarriage. This may happen after an ultrasound reveals a fetus with no heartbeat or otherwise definitive evidence that a pregnancy is not viable.
Bleeding that continues for more than 2 weeksFever and/or chills lasting form more than 24 hoursFoul-smelling vaginal dischargeHeavy bleeding that soaks more than 2 menstrual pads per hour for 2 hours in a rowHeavy bleeding that returns after 2 weeks after taking the medication
In these cases, the experience is similar to an induction of labor. A person will most likely need to check into a hospital for the procedure. By contrast, medical induction of first trimester miscarriages can often be done on an outpatient basis.
A Word From Verywell
If you have been diagnosed with a miscarriage and have not yet made a treatment decision, talk to your doctor about your options. If you choose medication, you will need to get a prescription from your doctor. You might need to go to the hospital or your doctor’s office to have a procedure or to be monitored. Other treatments can be done at home with your doctor’s oversight (outpatient). You should only take medications intended to manage a miscarriage or stillbirth under a physician’s supervision.
