Misoprostol is an E1 prostaglandin analogue, sold in pill form under the brand names Cytotec and Cyprostol, and in combination with the NSAID painkiller Diclofenac under the names Arthrotec and Oxaprost. There are two prominently recognized uses for misoprostol, the treatment and prevention of gastric ulcers (especially as a side product of NSAID use), and the induction of labor. This induction of labor effect is applied both for to facilitate the live birth of babies thought overdue, and as an abortificant.

The "abortion pill" (mifepristone, "RU-486") is actually given as half of a two-part regimen of which misoprostol is the second half. Mifepristone terminates the pregnancy by causing the endometrium to detach from the uterine walls, as in regular menstruation. Misoprostol is then administered to cause the uterus to contract and expel its contents. However, misoprostol can be used as an abortifacent by itself, with a lower, but still considerable, success rate (80%-90%). More importantly, misoprostol has other recognized uses and is thus available in many countries where abortion is restricted or illegal.

The remainder of this writeup, having originally been intended for how to get an abortion when it's illegal to do so in your country, is dedicated to use in such contexts. It is roundly agreed that this method should not be employed if at all avoidable - if you are able to seek help from a medical professional, even if this requires travel or subterfuge, it is recommended that you do so. On the other hand, it is acknowledged that often, the alternative is puncturing the womb with a sharp object, which may be a millennia-old tradition of birth control, but one which has a tragically high casualty rate. Accordingly, activist medical professionals have studied and determined a regimen for use, one which is intended to be one of the safest and most effective methods of nonprofessional abortion known, though these words certainly should be considered in relative terms. This is the method Women on Waves and similar international family planning organizations recommend, if it comes to it.

Misoprostol should not be used to induce abortion if you have an IUD in place or if you are experiencing an ectopic pregnancy. It is recommended that misoprostol be used only to terminate pregnancies less than 9 weeks old - beyond this point it may still work, but it will be more painful, and the rate of success will decrease while the chance of complications increases. To determine the gestational age and location of pregnancy, women should undergo an ultrasound scan before inducing abortion, if possible. Some people may experience allergic reactions to misoprostol. Of course, you won't know if you're allergic if you've never taken the drug before, though allergies to other prostaglandins are a warning sign. In case this or any other negative reaction occurs, you should make sure you have access to competent medical assistance before attempting abortion.

The first step for women attempting a misoprostol-only abortion should be to acquire at least 2400 micrograms of misoprostol. This should come out to 12 pills, though dosages may vary and you should examine packaging and dosage information to make sure. The sale of these drugs may be restricted or regulated by law. If you suspect you may be questioned about your purchase or need to fraudulently acquire a prescription and wish to prepare a cover story, keep in mind that Cytotec/Cyprostol is marketed for the treatment and prevention of stomach ulcers, especially for subjects regularly using NSAIDs, while Arthrotec and Oxaprost are sold for the treatment of arthritis. Alternately, you may wish to seek out pharmacies or suppliers willing to overlook these regulations, either in disreputable areas of your home country or through the internet. These operations might be more expensive or of questionable trustworthiness but you are, after all, breaking the law. Welcome to the black market.

To begin the process, insert 800 micrograms deep into the vagina, near the cervix. The pills' effectiveness appears to be increased if they are moistened with water once in place. It is also possible to employ sublingual or buccal administration - that is to say, holding the pills under the tongue or between the gum and cheek - though experts are unsure of the relative efficacy of each method, pending further studies. If you choose to do so, you are directed to use 800 micrograms in either case, which should be held in place for at least thirty minutes, if not longer.

If administered properly, you should notice painful cramps in the abdomen and bloody discharge from the vagina. These will be similar to menstruation but more intense in proportion to the age of the pregnancy. Twenty-four hours after the first administration, another 800 micrograms should be administered in the same manner. If, after the second dose, bleeding has still not begun, a third administration may be attempted after another twenty-four hours have passed. If this dose shows no effects, you should not administer a fourth dose immediately - after a week of recovery, the regimen may be repeated, but it is possible that your pregnancy will not respond. Sorry. Evidence shows that misoprostol use may exhibit teratogenic effects, however, and the possibility of birth defects resulting from its administration may itself be sufficient legal cause to allow abortion, in the manner Footprints describes here.

This pain and discharge may continue for some time, so you may prefer to seek medical assistance in completing the process, especially if heavy bleeding does not terminate after 2 to 3 hours, which may be a sign of incomplete abortion. If you make sure to remove the pills from the vagina, misoprostol-induced abortion is indistinguishable from spontaneous miscarriage, so even doctors in countries where abortion is prohibited should be willing to suction out the remaining contents of the uterus.

As bleeding is in and of itself not a guarantee of successful abortion and the remaining concentration of hormones in the blood will cause pregnancy tests to return positive for two to three weeks afterwards in any case, it is recommended that women receive another ultrasound scan afterwards to confirm the procedure's success.

Gynuity Health Projects and Reproductive Health Technologies Project. 2003. Consensus statement: Instructions for use—Abortion induction with misoprostol in pregnancies up to 9 weeks LMP. Expert Meeting on Misoprostol sponsored by Reproductive Health Technologies Project and Gynuity Health Projects. Washington, DC, Gynuity.
Ipas. 2004. Misoprostol alone for first-trimester medication abortion: Clinical practice notes. Chapel Hill, NC, Ipas.
Women On Waves

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