Clinical Updates in Reproductive Health

Summary of recommended medical abortion regimens

This resource is for health professionals. If you’re seeking personal health information about abortion with pills, go here: www.ipas.org/abortionwithpills

Last reviewed: April 23, 2023

Medical abortion with mifepristone and misoprostol

  • Before 13 weeks gestation:
    • Mifepristone 200mg orally
    • Misoprostol 800mcg buccally, sublingually or vaginally 1-2 days after mifepristone. The dose of misoprostol can be repeated to achieve abortion success. After 9 weeks gestation, routinely using at least two doses of misoprostol, administered 3-4 hours apart, improves abortion success rates.
  • At or after 13 weeks gestation (13-24 weeks):
    • Mifepristone 200mg orally
    • Misoprostol 400mcg buccally, sublingually or vaginally 1-2 days after mifepristone, then every three hours until fetal and placental expulsion.
    • The median time to abortion is 6-10 hours after beginning misoprostol, although some individuals will require more time to successfully abort.

Medical abortion with misoprostol only

  • Before 13 weeks gestation:
    • Misoprostol 800mcg buccally, sublingually or vaginally every three hours until expulsion
    • Individuals undergoing misoprostol-only medical abortion outside of a health facility should be provided with 3-4 doses of misoprostol depending on the scenario.
  • At or after 13 weeks gestation (13-24 weeks):
    • Misoprostol 200mg orally
    • Misoprostol 400mcg buccally, sublingually or vaginally every three hours until fetal and placental expulsion. Vaginal dosing is more effective than other routes.
    • The average time to abortion is 10-15 hours after beginning misoprostol, although some individuals will require multiple days to successfully abort.

Medical treatment for incomplete abortion, missed abortion or intrauterine fetal demise (postabortion care)

  • Less than 13 weeks uterine size:
    • Incomplete abortion:
      • Misoprostol 600mcg orally in a single dose or 400mcg in a single dose buccally, sublingually or, in the absence of vaginal bleeding, vaginally
    • Missed abortion:
      • Misoprostol 800mcg buccally, sublingually or, in the absence of vaginal bleeding, vaginally every 3 hours until expulsion (generally 1-3 doses)
      • Where available, add pretreatment with mifepristone 200 mg orally 1-2 days before misoprostol
  • 13 weeks or larger uterine size:
    • Incomplete abortion:
      • Misoprostol 400mcg buccally, sublingually or, in the absence of vaginal bleeding, vaginally every three hours until expulsion
    • Intrauterine fetal demise:
      • Misoprostol 400mcg buccally, sublingually or, in the absence of vaginal bleeding, vaginally every 4-6 hours until expulsion.
      • Where available, add pretreatment with mifepristone 200mg orally, 1-2 days before misoprostol.

Resources

Protocols for medical abortion (dosage card)

Mifepristone/Misoprostol Gestational Dating Wheels

Misoprostol-only Gestational Dating Wheels

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