Clinical Question

What are the effectiveness, safety, and adverse effects of different medical methods for first-trimester abortion?

Evidence-Based Answer

There is moderate-quality evidence that a combined regimen of mifepristone and misoprostol is more effective than misoprostol alone for medication abortions before 12 weeks of gestation. (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) The effectiveness of this regimen is no different with a mifepristone dose of 200 mg compared with 600 mg. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Vaginal administration of misoprostol is more effective than oral administration. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Adverse effects are typically self-limited and commonly include nausea, vomiting, and diarrhea. Major complications are rare.¹

Practice Pointers

In the United States, 20% of pregnancies, excluding miscarriages, end in abortion,² and more than one-half of abortions provided by U.S. facilities use medication rather than surgery.³ Many regimens have been used worldwide for medication abortion, most commonly prostaglandins, mifepristone, or a combination. Within these regimens, widely varying dosages, timing, and routes of administration have been used. The objective of this Cochrane review was to compare the effectiveness and adverse effects of different regimens.