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Methotrexate and Misoprostol
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In 1994, based on the work of two physicians in San Francisco, Vancouver doctor Ellen Wiebe began performing abortions using the drugs methotrexate and misoprostol. Methotrexate is commonly used to treat such ailments as cancer, arthritis, psoriasis and inflammatory bowel disease. Misoprostol, a "prostaglandin" is used to prevent and treat peptic ulcer disease. Both drugs were already put through a rigorous approval process for use in Canada, and it is not illegal to use an approved drug for a new purpose.
The methotrexate-misoprostol abortion can be performed as early as the fourth week of pregnancy, but cannot be performed later than eight weeks after the first day of the last period. In contrast, surgical abortions are not usually performed until after the seventh week of pregnancy. Women who choose the methotrexate-misoprostol combination are first given an injection of methotrexate (usually in the butt), which stops the growth of the foetus. (If you're Rh-negative, you'll be given a shot for that on the other side of your butt at the same time.) A few days later, at home, the woman inserts a gelatin capsule of misoprostol into her vagina. The misoprostol causes the uterus to contract and expel the foetus, in what has been compared to a "heavy period," lasting an average of 12 days. For 50 percent of all women, the foetus is expelled within 24 hours. Some women, however, require a second, or even a third dose of misoprostol. A small number of women, between two and four percent, find that the methotrexate-misoprostol combination doesn't work. For these women, a surgical procedure is necessary, both to complete the abortion process, and because methotrexate can cause birth defects. SIDE EFFECTS: After the methotrexate injection, you might experience a bit of nausea. After inserting the misoprostol, about 15 percent of women experience a range of side effects ranging from mild dizziness, headache and chills, to vomiting, diarrhea, and fever. PROS: The methotrexate-misoprostol combination is done in the doctor's office and at home, avoiding clinics, hospitals, anaesthetic, surgery, and anti-choice protesters. The process is more natural, more like a miscarriage, and the beauty of it is that you get to do it at home, with your books, stereo, TV, partner, and whatever else makes you comfortable. For some women, the cramping and bleeding involved are "no worse than my normal period." CONS: Some women prefer a surgical procedure because they get their abortion over with all at once, and because they are reassured by the presence of medical personnel. Other women find the delay, the uncertainty, and the amount of bleeding associated with methotrexate-misoprostol distressing. Overall, most of the women who choose the methotrexate-misoprostol option are highly motivated to avoid surgery, and report satisfaction with their medical abortion. Dr. Wiebe, however, would prefer to use RU-486, which is apparently faster and more reliable than methotrexate-misoprostol. Women who have used both methods prefer RU-486 to the methotrexate-misoprostol combination. Unfortunately, the federal health protection branch of the federal government is still in the process of evaluating RU-486, despite the fact that it has been used successfully for more than a decade in Europe. |
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For more information, check out www.ppcw.org/metho.htm www.cma.ca/cmaj/vol-154/0165e.htm www.cma.ca/cmaj/vol-154/0185e.htm |
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