Misoprostol Alone in Self-Managed Abortion Is Highly Effective

Use of misoprostol alone was shown to be effective in self-managed abortion, with minimal side effects, according to a prospective observational cohort study of callers to safe abortion hotlines in Nigeria, Argentina, and Southeast Asia.

In the cohort of 637 callers who used a misoprostol-alone regimen, 98.1% had a complete abortion without procedural intervention at last follow-up (median 22 days), reported Ruvani Jayaweera, PhD, MPH, of Ibis Reproductive Health in Oakland, California, and co-authors.

While 23.4% of participants sought additional medical care, the primary reason was largely to confirm abortion completion (89.2%) or due to concerns about symptoms (10.7%), they noted in JAMA Network Open.

“Overwhelmingly, the majority of people … weren’t seeking care because of experiencing a complication, they were seeking care just to confirm that their abortion was complete,” Jayaweera told MedPage Today. “I think that really even further highlights the acceptability of this model.”

Potential adverse events were reported by six participants. Of those who experienced bleeding, this mostly lasted less than a week (median 4 days), and most expelled their pregnancy within 24 hours of starting the abortion process (median 12 hours). Common side effects included nausea (52.6%), fever (36.4%), and diarrhea (28.4%).

“If people are having a misoprostol-alone abortion, having that information about what to expect can be really important in making sure that people are well prepared for their overall abortion experience,” Jayaweera said.

She noted that prior results from the study showed that 95.7% of patients completed self-managed medication abortion with misoprostol.

“I think our findings really demonstrate that misoprostol alone is highly effective — much more effective than we previously thought — and really is another highly effective method of abortion care that should be available to everyone,” Jayaweera said.

The findings “indicate that misoprostol-alone regimens may open opportunities for innovative access through nontraditional practitioners, pharmacists, and other contexts,” the authors noted.

“As abortion access, and specifically medication abortion, comes under increasing legal attack around the world, expanding the availability of existing, evidence-based methods for medication abortion can help to ensure that all people can access abortion when and where they need it,” they added.

For this study, callers to safe abortion hotlines and accompaniment groups in Nigeria (92.8%), Southeast Asia (7.1%), and Argentina (0.2%) were recruited from July 2019 to October 2020, prior to starting their medication abortion. Participants were eligible if they were 13 years or older, had no contraindications to medication abortion, and were not currently bleeding. Sixty percent of participants were ages 20 to 29, and 97.2% had completed secondary school or higher.

About half of participants were at pregnancy durations of less than 7 weeks when they initiated medication abortion, and 32.2% were at 7 to <9 weeks’ gestation.

Effectiveness and safety were assessed by a phone questionnaire 1 week after taking misoprostol and then again 3 weeks later. The actual misoprostol regimen varied slightly based on availability and individual adherence, but 83.5% of participants took the standard regimen of three 300-μg doses every 3 hours.

Jayaweera and team noted that the study was limited by use of self-reported data, although it was necessary because of the legal situation in the countries where data were collected. Furthermore, self-reports of abortion are generally accurate, they said.

In addition, 45 patients were lost to 3-week follow-up, although 41 of them had reported a complete abortion at 1 week.

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