Other than misoprostol and mifepristone, methotrexate is another substance that can be used to induce an abortion. As an abortion pill, methotrexate is used along with misoprostol to terminate a pregnancy. It must be noted that mifepristone is considered a more effective alternative and there are lesser side effects involved. The problem arises, however, with mifepristone not being readily available in all countries. Methotrexate on the other hand can be found in pharmacies in most countries. Generally, methotrexate is used in the treatment of certain types of cancer. It is also used to treat rheumatoid arthritis or control psoriasis. It has shown effectiveness in dealing with ectopic pregnancy (a pregnancy that takes place outside the uterus).
How Does Methotrexate Abortion Work?
Medical abortion with methotrexate works by decreasing the body’s capability of utilizing folic acid. The reason why it can be used in abortions is that the human body needs folic acid to sustain a pregnancy. Folic acid is essential for the development of the fetus. Basically, abortion works by using methotrexate for miscarriage.
Misoprostol in the form of pills such as Cytotec 200 mg is used along with methotrexate. Methotrexate also stops fetal cell duplication along with interrupting the implantation process. Because methotrexate can impair the process of cellular replication, it is also useful in the treatment of diseases such as cancer where it can be used to stop the replication of cancer cells. Anyone who has recently stopped consuming methotrexate should consult a doctor and wait for a while before attempting to get pregnant. They will also have to take extra doses of folic acid according to the doctor’s recommendation.
In an adult body, methotrexate is cleared out within a week provided the person has stopped taking any more doses. However, this time frame can vary depending upon the individual and their physical composition. There are also certain medications whose interaction with methotrexate can slow down the speed at which the substance clears out. Additionally, anyone with a low-functioning kidney or any condition that leads to extra body fluid may need a longer time to get rid of methotrexate.
Using Methotrexate for Abortion
Generally, an abortion that is induced using methotrexate and misoprostol is more effective than an abortion that only makes use of misoprostol. There are multiple ways of using methotrexate- one can use methotrexate injection for abortion or take it orally. Methotrexate tablets generally contain 5 or 10 mg of the substance. The dosage should depend on how much methotrexate is in each tablet, as one singular tablet may not be enough to ensure a successful abortion.
By using 50 mg of orally administered methotrexate dosage, abortion should be ensured. It can also be consumed orally when it is in liquid form or injected into the bloodstream. Misoprostol is placed under the tongue for around three to seven days after methotrexate has been administered. Keep misoprostol under the tongue for at least half an hour or so.
Research on Methotrexate Abortion
A few studies can be used to further clarify the success rate of methotrexate in terminating a pregnancy, while also comparing it with other means of inducing abortions.
A study done on women who were less than 49 days into the gestation period tested the effectiveness of methotrexate in causing abortion. The result was that methotrexate followed by misoprostol turned out to be more than 90% effective in terminating the pregnancy. Additionally, an intramuscular regimen was found to be more advantageous as it is less expensive. The study was done in Pittsburgh, Pennsylvania on 99 women who were under the 50 day gestation period. A successful and complete abortion occurred in 94 out of 99 patients (almost 95% success rate). The patients were given a single dose of methotrexate intramuscularly followed by misoprostol about a week later.
Women who aborted within 24 hours experienced around 17 days of bleeding whereas women who had a more delayed abortion had vaginal bleeding or 11 days. Common side effects that were experienced included hot flashes and nausea. Rarer side effects included dizziness, diarrhea, vomiting, and headache.
Another study attempted to evaluate the ongoing trial of pregnant women who were under an eight-week period of gestation and wanted to get an abortion. On the first day, the subjects were given intramuscular methotrexate. The total number of subjects involved in the test was 282, out of which 274 had successful medical abortions and eight required surgery.
Out of the eight, four continued with their pregnancies and did need to get a surgical abortion. The other four needed surgical intervention due to excessive bleeding. Overall, the success rate of the test was at 97% for those who had a medical abortion, and 3% needed surgical assistance. 162 out of the 274 medical abortions only needed one dose of misoprostol to induce abortion about 6.2 hours later. The side effects experienced were mostly gastrointestinal, mild, and lasted for a short period of time.
Contraindications
There are certain pre-existing conditions that can be made worse by methotrexate. In such circumstances, the use of methotrexate should be completely prohibited. There are also side effects that can crop up in a few cases. Here is a list of the conditions and side effects that one should keep an eye out for:
- Liver problems: Methotrexate can lead to severe problems in the liver, and patients with any pre-existing liver condition should definitely avoid this substance. Patients with alcoholism should also not use it. Additionally, anyone taking methotrexate should avoid consuming alcohol.
- Immunity: Methotrexate can also weaken the immune system under certain circumstances. Medical professionals should be alerted immediately if there is any sign of an infection. Those who have any kind of underlying deficiency relating to the immune system should also steer clear of methotrexate.
- Lung toxicity: In very rare cases, Methotrexate can lead to a dry and non-productive cough which can be an indication of a type of lung toxicity. Such symptoms should be reported to a doctor immediately.
- Symptoms of toxicity: Methotrexate is well tolerated in a lot of cases. There are uncommon circumstances wherein methotrexate can cause toxicity in proportion to the dosage. This kind of severely toxic reaction is not considered common. The most frequent ways in which the toxicity manifests itself are in the form of mouth sores, low white blood cell count, and mouth sores. As mentioned earlier, it can also lead to toxicity in the liver or the bone marrow. The symptoms that one should be on the lookout for are: itchiness, drowsiness, frequent headaches, dizziness, skin rash, or hair loss.
Finally, of course, methotrexate is toxic for the embryo and can terminate an ongoing pregnancy. This is the reason why in the absence of mifepristone, methotrexate is considered as an alternative form of medical abortion. The necessity of methotrexate miscarriages to induce abortions has lessened.
Mifepristone vs Methotrexate
Medical abortion is a safe and convenient alternative to surgical abortion. Surgical abortions are quickly being replaced by forms of medical abortions such as MTP Kit. The most widely used medical abortion technique in the USA and Canada right now involves Misoprostol along with methotrexate or Mifepristone. Several studies have proven that the combination of methotrexate and misoprostol is safe and can ensure a successful abortion. The process of using shots to terminate a pregnancy has become very common.
Outside of the United States and Canada, Mifepristone is the one that’s used widely to induce a medical abortion. In North America, before the FDA approved Mifepristone, it was not easily available except in specific places such as research centers. As methotrexate was approved for the treatment of other diseases in both countries, it tended to be much more easily available. In comparison to mifepristone, it is also inexpensive.
Currently, health experts internationally prefer to use mifepristone as the abortifacient, also known as RU-486. This abortion pill, approved by the FDA, is combined with misoprostol although misoprostol alone can be used to induce an abortion. However, using methotrexate or mifepristone with misoprostol is the more common procedure. American clinics do provide methotrexate abortions still, which can be taken orally instead of being injected. As FDA approved the use of mifepristone for abortions around 2000, it has also come into frequent use now because of its success rate and the lower chance of experiencing abortion shot side effects.
The efficiency of methotrexate and misoprostol ranges from 83% to 96% and the efficiency of using mifepristone and misoprostol ranges from 92% to 97%. The numbers are very similar, and considering the availability of methotrexate, Planned Parenthood has been looking further into the process of medical abortion replacing surgical abortion. In the United States, Planned Parenthood provides up to 12% of abortions and serves a diverse range of people.
References
- Creinin MD. Oral methotrexate and vaginal misoprostol for early abortion. Contraception. 1996 Jul;54(1):15-8. DOI: 10.1016/0010-7824(96)00113-8
- Schaff EA, Eisinger SH, Franks P, Kim SS. Methotrexate and misoprostol for early abortion. Fam Med. 1996 Mar;28(3):198-203. PMID: 8900553. https://pubmed.ncbi.nlm.nih.gov/8900553/
