Misoprostol is a drug that is widely used in many gynecological and obstetrical situations including the treatment of missed or incomplete miscarriages. It causes your uterus (womb) to contract and your cervix (opening to the uterus) to soften and open, allowing the passage of the pregnancy and tissue from your uterus.

There are several ways to take misoprostol. When using it to treat a miscarriage without surgery, you will usually be advised to insert the tablets into your vagina. If you are using it as part of a surgical procedure, you are usually advised to put it under your tongue.

Please be sure to have someone with you at home when you take the Misoprostol and allow 24 to 48 hours to rest at home.

Misoprostol is 80% to 90% effective when used as directed. Occasionally some pregnancy tissue may still be present, and you may be offered a surgical option called a dilation and curettage (D&C), or a repeat dose of Misoprostol to ensure that all the tissue is passed.

Side effects of misoprostol that some people experience are chills, fever, nausea, vomiting and diarrhea. Most people find these side effects tolerable.

How to Insert the Tablets into Your Vagina

Each dose of misoprostol consists of four tablets. Wash your hands first. Then gently push one tablet at a time, for a total of four tablets as far up into your vagina as you can. You do not need to wear gloves. Depending on the reason for the medication, the doctor may have advised you to repeat the same process with the other 4 tablets in 24 hours. Make sure you make a note of the time you inserted the first dose of tablets.

You should then rest for one hour before resuming normal activity. Once cramping and bleeding start, you may feel uncomfortable and want to rest or be away from public areas. It is advised that you plan your activities with this in mind. You may want to take your pain medication at this time.

Do not worry if you still find tablets present in your vagina several hours later. The medication is rapidly absorbed by your body shortly after the tablets are inserted and there is no harm to you. Occasionally they may even fall out. Again, there is no harm to you if this happens after the first few hours – the medication will have been absorbed by your body.

What to Expect

The cramping and bleeding often starts 2 to 4 hours after the insertion of the tablets. Heavy bleeding usually lasts between 1 to 4 hours but may continue for 24 hours in some women. Not everyone experiences these results and it may take longer for the misoprostol to have an effect in some people. You will need to wear a thick sanitary pad; do not wear tampons at this time. Over the next few days, the bleeding should slow down. It is not unusual to continue to bleed lightly for 7 to 10 days after the passage of the pregnancy and tissue and for you to continue to have spotting for several days after that.

The length of time that each woman experiences bleeding, may vary from the above.

Most people find that ibuprofen (Advil®) and acetaminophen (Tylenol®) help to lessen the cramping pain when taken according to the package directions. The physician will give you a prescription for stronger pain relief to use as needed if you find that ibuprofen and acetaminophen do not lessen the pain enough.

When to Seek Medical Attention

If you experience excessive bleeding (more than two to three thick pads per hour for more than two hours), or if you are experiencing severe pain or cramping that is not relieved with pain medication, you need to go to the nearest emergency department.

If you experience fever, chills or foul-smelling vaginal discharge, please call the Early Pregnancy Assessment Clinic at 416-756-6837. Clinic business hours are Monday, Wednesday and Friday from 9 a.m. to 12 p.m. If it is outside normal business hours, please go to the Emergency Department.

If you have not experienced bleeding or cramping within 48 hours after taking the medication AND YOU WISH TO DISCUSS OTHER OPTIONS, please call the Early Pregnancy Assessment Clinic at 416-756-6837. It is ok to wait until the clinic is next open to call about this concern because it is not an emergency. In some cases, the tablets will take longer to have an effect but it is usually within the first week after use. If nothing has changed within 48 hours, you may simply wait until your scheduled follow-up appointment.

Follow-up

We will arrange an appointment at the Early Pregnancy Assessment Clinic with you within 10 to 14 days to follow-up to ensure that your pregnancy and all the tissue has been expelled. At this appointment, you will have another ultrasound and will be given an opportunity to discuss with the clinic staff any concerns you may have.

Emotional and Bereavement Support

Individuals and families experience and respond to the experience of miscarriage in a variety of ways. Our clinic staff and physicians are highly sensitive to the needs of individuals and families going through pregnancy loss and are here to help you. Please reach out to a member of the team if you need additional support or resources.

The Pregnancy and Infant Loss (PAIL) Network is an organization dedicated to supporting families who are/have experienced a pregnancy loss. They offer free group and individual peer support services. The PAIL Network also acknowledges that there is no time limit on grief. For this reason, families can access their services at any time for as long as they need. If you would like to access these resources please go to https://pailnetwork.sunnybrook.ca/ or call 888-303-7245.

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