Methotrexate (MTX) for Early Abortion

Methotrexate (MTX) is a chemotherapy agent that has been used for many years in the treatment of cancer because it affects cells that are rapidly dividing. In a Methotrexate (MTX) Abortion, it stops embryonic cells from dividing and multiplying and is a non-surgical method of ending pregnancy in its early stages.Within a few days or weeks of receing an injection of Methotrexate (MTX) at the clinic the, the pregnancy ends through an experience similar to an early miscarriage.

Methotrexate is a FDA approved drug, but is not labeled for use in the termination of pregnancy. It has been successfully used since 1982 in a single dose to treat ectopic (tubal) pregnancies (where the fertilized egg is embedded in the fallopian tube instead of the uterus). In 1996-97, FWHC participated in clinical trials with the University of Washington to study MTX for Medical Abortion. The study showed MTX alone to be effective and we continue to offer it as an option to women at our clinics.

Methotrexate is given by injection the amount of which is individually calculated by each woman’s weight and height. As the medication takes effect, MTX interferes with folic acid and stops fetal cell duplication, and disrupts pregnancy at the stage of implantation in the uterine wall. When given early in pregnancy, it is effective in ending the pregnancy. (If a pregnancy were to continue after taking this drug, the fetus has a high risk of deformities.)

The "miscarriage" after the MTX injection occurs anywhere from two to six weeks later, when the uterus expels the fetus. Passing the tissue is unpredictable. It may occur any time, day or night, any place.

Side Effects

There is limited information on childbearing after taking Methotrexate. Since the medication works on dividing cells and a woman’s eggs do not divide until they are fertilized, future pregnancies should not be affected. However, to be extra-safe, women should avoid getting pregnant by using birth control for at least three months after receiving Methotrexate.

When used in early pregnancy Methotrexate safely and effectively induces abortion 90-97% of the time. Women who have chosen a medical abortion said it felt more private and natural than a surgical procedure. If the medication does not induce termination, a surgical suction abortion will be performed at no additional charge. Medical abortion with Methotrexate (MTX) is an option up to six weeks measured since last menstrual period (LMP).

Possible side-effects of Methotrexate include nausea, vomiting, diarrhea, abdominal cramping, sores in the mouth, headache, dizziness, insomnia, and vaginal bleeding. Except for nausea, these side effects are unusual for the single dose given to induce abortion.

Risks

Vaginal bleeding during the miscarriage caused by MTX may be heavy. In rare situations it could require a surgical abortion and very rarely, a blood transfusion. If a minor under age 18 has complications, their confidentiality cannot be guaranteed as their parents or guardians may need to give consent for care if complications occur.

Studies show MTX abortion has a failure rate of 1-10%. If spontaneous abortion has not started by 6 weeks after injection, a surgical abortion is required.

Eligibility for MTX at FWHC

• Less than six weeks gestation by ultrasound
• Willing and able to give informed consent
• Have access to reliable transportation and telephone
• Live no more than two hours from emergency medical care
• Agrees to come back to the clinic for two to three follow up visits
• Agrees to have surgical abortion if the drug does not induce termination
• Agrees to avoid sexual intercourse until abortion is complete

MTX Medical Abortion is not recommended for women with

• History of hepatitis, liver, kidney disease or inflammatory bowel disease
• HIV positive status
• Abnormal blood profile and/or severe anemia
• IV drug user
• Known containing folate deficiency
• Known intolerance or allergy to Methotrexate
• No telephone, no transportation
• Living more than 2 hours away from emergency medical care.

RU-486, the French Abortion Pill, Mifepristone is another medication used to cause an early medical abortion. It has been used in the United States in clinical trials at a few selected sites. Soon it is expected to be approved by the FDA (Food and Drug Administration) for widespread use in the U.S.

According to the 7/15/98 Kaiser Daily Reproductive Health Report and the Population Council, "More than 90% of U.S. women who tried RU-486," also known as mifepristone, "would recommend it to others and choose it over surgery again," according to a new study.

Published in the Archives of Family Medicine, the study found that many of the women "found the miscarriage-inducing method less invasive than surgery." Study author Beverly Winikoff of the Population Council in New York said, "Even a large percentage of women for whom the method failed said they would try [the two-step oral prescription method] again if needed and that they would recommend it to a friend or relative. Our trial results accord with previous research findings that early medical abortion is desirable to the women who choose it," Winikoff said. She added, "[W]hen asked why they had chosen medical abortion, women in this study assigned great importance to avoiding invasive surgical procedures and to an experiential quality of the method that women consider natural."

The 2,121 American women in the study followed the oral mifepristone-misoprostol regimen that is standard in France. All participants were 63 days pregnant at most. Half of the women had previously had surgical abortions. Seventy-seven percent of that group "rated the medical abortion with pills more satisfactory." Although almost all of the women said the method had been adequately explained through counseling, almost half said their experience differed from what they had expected; two-thirds said the experience was better than they had expected.

When asked, both the women and providers participating in the study endorsed the feasibility of home administration of the method, as some women found the three clinic visits required by the method difficult to manage. Winikoff said, "If misoprostol is used at home, specific counseling about what to expect in the hours after self-administration and the availability of a 24-hour telephone support line may help allay women's concerns."

On Wednesday June 24, 1998, the U.S. House of Representatives passed the Coburn amendment, prohibiting FDA funding for approval of mifepristone and other drugs that cause abortion, by a close vote of 223 to 202. The Coburn amendment, which was attached to an agricultural bill, threatens FDA approval of mifepristone (known in Europe as RU 486). Similar language will be considered in the Senate.

Mifepristone, which is available to women in France, Sweden, and Great Britain, and is currently undergoing preliminary testing required for FDA approval. The Coburn amendment would ban the FDA from approving the production of mifepristone.

This affects several treatments besides abortion -- Mifepristone's other potential non-abortion uses such as a contraceptive, emergency contraception, endometriosis, fibroid tumors, meningioma, Cushing's Syndrome, and labor induction, would also be hindered.

more:

• Ibis Reproductive Health and the Population Council are pleased to announce the launch of a Spanish version of http://www.medicationabortion.com/, a multi-language website dedicated to medication abortion.  http://www.medicationabortion.com/ is designed to provide accurate information about medication abortion to health service providers including physicians, nurse practitioners, physician assistants, counselors, and office staff. Educational information is also provided for women considering the option of medication abortion.  http://www.medicationabortion.com/ is also available in English, French, and Arabic. 
• University of Rochester is conducting a multi-center trial of mifepristone (RU486) for medical abortion:
• Feminist Majority Foundation's info on RU 486.
• New York Times Magazine article on RU-486, The Little White Bombshell by Margaret Talbot. July 11, 1999 regarding mifepristone and misoprostol.
• Journal of the American Medical Women's Association (JAMWA) on Medical Abortion.
• Medical Abortion in Canada with RU-486.
• www.earlyoptions.org - the new early options abortion pill, Mifeprex, was approved by the FDA in October 2000 and will be available soon throughout the USA.

"Women are endowed by nature or god with the responsibility for babies. I believe women are endowed by nature and god with the right and responsibility of choice about abortion. It's an inherent right given to women by nature. It's equal in weight to any other human's right to life."

Feminist Women's Health Center