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Methotrexate
 
 

When the availability of RU-486 to women in the United States was delayed during the 1990s, researchers looked to other drug alternatives for early pregnancy termination. Methotrexate has been used in the United States since 1953, when it was approved by the FDA to treat certain types of cancer. Because methotrexate affects cells that are rapidly dividing (i.e. cancerous cells) researchers tested it for use in termination of pregnancy. When administered by injection or shot and used in combination with misoprostol, methotrexate effectively terminates a pregnancy 94-96% of the time. Given the widespread availability of mifepristone in the United States, methotrexate is used infrequently for medical abortion.

Frequently Asked Questions About Methotrexate

How does methotrexate work?

What is the standard protocol for using methotrexate for pregnancy termination?

When can methotrexate be used to terminate a pregnancy?

What are the advantages to using methotrexate?

What are the side effects of methotrexate?

Who can offer methotrexate?

How does methotrexate differ from mifepristone?

Will methotrexate eliminate the need for mifepristone or surgical abortion?

Where can women receive more information on methotrexate?

Don't see your question here? Let us know.

How does methotrexate work?
Methotrexate can cause an early abortion by stopping the ongoing implantation process that occurs during the first several weeks after conception. It may also affect attachment of the embryo to the uterine wall. Misoprostol is the second drug used in this regimen which causes uterine contractions that expel the embryo.

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What is the standard protocol for using methotrexate for early abortion?
Since 1993, physicians have prescribed methotrexate with misoprostol for early pregnancy termination. While no single, standardized protocol has been established, typically a woman receives an injection of methotrexate and anywhere from three to seven days later, she administers misoprostol — either orally or vaginally. The regimen typically takes several days or weeks to complete: 60% of women will abort within 24 hours, and 70-80% of women will abort within 3 weeks. Some will take longer and may need additional doses of misoprostol. However, a recent study shows oral methotrexate in pill form works as well as the injectable form for early abortion.

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When can methotrexate be used to terminate a pregnancy?
Methotrexate can be taken to end a pregnancy from the time a woman knows she is pregnant up to 49 days after the beginning of her last menstrual cycle.

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What are the advantages to using methotrexate?
By using methotrexate, women can typically avoid the use of surgical instruments and anesthesia when terminating their pregnancies. Evidence-based alternatives have allowed home administration of misoprostol which may offer women more privacy. Other advantages are that it can be used to treat a pregnancy outside of the uterus (an ectopic pregnancy) and women who have used it report that it resembles a "natural miscarriage." Methotrexate is as safe and ultimately as effective as other forms of medical abortion.

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What are the side effects of methotrexate?
Methotrexate has a remarkable record of being safe and effective with few side effects. Potential side effects include headache, nausea, and diarrhea.

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Who can offer methotrexate?
Qualified health care providers, including physicians and mid-level providers can offer methotrexate to their patients.

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How does methotrexate differ from mifepristone?
While there is much less experience using methotrexate for abortion than there is with mifepristone, clear differences exist between the two regimens.

  • Methotrexate is a folic acid antagonist that prevents development of the embryo. It may also affect the attachment of the embryo to the uterine wall. Mifepristone is an antiprogestin which works by blocking the hormone progesterone that is necessary to sustain an early pregnancy.

  • Methotrexate works on both ectopic and intrauterine pregnancies, while mifepristone may only be effective in aborting an intrauterine pregnancy.

  • While studies have shown methotrexate to be as effective as mifepristone in terminating a pregnancy, the entire abortion process often takes longer to complete.

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Will methotrexate eliminate the need for mifepristone or surgical abortion?
Methotrexate should be considered an additional option for women, not as a substitute for either mifepristone or surgical abortion. When drugs that can be used for abortion — like methotrexate and mifepristone — become widely available for this use in the United States, they will provide women with an important alternative to surgical abortion. They will not, however, eliminate the need for that option.

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Where can women receive more information on methotrexate?
For more information on methotrexate and its use for early abortion, women can contact Planned Parenthood and the National Abortion Federation.

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Resources

Instituting Medical Abortion Services: Changes in Outcome and Acceptability Related to Provider Experience
A prospective case series carried out at 34 Planned Parenthood sites studied the safety, efficacy, and acceptability of medical abortion with methotrexate and misoprostol in 1973 women. (See also PDF, 57KB)

 
 
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