Dr. D’s Blog

Methotrexate, Misoprostol and Mifiprex (RU486) and Abortion

Posted on: May 11, 2009

Before the French Abortion Pill (RU486/Mifiprex) became available in the United States, medical abortions were performed using a cancer therapy drug called Methotrexate that interferes with the uptake of folate to the developing early pregnancy (before any fetal form) and a prostaglandin medicine (Misoprostol) used to contract the uterus to expel the pregnancy tissue.

Using these two medications, I assisted approximately 100 patients with medical abortions.  I was impressed with how well patients tolerated this approach to early abortion and how, when successful, it avoided the invasive aspects to the surgical approach to abortion.  However, this particular combination of medication required a five-day wait between taking the Methotrexate (an injection) and the Misoprostol.

There was also an unacceptable high failure rate of up to 15 to 25% requiring a repeat dose of Misoprostol or a D&C to complete the abortion.  Although I was comfortable with medical abortion as an option for my patients, I was frustrated with the waiting period and unacceptable failure rate.

The French Abortion Pill, which was being used in Europe for many years, offers advantages over Methotrexate when used with Misoprostol.  RU486 is a pill, not an injection, and the waiting period between the two medications is only one or two days.  The success rate approaches 98%.  It first became available in the United States by way of clinical trials which paved the way for ultimate FDA approval of RU486.

I participated in those trials for two years during which I became convinced that medical abortion with RU486 was a valid and beneficial approach to early abortion.  Patients prefer it because it avoids surgery.  It also offers an approach that they perceive as more “natural”, and is able to be completed in the privacy and comfort of their own homes.

I am now an advocate for medical abortions, and in fact have participated in several training sessions to help other abortion providers learn how to introduce it to their practice.

For more information you can go here: www.sjwc.net


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  • Mignon C: Dr. D, Thank you. Good insight. Med Student
  • Interested Citizen: Dr. Dee, I have been searching all over for a blog on abortion, but only from the medical perspective and that is written by a doctor that is in th


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