Expert: Doctor Early Options - 11/1/2008

Question
QUESTION: Dr.Joan,


My period was delayed and i took a home pregnancy test which showed negative at first so after a couple of days i took the test again and it showed positive,calculating from my last first day of menstruation which was Sept.11 i am now 4 or 5 weeks pregnant,i took misoprostol and followed the direction on how to use it put it under my tounge(its my 2nd time to have a medical abortion)and on the first and second dose i had bad cramps and diarhea but no blood loss so after 3 hours i took the 3rd dose again and i had little blood loss and just watery brownish fluid only.Right now im feeling ok the diarhea stopped and im feeling no cramps or anything but i just wanna know if i had a failed medical abortion? im thinking of doing it again and next time i wanna insert it vaginally but im scared coz i read that there might be some infection or something if u use it vaginally.Im also thinking if i should do a pregnancy test again coz the blood loss was really not much and im concerned about the brownish fluid that came out from me.please tell me if i should repeat the procedure and if inserting it vaginally is the better thing to do or if i should go to a doctor.

Thank you.


ANSWER: Dear Akina,
First, I would try another pregnancy test to confirm that you are pregnant.  Don't use the "digital" kind (the ones that have words on them)- use the ones that have the line that comes up positive. If it is positive, I agree with you - I think the pills have not worked yet. It would be best for you to insert the tablets vaginally. The risk of infection is extremely low, and I wouldn't worry about it.  Just make sure to wash your hands with soap and water before inserting the tablets.  Take FOUR tablets and put them in your vagina, and let them dissolve (don't take them out). If it doesn't work, do this again 24 hours later.  If this doesn't work, you can do it a third time, 24 hours later.  If you don't bleed, then I would see a doctor.  
Good luck!
Doctor Joan

---------- FOLLOW-UP ----------

QUESTION: Dear Dr.Joan,
I wrote you a letter before saying i had a failed medical abortion by drinking misoprostol and you told me to do it again and put it inside my vagina so i did.I did it for 2 days and all i had was bad cramps and diarhea but no bleeding so i went to a doctor for a checkup and was found still pregnant by 4 weeks.I told the doctor i took misoprostol coz i wanna know the condition of the baby but he told me he cant tell yet coz its still really small and maybe i should get a checkup again after another week.Dr.Joan i was thinking if maybe the medicine didnt work the first time(i just bled a little) becoz the baby was still to small and i was just thinking if what if i wait again for a couple of days or week and take the medicine again? or should i just really go to the hospital and have an abortion?i used the same medicine before and i was almost 2 months pregnant that time and it worked without hassle im just curious why the medicine wont work now for a 4 weeks pregnancy?



ANSWER: Dear Akina,
I'm sorry this has been so difficult for you.  You have three options. You can go to get an abortion.  You can try to get mifepristone (RU486) and then take the misoprostol.  This is much more effective than misoprostol alone. Or, if you want to try again, I would do the misoprostol (4 tabs in your vagina) again, 24 hours apart, up to three days in a row.  If this doesn't work, you will have to get an abortion.  You have already taken enough misoprostol to cause damage to the pregnancy.  They would not be able to detect birth defects for months. Sometimes the misoprostol is old and it loses its strength, and that's why it doesn't work. You might want to get some new tablets.  
Let me know what happens,
Doctor Joan
Early Abortion Specialist
EarlyAbortion.com
New York City

---------- FOLLOW-UP ----------

QUESTION: Dear Dr.Joan,
I did what you told me and tried the medicine again (4 tabs in vagina)and i bled a lot and i think this time the medicine worked,should i do a second dose again?or not needed anymore?and when do u think i should start my pills?

Thank you so much for all your advice i really appreciate it.

Akina

Answer
Hi Akina,
I am so glad - if you bled more than a period - it sounds like it worked!  The only way to be 100% positive that a medical abortion worked is to get an ultrasound.  If you can't do that, pay attention to your pregnancy symptoms - they should be going away.  You don't need to take a second dose if you don't feel pregnant.  You can check a pregnancy test in a few weeks.  You should start your birth control pills right away.
I'm so happy for you!
Doctor Joan
Early Abortion Specialist
EarlyAbortionOptions.com
New York City