Abstract
It is now well established that pregnancy can be terminated safely medically at all gestations using the antiprogestogen mifepristone and a prostaglandin analog. This is an effective alternative to surgery, offering women additional choice. Although a regimen comprising 600 mg mifepristone and the prostaglandin analog gemeprost administered vaginally is licensed for use, evidence suggests that mifepristone in a 200-mg dose together with the prostaglandin E1 analog misoprostol is equally efficacious and cost effective. Additionally, unlike gemeprost, misoprostol does not require stringent storage conditions and can be administered orally, vaginally or sublingually. Efficacy of the medical regimen decreases with increasing gestation and also varies with the dose and route of the prostagladin analog administered. For the majority of women undergoing medical abortion, oral analgesia suffices. Initial studies have reported high efficacy and good acceptability of medical abortion in home settings. Developing and introducing home medical abortion will increase women’s choice. This article presents an overview of medical abortion using low-dose mifepristone and misoprostol, with a focus on current practice and research in Europe and, in particular, the UK.