Egypt – Early Medical Abortion with 91 to 98% success rate

Quick facts

  • Mifepristone is not registered anywhere in Middle east region, including Egypt.
  • Misoprostol is registered in Egypt. Misoprostol trade names: Cytotec (imported brand), Misotac and Misoprost.
  • Regimes of misoprostol in combination with methotrexate or alone for the early medical abortion are both safe and effective methods without serious side-effects.
  • misoprostol-alone regimen has slightly lower success rates compared with methotrexate–misoprostol regimen for early abortion.
  • Several studies have documented that misoprostol-alone regimen has success rates range from of 83–97%, while Methotrexate–misoprostol regimen has success rates range from 91 to 98%.
  • For those who live in Egypt, and want to terminate an unwanted pregnancy through medication, Methotrexate–misoprostol regimen is an effective alternative to Mifepristone-misoprostol regimen.
  • For those who live in Egypt, and want to terminate an unwanted pregnancy through medication, can contact us. You will be provided with a package containing a 50 mg vial of methotrexate with 14 tablets of misoprostol.

Egypt- Getting the abortive medicines by shipping

This service is limited to those who live in Egypt. The shipment can be delivered to any place all over Egypt. We cannot ship medicines abroad (outside Egypt).

Getting your package – step by step

  • Contact us through Whatsapp on 002 0106 128 2386. Please do not call this number, we accept only Whatsapp messages only.
  • Type the following text: L04 / A02.
  • Type the information needed for shipping purpose: ① Name, ② Address, ③ Valid Egyptian phone number. All information is confidential, used for delivery purposes only.
  • Estimated delivery time: The delivery time varies depending on your address. all shipments arrive within 2 to 3 working days. If you’re in a hurry, let us know during the WhatsApp chat.
  • Shipment content: check these Photos: image 1 image 2
  • Required amount: L.E. 1500, paid cash on delivery.

how to use Methotrexate–misoprostol combination – Step by step instructions

  • Step 1 – DAY 1: take Methotrexate vial by Intramuscular injection, at your nearest pharmacy or polyclinic or even at home by anyone trained to inject Intramuscular Injection. (N.B. dissolve the vial in 2 ml water for Injection). Click the link here to watch this video about: How to Give an IM Intramuscular injection in the Buttocks.
  • Step 2: wait for 4 days.
  • Step 3 – Day 5: start the Cytotec as following: insert 2 tablets deeply into the vagina (lay on your back for 30 minutes after vaginal insertion), in the same time, put 4 tablets at once under your tongue (let the 4 tablets dissolve into your mouth cavity for 15 minutes, then swallow any remains). Bleeding may start any time during the following 24 hours.
  • Step 4: if the bleeding does not start after 24 hours from step 3, repeat the same dosage as in step 3(2 vaginal, 4 oral).

General Notes

  • If you need pain killer, recommended to use Cataflam 50 mg tablets (one tablet when you experience strong cramps), you can take Cataflam 50 mg tablets up to 3 times per day, if needed.
  • You will consume only 6 or 10 tablets of Cytotec. Don’t throw away the remaining Cytotec pills, as you may need the remaining pills after the abortion completed.

How do you know when it’s over?

The success rate of methotrexate followed by misoprostol for medical abortion up to 10 weeks gestation is over 95%, with ongoing pregnancy rates of less than 2%. Multiple strategies have been examined to confirm a successful medical abortion and identify rare ongoing pregnancies when using the methotrexate and misoprostol regimen.

As a general guideline, 2 – 3 days after methotrexate injection, you will notice a decline in the common pregnancy symptoms such as morning sickness, breast tenderness, nasal congestion, feeling sleepy, excessive urination … etc. N.B. home pregnancy test is not indicative at this early stage, and might give false positive result. We advise that you take a pregnancy test 1-2 weeks after your treatment to confirm that your abortion has been successful and that your body is returning to normal.

Women’s assessment of successful abortion: Evidence indicates that women can accurately determine when their methotrexate and misoprostol medical abortion is successful—that is, whether pregnancy expulsion has occurred. In studies comparing women’s assessments of expulsion based on their symptoms to those made by clinicians and by ultrasound, women have repeatedly proven to be nearly as accurate as both.

Clinical assessment: Providers may help confirm successful methotrexate and misoprostol abortion at a follow-up visit by reviewing a patient history and performing a bimanual exam, if indicated. In studies comparing clinical assessment to ultrasound, clinicians determined pregnancy expulsion with high levels of accuracy.

Ultrasound: Ultrasound can be used to confirm successful abortion but is not necessary and can add to the cost and complexity of medical abortion, particularly where providers are inexperienced in reading post-medical abortion ultrasound. Ultrasound is helpful in cases where there is doubt about the presence of an ongoing pregnancy.

Serum pregnancy testing: Serum pregnancy testing has been used as an alternative to ultrasound to diagnose an ongoing pregnancy following methotrexate and misoprostol and compares favorably to ultrasound in reducing interventions at the time of follow-up. Serum pregnancy testing is mostly useful when a pre-treatment hCG has been obtained for comparison; hCG declines by more than 90% seven days after methotrexate is administered in the case of a successful medical abortion. A serum hCG level below 900 IU 14 -21 days after early (<63 days gestation) medical abortion excludes ongoing pregnancy.

Urine pregnancy testing: A negative urine pregnancy test is reassuring that an abortion has been successful. Rarely, however, a pregnancy test is negative but a woman is still pregnant (false negative). Both high-sensitivity and low-sensitivity urine pregnancy tests can have positive results even when the medical abortion has been successful (false positive). Find out more about: Pregnancy Test After Abortion from the link here.

Misoprostol-alone VS Methotrexate–misoprostol combination for early abortion

Regimens of 50 mg methotrexate followed by 400 micrograms oral misoprostol or 800 micrograms vaginal 5 to 7 days later have proven to be highly effective medical abortion methods and are used widely in the USA and elsewhere. In many settings; however, women do not have access to either misoprostol or methotrexate. These are often settings with highly restrictive abortion laws. Middle east countries, including Egypt provide some of the most dramatic examples: abortion is illegal in all but extreme circumstances in many countries or is entirely prohibited, as is the case in KSA, Syria, and Yamen. Misoprostol is not registered anywhere in the region.

Consequently, mortality due to unsafe abortion remains high, with an estimated 6000–7000 deaths annually worldwide. Given these obstacles; safe abortion services must often be provided through reserved means and, with respect to medical abortion, using alternative regimens of misoprostol alone and/or methotrexate with the use of misoprostol in combination with methotrexate or alone for the early medical abortion are both safe and effective methods without serious side-effects. These two methods can be used alternatively, but the results of the studies suggest that misoprostol alone is easier. This is due to the fact that there is no need for intramuscular injection and possible side-effects of methotrexate that is a cytotoxic drug are eliminated. Most of the patients expressed their consent of this method and suggested it to other patients.

In the published literature, trials tend to show slightly lower success rates for misoprostol-alone regimens compared with methotrexate–misoprostol regimen for early abortion. Several studies have documented success rates of 83–97% using variants of a misoprostol-alone regimen. A small number of trials have tested oral misoprostol, although a recent review of seven misoprostol-alone regimens for early medical abortion found that vaginal administration was significantly more effective.  While further research would help determine the optimal protocol, 800 micrograms vaginal misoprostol, repeated after 24 hours, has been recommended for pregnancies up to 63 days last menstrual period (LMP).

For methotrexate–misoprostol regimens, success rates in past trials generally range from 91 to 98%. For pregnancies up to 49 days of gestation, a widely used current regimen is 50 mg/m2 intramuscular (IM) methotrexate followed 5–7 days later by 800 micrograms vaginal misoprostol, repeated in 24 hours if necessary. Comparable efficacy rates have also been found using 50 mg oral methotrexate.

As with any pharmacological agent, both misoprostol and methotrexate are associated with risks and adverse effects. Methotrexate is a known teratogen and as such requires careful follow up for women with failed methotrexate–misoprostol abortions. Several cases of anomalies associated with in utero exposure to misoprostol have also been documented; however, the absolute risk of teratogenicity appears to be low, at roughly 10 per 1000 exposed fetuses.

Adverse effects of the two medical abortion regimens are generally similar and include bleeding, cramping, fever, nausea, vomiting, and diarrhea. Since both regimens include similar doses of misoprostol, this similarity in adverse effect profile is perhaps not surprising. In the large majority of trials, these conditions are short-term and easily managed.

With regards to efficacy, useful comparisons between misoprostol-alone and methotrexate–misoprostol regimens based on published trials are hampered by the wide variability of samples, regimens used, gestational age limits, and points of follow up. In a study, women with pregnancies of 56 days LMP (Last Menstrual Cycle) were randomized to a regimen of either IM methotrexate plus misoprostol or 800 micrograms vaginal misoprostol alone, repeated after 24 hours if the abortion had not occurred. Success rates, defined as complete abortion at the 2-week follow up, were 90% for the methotrexate–misoprostol group and 47% for the misoprostol-alone group. The study is designed to compare between administration of Misoprostol and combined Misoprostol & methotrexate in treatment of missed abortion. Referances: ①.

Disclaimer: Some women choose to terminate their pregnancies early for various reasons, we believe that all women anywhere, have the right to have safe abortion options, and we work to provide facts and information related to abortion drugs such as what should be taken into account in advance before using drugs How to get high-quality abortion pills, how to use them safely, what you can expect and when to seek medical help when needed. Our mission is to educate women about the information needed to pass the process of early termination of pregnancy safely and securely. We have made every effort to ensure the accuracy of the information on this page, but this content is subject to change from time to time, and the authors of the site will not accept any responsibility for the accuracy of the information provided at any time. Ref: A02BB01 , L04AX03.

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