Although a combination of mifepristone and a prostaglandin is a safe, acceptable alternative to vacuum aspiration for inducing abortion in early pregnancy, the longer period of vaginal bleeding after medical abortion is a disadvantage. The present study investigated whether administration of the combined oral contraceptive pill (COC) or the injection of methotrexate at the time of abortion would shorten the period of vaginal bleeding after medical abortion. After having a medical abortion induced with mifepristone (200 mg) and 0.5 mg gemeprost pessary, 80 women were randomized to four groups of 20 women each; Group A, COC; Group B, control; Group C, 50 mg/m2 methotrexate; and Group D, placebo injection. There was no significant difference in the duration of bleeding between Groups A and B (median 14 and 17 days) or between Groups C and D (18 and 15 days), or in the amount of bleeding (4 days of heavy bleeding in each group). The first period occurred sooner in Group A who took the COC (median/range: 25/15-54 control group versus 32/16-46 days, p < 0.04). The administration of methotrexate was associated with a temporary elevation in liver enzyme concentration in one woman. It is concluded that women who wish to use COC can start immediately after medical abortion. Addition of methotrexate after abortion has no significant beneficial effect on patterns of bleeding and cannot be recommended.
PIP: The capability of administration of a combined oral contraceptive (OC) or injection of methotrexate at the time of medical abortion to shorten the duration of vaginal bleeding was assessed in a randomized trial conducted in Edinburgh, Scotland, in 1996-97. 80 women seeking pregnancy termination at less than 63 days' gestation were given 200 mg oral mifepristone, followed 48 hours later by 0.5 mg cervagem by vaginal pessary. After the products of conception had passed, women received one of the following four regimens: Group A--an OC (30 mcg ethinyl estradiol and 150 mcg levonorgestrel) to be started immediately after termination; Group B--the same OC, to be started on the first day of the next menstrual period; Group C--50 mg/sq. mm of methotrexate; or Group D--placebo (saline) injection. There was no significant difference between Groups A and B in the median duration of bleeding (14 and 17 days, respectively) or between Groups C and D (18 and 15 days, respectively). Women in all four groups experienced 4 days of heavy bleeding. The first menstrual period occurred after a median of 25 days in Group A compared with 32 days in the other groups. These results indicate that methotrexate administration after medical abortion has no significant beneficial effect on bleeding patterns. Although OCs also failed to control bleeding, their initiation immediately after medical abortion can be considered to ensure rapid restoration of menstruation and provide women with reassurance that they are not pregnant again.