Where babies happen

3146 Deming Way
Middleton, WI 53562

Phone: 608-824-0075 | Fax: 608-829-0748

Misoprostol for Medical Treatment of Early Pregnancy Loss

Treatment Options for a Missed Abortion (Miscarriage)

  • Waiting for spontaneous expulsion of the products of conception
  • Surgical dilation and curettage (D & C)
  • Medical treatment with a medication called misoprostol

Using misoprostol can expedite the normal processes involved while emptying the uterus spontaneously. It also avoids using instruments that could possibly damage the uterus. Using the medication will also speed up the resolution faster than just waiting for the pregnancy to pass.


You will pick up your prescription at the pharmacy. The prescription will be for:

  • Misoprostol 200mcg Dispense 4 tablets (total of 800 mcg). Refill x 1. (Moisten 2 at a time and insert into vagina, repeat)
  • Vicodin, Tylenol with Codeine, or Percocet will also be supplied (can be oral or rectal-for nausea)

Prior to starting the medication, you should wash your hands and dry them well. You should insert all four tablets of misoprostol into your vagina. If you place the tablets and then you don’t see them, you have inserted them correctly. Do try to place them as far up into the vagina as possible. We expect bleeding and cramping to result from the medications.

Bleeding and cramping typically start 4-8 hours after insertion of the tablets, but can start within an hour of inserting the tablets. Bleeding will most likely be heavier than a heavy period. The bulk of the heavy bleeding typically occurs within 24 hours, but bleeding can continue 1-2 weeks. Many women will experience  1-3 hours of very heavy bleeding. You can expect to pass some blood clots; they may be as large as the size of a 50 cent piece. Misoprostol side effects include nausea, vomiting, diarrhea, fever, and chills.

You may want to take a pain reliever when you insert the misoprostol. You can take pain medications every 4-6 hours as directed. Heating pads may also keep you comfortable. There are no restrictions on eating or drinking. You should plan on taking the day off work for at least the first 24 hours after inserting the misoprostol.

When to Call

  • No bleeding or cramping within 24 hours of inserting the misoprostol
  • Bleeding is excessive, defined as bleeding through a pad every 30 minutes for more than 2 consecutive hours
  • Any sign of infection: fever, chills, odorous vaginal discharge, or pelvic pain that starts more than 12 hours after inserting the misoprostol
  • Temperature greater than 101 degrees
  • Severe abdominal pain
  • Fainting

Follow Up

If you have minimal or no bleeding/cramping after inserting the misoprostol, call the clinic. You may be instructed to insert a second set of the misoprostol tablets.

Occasionally, the body is unable to pass the products with the misoprostol and a D&C is required.


If you have the expected bleeding and cramping, we will want to see you approximately 1 week after the misoprostol insertion for an ultrasound to confirm the miscarriage is complete.

What to Expect after the Miscarriage

  • Your next period will typically occur 4-6 weeks after the pregnancy was miscarried. If you do not get your period, please call.
  • You may feel tired and experience moderate cramping for up to a week following the pregnancy expulsion. Ibuprofen, Naproxen, or Tylenol is fine to take.
  • Symptoms of pregnancy (breast tenderness/nausea) should disappear within a week.