A MEDICAL METHOD OF EARLY-PREGNANCY TERMINATION USING TAMOXIFEN AND MISOPROSTOL

A study was undertaken to determine whether ingestion of the selective estrogen receptor modulator tamoxifen followed by vaginal administrat ion of the prostaglandin misoprostol would be an effective medical met hod of elective termination of early pregnancy. A clinical trial was c onducted with a study group of 100 healthy women with pregnancies of 5 6 days gestational age or less who desired elective pregnancy terminat ion. Each subject ingested 20 mg of tamoxifen once daily for 4 days fo llowed 4 days later by intravaginal placement of four 200 mu g tablets of misoprostol. If abortion did not occur within the next 24 h a seco nd dose of 800 mu g of misoprostol was given. The main outcome measure s were incidence of complete abortion, hemoglobin levels, duration of vaginal bleeding, and incidence of side effects. Complete abortion occ urred in 92 (92%, 95% CI 86.7 97.3%) of 100 subjects. Of these 92 wome n, four aborted after ingesting tamoxifen without use of misoprostol, 84 within 24 h after receiving a single dose of misoprostol, one 21 da ys following a single dose of misoprostol, and three after a second do se of misoprostol was administered. There were six (6.0%) complete tre atment failures and two (2%) incomplete abortions that required a dila tation and curettage. The mean duration of uterine bleeding was 8.1 da ys (range 1-34 days) and there was a median decrease in hemoglobin lev el of 0.50 g/dL (+2.2 to -4.7 g/dL). Vomiting occurred in 28% of subje cts and diarrhea in 8%. These initial data suggest that ingestion of t amoxifen followed by intravaginal misoprostol may be an effective, eas ily administered, and inexpensive method to electively induce complete abortion in pregnancies of 56 days gestational age or less. Additiona l studies are necessary to determine whether the addition of tamoxifen increases the success rate compared with that obtained with the use o f vaginally administered misoprostol by itself. (C) 1998 Elsevier Scie nce Inc. All rights reserved.