A PILOT-STUDY OF THE EFFECT OF METHOTREXATE OR COMBINED ORAL-CONTRACEPTIVE ON BLEEDING PATTERNS AFTER INDUCTION OF ABORTION WITH MIFEPRISTONE AND A PROSTAGLANDIN PESSARY

Although a combination of mifepristone and a prostaglandin is a safe, acceptable alternative to vacuum aspiration for inducing abortion in e arly pregnancy, the longer period of vaginal bleeding after medical ab ortion is a disadvantage. The present study investigated whether admin istration of the combined oral contraceptive pill (COC) or the injecti on of methotrexate at the time of abortion would shorten the period of vaginal bleeding after medical abortion. After having a medical abort ion induced with mifepristone (200 mg) and 0.5 mg gemeprost pessary, 8 0 women were randomized to four groups of 20 women each; Group A, COG; Group B, control; Group C, 50 mg/m(2) methotrexate; and Group D, plac ebo injection. There was no significant difference in the duration of bleeding between Groups A and B (median 14 and 17 days) or between Gro ups 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 Gro up A who took the COC (median/range: 25/15-54 control group versus 32/ 26-46 days, p <0.04). The administration of methotrexate was associate d with a temporary elevation in liver enzyme concentration in one woma n. It is concluded that women who wish to use COC can start immediatel y after medical abortion. Addition of methotrexate after abortion has no significant beneficial effect on patterns of bleeding and cannot be recommended. (C) 1998 Elsevier Science Inc. All rights reserved.