WARNING: I’m not writing this blog for regular TKC readers. Of course, you all are more than welcome to read about my miscarriage (which I’m sure this is the first you’re hearing of), but I warn you that this is a graphic post. I’m writing this blog for those of you Googling Misoprostol or Cytotec and what it’s like having a medically assisted miscarriage.

First of all, I’m sorry. I’ve been there. I know you’re sad and afraid that this is going to be painful or worse–that it will be incomplete and you’ll have to do it a second time or get a D&C. I know that’s what I was most afraid of. I can’t promise you that it won’t be. From what I’ve read each woman has a very different reaction to the medicine. I can only share my experience, and for what it’s worth, I had a “good” experience with Misoprostol.

Of course there are no good miscarriages. But I wasn’t in a lot of pain and I didn’t need surgery. I really wanted to avoid having a D&C because I’m scared of anesthesia and non-essential surgery. I already felt so out of control of what was happening to me, I wanted to at least have some closure with my pregnancy—closure I was afraid I wouldn’t have if I just woke up in a hospital un-pregnant.

I knew something was wrong with my pregnancy very early on, I had pretty regular spotting and very little in terms of pregnancy symptoms. When we went in for our first ultrasound the baby had a heartbeat, but he (we thought it was a boy) measured a week behind. My OB told me that I probably had my ovulation date wrong, but I have a cycle you can set a clock by. I knew exactly when I ovulated, because I have a telltale pinch, every month—right on day 13 of my cycle. Still, we’d been told that since we had a heartbeat we were assuredly safe.

We were supposed to come back in two weeks for a follow-up ultrasound, but I started bleeding heavily two days before our appointment. The doctor fit me in and I was ushered in for another ultrasound. I knew as soon as I saw my little blob that he no longer had a heartbeat and the doctor confirmed. His poppy-seed sized heart had stopped two days after our last appointment.

My doctor told me that since I was already bleeding my cervix was already softening and that the miscarriage was probably already in the works. I could let it happen naturally, which could take weeks; help it along with some medicine (Misoprostol), or get surgery (D&C).

“No surgery,’ were the first things out of my mouth.

I asked what I should expect and what the difference between the pills and letting the miscarriage proceed naturally would be and the doctor told me that it was just a matter of time, both would involve cramping and bleeding.

I had to psyche myself up to take the pills. At first I was planning to let the miscarriage happen naturally, but after my bleeding tapered off I realized it might take a long time to get through the actual physical loss of my pregnancy and if there wasn’t a living embryo inside me then I wanted to stop feeling pregnant. 

Here are a few things I found helpful to have on hand ahead of time:

  • A heating pad. I ended up using two, one for my front, one for my back. The heat really helps soothe the cramps.
  • A loose nightgown. I needed to run back and forth to the bathroom and not having pants helped.
  • Blankets, once there’s enough blood loss you’ll feel cold—no matter what time of year it is.
  • Pain killers. Some doctors prescribe “good” pain medications. Mine wouldn’t, so I had a bottle of Motrin and and took 3 pills every 4 hours. Don’t use a painkiller that is also a blood thinner, like aspirin.
  • Overnight sanitary pads. Depends or adult diapers are also a good alternative. I asked my husband to buy the biggest box of big pads he could, there were times during the day where I had to change my pad every few minutes.
  • Moist flushable wipes. It’s a messy business, and using moist wipes helped with clean up; they were also gentler on my vagina than regular toilet paper.
  • Tissues, the good ones with lotion. You’ll cry. That’s okay.
  • Another person. This probably goes without saying, but you need someone to be there with you. There can be complications; excessive blood loss can lead to shock or fainting. Even if you’re feeling private (I understand), you need to have someone with you to take you to the hospital if need be.
  • Netflix. There’s a lot of sitting around waiting and bleeding and crying. You’ll want a distraction. I watched a “The Americans” marathon while I went through my Misoprostol miscarriage. It sounds trite, but after a while I just wanted to not cry, I needed to think about something else.
  • Food. You’ll be emotional and you may not want to eat, but you should eat. I didn’t and got very light headed.

Misoprostol can be taken orally, sublingually (under the tongue), or vaginally. My doctor told me that she’d had better luck with taking it sublingually than vaginally, so I went with her advice.

I took two (out of four) 200mg pills around 10am and I started bleeding heavily before they’d even finished dissolving. That was the hardest part of the day—it was really happening. I cried, and then I told myself it was just like having a really heavy period.

Sometimes you have to tell yourself whatever you need to in order to get through things. It actually helped.

I bled heavily for about six hours, but wasn’t passing any tissue and I only had slight cramping, much lighter than I’d experienced during a bad period. I was worried that the pills weren’t working for me. I asked my husband to call the doctor to see if they could call-in a second prescription in case it took longer/more pills. They said no, and we should wait and see how the second dose went, and if still nothing we’d wait three days and do it again.

I was originally instructed to wait 12 hours between doses, but I didn’t. Things seemed to be coming to a close and I wanted to get it over with as quickly as possible. I waited eight hours and took the second dose of pills. I started cramping immediately—but still, it wasn’t that bad. Bad period style cramps at most, I really didn’t need more than the Motrin and a heating pad to sooth them. I started passing large pieces of tissue fairly shortly after the cramping started—again, there was still some pill dissolving under my tongue—it happened within 10 minutes of placing the pills. The majority of the tissue passed in the following two hours. I wasn’t in much pain, but I felt sort of like I was wetting myself. I had to change my pad every few minutes because the blood and tissue soaked through very quickly.

I’m sure that somewhere in that tissue I passed the gestational sac, but I didn’t see it. I’d read that it would look like a grayish golf ball, but it could also breakup during the trip through the cervix and come out with the tissue. I was very nervous that I would need to go through the process again or go in for the D&C, and we called the doctor the next morning to make an appointment to get an ultrasound on Monday (I took the pills on Thursday) to make sure my uterus was clear of tissue.

By about 10pm my bleeding slowed down considerably. I was still a little crampy, and I was bleeding a bit—like a second day-period bleed. Physically, I was exhausted and cold, the blankets and heating pads came in handy. I took some Nyquil to help me sleep (I’m not above abusing cough syrup for a good night’s sleep after a traumatic event). I did have to wake up a couple of times during the night to pass some tissue and change my pad, but honestly I was totally desensitized by this point, and it didn’t phase me.

I passed small pieces of tissue for the next few days and the bleeding tapered off to a light spotting within 3-4 days.

When I went to see the doctor I was told that my uterus was completely clear of tissue, but that my lining was still a little thick and I would still bleed for a little while as it thinned out. All in all, it was a successful miscarriage in that I wouldn’t need any follow up procedures.

My husband and I had some questions about sex, exercise, and when to try again. Here are the answers we received:

Exercise: It’s fine to go back to normal exercise as soon as I/you feel ready.

Sex: Go for it, but use condoms to prevent infection and pregnancy. Misoprostol can stay in the system for up to a month, it would be a bad idea to get pregnant again right away, putting a future pregnancy at risk.

Getting pregnant again: We were told to wait two complete menstrual cycles, and that it could take 4-6 weeks for my menses to start again. My doctor will also be monitoring my hcg levels regularly to make sure they go back down to 0—she doesn’t want me to get pregnant again until my hormones have gone back normal, but I would encourage you to speak to your own doctor about what’s best for you.

She also said something that made me feel better: I’m not alone. I knew that already, but it’s good to hear. Forty percent of women will experience a miscarriage in their lifetime, and she thought it was probably even higher than that—women who weren’t trying to get pregnant and just thought they had a late, heavy period.

Most miscarriages are a result of chromosomal abnormalities–there’s nothing you could do to prevent them. I happen to have an underactive thyroid, which I knew about before getting pregnant, but didn’t know until now can effect the viability of a pregnancy. Now I know that 50% of women with untreated hypothyroid will experience a miscarriage in the first 20 weeks–I will have to be medicated and my thyroid monitored carefully from here on out. 

I know this is a hard time for you; it’s a hard time for me too. I’m sorry we’re going through this. But if I were faced with this situation again I would go the same route—taking the Misoprostol to speed up the natural process. Again, I read very different reactions to Misoprostol, and I just felt like I needed to share my experience to maybe help make someone else’s experience a little less awful.

Here are some links to other blogs about Misoprostol/Cytotec miscarriages, I found them more than a little comforting: