Cytotec (misoprostol) is a medication often used for medical abortion. It works by softening the cervix and causing uterine contractions to expel pregnancy tissue. However, in some cases the body can develop a resistance to Cytotec, preventing it from working effectively. Here we’ll examine why resistance happens and the options for overcoming it.

How Does Cytotec Work?

The active ingredient in Cytotec, misoprostol, is a prostaglandin. It stimulates the uterus to contract and the cervix to soften and dilate. This empties the uterus, terminating the pregnancy in a process similar to natural miscarriage.

Cytotec tablets come in 200mcg doses. For medical abortion, the typical regimens are:

This stimulates strong enough contractions in most cases to complete the abortion.

What Causes Cytotec Resistance?

In some cases, a woman’s body does not respond as expected to Cytotec. Reasons this may happen include:

When the uterus does not contract adequately in response to original Cytotec, complete abortion may not occur. This is known as Cytotec resistance.

How Common is Cytotec Resistance?

Most studies estimate Cytotec resistance in early medical abortions occurs in around 2-5% of cases. Rates may be higher in certain populations and are higher later in the first trimester.

Being aware of the potential for resistance can allow proper planning and management if it does occur.

Signs of Potential Cytotec Resistance

Signs that the Cytotec may not be working as expected include:

If these occur, Cytotec resistance should be suspected. Further steps can then be taken.

Overcoming Cytotec Resistance: The Options

If Cytotec does not terminate the pregnancy as planned, there are a few options available:

Additional Doses of Misoprostol

Taking additional doses of 400-800mcg Cytotec every 3-4 hours allows another chance for the uterus to respond. This works in some cases.

Switch to Alternative Prostaglandins

Alternate prostaglandins like dinoprostone may be more effective when Cytotec fails. These are administered vaginally for 12-24 hours.

Surgical Aspiration

If prostaglandins fail to work, surgical aspiration provides a definitive solution. This gentle suction procedure safely empties the uterus.

Expectant Management

Rarely, pregnancy tissue may still pass naturally over days to weeks without further intervention. But medical management is typically recommended.

The best approach depends on each unique case. An exam and ultrasound can help determine the safest course.

Improving Cytotec Effectiveness

To facilitate the best response to Cytotec and avoid potential resistance, the following tips can help:

While resistance is uncommon, being aware of the possibility and solutions allows appropriate planning and action if needed for a successful outcome.

Frequently Asked Questions

What percentage of women are resistant to Cytotec?

Studies show around 2-5% of women don’t respond as expected to Cytotec for medical abortion in the first trimester. Rates are higher later in pregnancy.

Can anything reduce the effectiveness of Cytotec?

Yes, taking anti-inflammatories like ibuprofen may interfere with Cytotec’s action. Uterine scarring can also inhibit contractions.

How long does it take for Cytotec to work?

Most women abort within 24 hours of starting Cytotec. If pregnancy symptoms continue after 24 hours, resistance should be suspected.

What are signs that Cytotec didn’t work?

Lack of bleeding, ongoing pregnancy symptoms, no passed tissue and continuing visible pregnancy on ultrasound may indicate Cytotec failure.

What are the options if Cytotec fails?

Additional Cytotec doses, switching to a different prostaglandin, surgical aspiration, or rarely expectant management are options for Cytotec resistance.