Sometimes, a miscarriage doesn’t cause symptoms and might be diagnosed during a routine scan. This is known as a missed miscarriage or spontaneous abortion.

After a missed miscarriage, the pregnancy may not pass on its own. The medication misoprostol can help. Misoprostol (Cytotec) causes contractions to help your body pass the pregnancy.

Here, we look at how the medication treats missed miscarriages in the first and second trimesters of pregnancy, the potential side effects, and ways to alleviate discomfort.

Your clinician may recommend taking 600–800 micrograms (mcg) of oral misoprostol (Cytotec) to treat a missed miscarriage during the first trimester. The medication usually comes in 200-mcg tablets, so you may have to take 3–4 depending on the prescribed dosage.

Decide on a time when you’re able to rest for a while after you take the tablets.

Insert 1–2 tablets into each cheek pouch, or put all of the tablets under your tongue. Hold them there for 30 minutes, and then wash down anything that’s left with a glass of water.

Consider putting a heavy-duty pad in your underwear so you can monitor any bleeding that occurs. Replace as needed.

Placing a hot water bottle or heating pad on your abdomen can help soothe cramping.

You might find it helpful to take 600 milligrams (mg) of acetaminophen (Tylenol) or ibuprofen (Advil) when you begin to feel cramps. Repeat the dose every 6–8 hours with a light meal until the discomfort begins to lift and the pregnancy has passed.

You may also experience the following side effects within the first 24 hours of taking misoprostol:

The pregnancy is likely to pass within 24 hours. It may pass in a blood clot. You might not notice it.

If you’re further along in the first trimester — 10 weeks or more after the first day of your last period — the tissue may have more recognizable details.

Your clinician may recommend taking 400–800 micrograms (mcg) of vaginal misoprostol (Cytotec) to treat a missed miscarriage during the second trimester.

Misoprostol usually comes in 200-mcg tablets, so you may have to insert 2–4 depending on the prescribed dosage.

Pick a time when you’re able to lie down for at least an hour after you insert the tablets. Wash your hands thoroughly before you begin.

Some people find it easier to insert the medication while standing up, while others find it easier when lying down. The goal is to push the tablets — one at a time, or all at once — as high up into the vaginal canal as possible.

After you’re done, you can consider putting a heavy-duty pad in your underwear. This can help you monitor any bleeding that occurs.

If you don’t experience any cramping or bleeding within 3 hours of inserting the medication, your clinician might recommend administering a second dose.

Generally, the side effects, duration, and tips for management are the same when using misoprostol during the first or second trimester.

The main difference is in the amount of fetal tissue that will pass. During the second trimester, the tissue will be 2–3 inches long, and it will likely have more recognizable details. It’s unlikely to pass unnoticed in a blood clot.

Avoid the following for at least 1 week after using misoprostol:

  • strenuous physical activity
  • penetrative vaginal sex, including fingering
  • tampons, menstrual cups, and other internal period products
  • products like bath bombs and body wash
  • nipple stimulation, if you’re experiencing nipple discharge

You may experience further side effects during this time, including a “second wave” of heavy bleeding and cramps 2–3 days after taking the medication.

Massaging your abdominal, uterine, and pelvic areas may help alleviate cramping. Taking a shower, sitting on the toilet, or having someone rub your back may also help.

If you feel feverish, take your temperature twice daily for 48 hours. If you have a fever of 101.4°F (38.5°C) or higher for 12 hours or more in a row, seek emergency medical attention.

Your feelings and emotions, whatever they are, might feel stronger than usual due to the hormonal changes that occur after a miscarriage. They may not last very long, or they may intensify over time.

Allow yourself the time and space to process and recover in a way that feels right for you.

How long does it take for misoprostol (Cytotec) to work?

In many cases, the pregnancy will pass around 4 hours after taking misoprostol. It may occur sooner or take a bit longer for some people. The pregnancy will likely pass within 24 hours of taking the medication.

Are there other treatment options for missed abortion?

Some people pass a pregnancy without medication. This is called expectant management. Others may take a combination of mifepristone (Mifeprex) and misoprostol (Cytotec).

In some cases, a procedure called dilation and curettage (D and C) may be necessary to remove the tissue.

What else is misoprostol (Cytotec) used for?

Misoprostol is probably best known for its role in medical or medication abortion. It can also induce labor, treat postpartum bleeding, and treat stomach ulcers.

Misoprostol (Cytotec) is often used to help pass a pregnancy after a missed miscarriage or spontaneous abortion. The recommended dosage and route of administration depend on how far along the pregnancy is.

The expected side effects and ways to manage them are typically the same during the first and second trimesters.

If you’ve taken misoprostol or need to take it and have any questions, consult a doctor or other healthcare professional. They can offer advice based on your individual needs and situation.

Your location may determine how you approach a clinician or medical personnel, so it’s important to be aware of any laws or restrictions around pregnancy, miscarriage, and abortion in your area.

Adam England lives in the UK, and his work has appeared in a number of national and international publications. When he’s not working, he’s probably listening to live music.