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Medically terminating a pregnancy during breastfeeding

Published Last updated See all updates
Topics: GemeprostMifepristoneMisoprostol · Reproductive healthSafety in Breastfeeding ·

Breastfeeding can be continued following short term treatment with mifepristone and misoprostol. Recommendations apply to full term and healthy infants.

Contents

  1. General considerations
  2. Recommendations
  3. Specific recommendations
    1. Mifepristone
    2. Misoprostol
  5. Patient Information
  6. Contact us
  7. About our recommendations
  8. Bibliography
  9. Update history

General considerations

It is important to complete an individual risk assessment (SPS page) for your patient and to apply the principles of prescribing in breastfeeding (SPS page) when looking at the available information and making treatment decisions.

Recommendations

Mifepristone and misoprostol are recommended for medical termination of pregnancy (abortion). They are often given as single doses, with mifepristone being administered first, followed by misoprostol; although further doses of misoprostol may be required.

As there are negligible amounts for each medicine found in breast milk and the risk of accumulation in the infant is minimal, they are considered compatible with breast feeding.

There are no data on the direct effect of mifepristone or misoprostol on the lactation process.

Gemeprost is no longer routinely recommended.

Specific recommendations

Use with caution

Mifepristone can be used during breastfeeding due to negligible levels in milk.

Infant monitoring

As a precaution, monitor the infant for nausea, vomiting, diarrhoea and poor feeding.

Further information

Limited data suggest that the levels of mifepristone in milk are negligible when single doses of up to 600mg have been administered. Breastfeeding can continue in an uninterrupted manner during medical termination.

No side effects have been reported for infants after exposure to mifepristone via breast milk.

Use with caution

Misoprostol can be used during breastfeeding due to negligible levels in milk.

Infant monitoring

As a precaution, monitor the infant for nausea, vomiting, diarrhoea and poor feeding.

Further information

Oral misoprostol is excreted into breast milk in negligible to very small amounts when doses up to 600micrograms have been administered, which are rapidly eliminated.

Although there is no evidence for vaginal or rectal administration, similar low levels are anticipated in breast milk.

No interruption of breastfeeding is necessary when misoprostol is given by any route, or if repeated doses are required in the short term.

No side effects have been reported for infants after exposure to misoprostol via breast milk.

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS) (SPS page), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.

Update history

  1. Amendment to misoprostol dose
  1. Published