Efficacy of Adjunctive Use of Letrozole and Misoprostol in the Medical Induction of First Trimester Abortion

Abstract

Background: Misoprostol is not only economical and effective, but it also has less adverse effects and doesn't require special handling  when being used. Patients tolerate this medication well, and it greatly lowers treatment expenses, curettage, and the necessity for surgical intervention.

Objective: This work aimed to compare the use of misoprostol and letrozole in combination versus misoprostol alone for medical  termination of first-trimester abortions.

Patients and methods: This prospective cohort study included 260 patients. This study was  conducted at Menoufia University & El-Sadat Central Hospitals after being approved by the Committee of Medical Ethics. With a GA of age from 6 - ≤ 12 weeks, those who were candidates for abortion were selected and divided into two groups. Group A received 7.5 mg of  Letrozole daily (3 tablets of 2.5 mg) for 3 days before taking Misoprostol and group B received Misoprostol only.

Results: Successful  abortion rate was significantly higher in group A (69.2%) than in group B (57.7%); p=0.0001. There was a significant difference between  the two groups regarding time from induction to abortion as group A has a shorter duration from the start of Misoprostol doses to  complete abortion than group B with mean 6.2±2.18 vs 9.11±1.92 hours respectively (p value 0.001). Also, there was a significant  difference between both groups as regards doses of misoprostol needed for complete abortion as group A needed lower dose of  misoprostol than group B. There was no significant difference between both groups regarding hemoglobin level before and after  abortion or side effects of treatment.

Conclusion: It could be concluded that using 7.5 mg daily Letrozole for three days, followed by  vaginal Misoprostol, leads to a considerably greater rate of complete abortion than misoprostol alone in women with a GA of less than 12 weeks.