Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
160 Doctors are Online

Noticed light cramps and light diarrhoea after taking misoprostol. What to do?

User rating for this question
Very Good
Answered by
Practicing since : 2008
Answered : 689 Questions
Hi. Need your help urgently. I took Misoprostol in the following sequence:
5:00pm - 4 tablets bucally, 2 tablets inserted in vagina
6:30pm - 2 tablets bucally
Local time is now 1:37am, approximately 7 hours and 7 minutes has elapsed since I started. Light cramping and light diarrhea was experienced. No spotting and no bleeding. I desperately need you help. Please advise me what to do.
Posted Mon, 12 Nov 2012 in Women's Health
Answered by Dr. Asra Ishtiaq Ahmed 49 minutes later
hello there..
thanks for writing to us.
What I interpret as that you have taken self medication for abortion. But wanted to know how did you confirm your pregnancy as its important to get an ultrasound abdomen before taking any abortificient. This is because at times pregnancy happens elsewhere than the uterine cavity called as the ectopic pregnancy wherein abortificients fail to induce bleeding.
Now since you have taken the drug , I should say you have taken it in the wrong way as you have used both oral and vaginal routes making an excess of the required dose.
For termination unwanted pregnancy up to 12 completed weeks with Misoprostol alone you have to take it as follows :
vaginally of 800mcg repeated up to 3 times at 6 or 12 hour intervals depending on the bleeding
800mcg orally (sublingual) at 3-hour intervals
The oral use of Misoprostol is better accepted and have the same effectiveness. But side effects like diarrhea, cramping, pain, nausea vomiting are more with oral use.This might be the reason you are having the diarrhea you mentioned.
Bleeding usually starts within 4 to 7 hours after taking the Misoprostol, though it can be as early as an hour or late as 24 hours. It generally lasts 7 to 14 days.
Now since you have not had bleeding , I suggest you see a gynecologist personally. Donot take any further medication on your own. Let her examine you internally. If your cervix is dilated , its probable that you would expel soon. Further intake of misoprostol should depend on your XXXXXXX findings.
In case you have no such findings, you should get an ultrasound done and management further would be decided according to it.

Self medication for abortion can at times be XXXXXXX due to the risks of heavy bleeding, continued bleeding, incomplete abortion and shock .
So please see a gynecologist personally soon. Till then wait for your bleeding to start and do not take any further dose.

take care

Above answer was peer-reviewed by
Follow-up: Noticed light cramps and light diarrhoea after taking misoprostol. What to do? 13 hours later
Dear Dr. Asra,

Thank you for your reply. To update, Local time right now is 4:04 pm.

Total time 14 hours and 31 minutes has elapsed since I started the procedure.

There is still no bleeding but there has been occasional discharge from my vagina. Is this normal? At what point should I expect the bleeding?

Kindly give me detailed point-by-point instructions as what to do. I am very scared of what might happen to me.

Please advise urgently.
Answered by Dr. Asra Ishtiaq Ahmed 51 minutes later
Hello there.

Thanks for writing back.

Bleeding can start as late as 24 hours after the first dose of misoprostol. I am not asking you to take repeat dose as the way you had taken was wrong and took both orally and vaginally, making the total dose at a time to be around 1000ug and repeated the dose within an hour orally.

The regime to take misoprostol was as I mentioned in my previous answer. Proper dose and interval between doses is a must for effective abortion. Ultrasound is a must prior to any abortion procedure. So please do not take any further steps on your own.

You should see a gynaecologist at the earliest. Let her examine you internally to see for any changes of the cervix. If your cervix is dilated and soft, it’s likely you would expel and dose can be given accordingly.

If no such changes are present, you take an ultrasound. Depending on the size and state of pregnancy on the ultrasound, you can start a fresh cycle of misoprostol in the proper dose and interval as recommended for abortion.

But I don’t want you take any self medication. Let your gynaecologist assess you internally and decide further. At times failed medical abortion is taken for surgical evacuation.

Do not delay.

Take care.
Above answer was peer-reviewed by
Follow-up: Noticed light cramps and light diarrhoea after taking misoprostol. What to do? 29 hours later
Dear Dr. Asra,

So I took your advice and went to get a transvaginal ultrasound. Below is the Gynecology Ultrasound Report:

G: 0
CERVIX: meassure 2.9 x 2.6 x 2.4 cm (-) Nabothian cyst
ENDOMETRIUM: measure 0.47 cm
UTERUS: measures 5.1 x 4.7 x 4.1 cm, anteverted
RIGHT OVARY: measures 2.2 x 1.7 x 1.2 cm, normal size and echopattern
LEFT OVARY: measure 2.3 x 1.9 x 1.6 cm, normal size and echopattern
CUL-DE-SAC: no free fluid noted

OTHER FINDINGS: There is a tubular structure superomedial to the left ovary measuring 1.8 x 0.67 x 0.89 cm., with slight tenderness on p[robe manipulation probably representing a dilated segment of the fallopian secondary to an ectopic pregnancy.

IMPRESSION: Normal sized anteverted uterus with thin and intact endometrium normal both ovaries. Complex Structure left as described, consider ectopic pregnancy suggest correlation with beta hcg titers.

Please let me know your feedback regarding this matter. Thanks
Answered by Dr. Asra Ishtiaq Ahmed 1 hour later
Hello there..

Kindly refer to the second line of my first answer to your query stating why ultrasound is a must before any abortion procedure ("This is because at times pregnancy happens elsewhere than the uterine cavity called as the ectopic pregnancy wherein abortificients fail to induce bleeding").

Now please XXXXXXX a gynecologist. NO abortificient helps in ectopic pregnancy. I asked you before also how you confirmed your pregnancy or you did not confirm it all??
If delayed, ectopic pregnancy can land into complications like rupture leading to bleeding inside the abdomen and shock.
I would reiterate that you XXXXXXX a gynecologist now that you have an ultrasound in hand. Complex adnexal mass suggesting ectopic pregnancy has to be confirmed by blood test called beta hcG. Ectopic pregnancy is surgically managed by a laparotomy (opening the abdomen). Very rarely its medically managed.
But misoprostol has no role in ectopic pregnancy.
Do not delay in meeting a gynecologist.
As if you have ectopic pregnancy, its serious and needs early intervention.
All the best and wishing you speedy recovery.
take care.
Above answer was peer-reviewed by
Follow-up: Noticed light cramps and light diarrhoea after taking misoprostol. What to do? 44 hours later
Dear Dr. Asra,

I took your advise and went to see a gynecologist. I told her about my situation (omitting my previous intake of misoprostol as any kind of abortion is punishable in my country) and upon inspection, together with her analysis of the previous Gynecology ultrasound report, it appears to her that what I was experiencing was an ectopic pregnancy. She advised me to get a second ultrasound to get a more recent update on the situation.

So I took her advise and did get this, but the sonologist stated that she did not see or feel anything that would resemble an ectopic pregnancy. Below are the data:

UTERUS: 4.54 x 3.87 x 4.44 cm ANTEVERTED

Compatible with phase of menstrual cycle
Abnormalities noted: There is no sonologic evidence of intrauterine pregnancy at the time of scan

RIGHT OVARY: 3.06 x 1.51 x 2.00 cm
Located: Lateral to the uterus
Comments: Within both ovaries are several small follicles measuring < 1 cm

LEFT OVARY: 2.70 x 1.54 . 2.76 cm
Located: Lateral to the uterus
Comments: within the left ovary is a unilocular cystic structure measuring 1.40 x 1.11 cm, with an echogenic rim , anechoic and demonstrate "ring of fire" on color flow suggestive of corpus luteum

CERVIX: 2.43 x 2.53 x 2.24 cm

OTHERS: very minimal free fluid in the right adnexal area

IMPRESSION: Normal sized anteverted uterus
Thin intact enometrium
Polycystic-like feature both ovaries with corpus luteum on the left
No sonologic evidence of intra nor extrauterine pregnancy noted at the time of scan. Please correlate clinically and with serum B-HCG titers, short interval follow-up scan is suggested to re-evaluate viability if titers suggest pregnancy. Concordance scan was done with another sonologist and both readings show normal gynecologic findings at the time of scan.


I could not understand fully the situation, but what was explained to me was that at the time of scan, there appeared to be no sign of an ectopic pregnancy, but the gynecologist did suggest that based on experience, this was indeed an ectopic pregnancy. What does this all mean? Please help me. I am very afraid for my life and my doctors cannot say without ambiguity what my situation is.

P.S. The gynecologist also mentioned that if B-HCG levels went down, the ectopic pregnancy could be regressing. Is this possible? What are the chances of this happening?

Please help.
Answered by Dr. Asra Ishtiaq Ahmed 1 hour later
Hello there.

I understand your anxiety. If you have missed your periods and your urine test or blood test for Beta hcG is positive, then there has to be pregnancy somewhere. Now both your scans show no intrauterine pregnancy. In both there is an adnexal mass , one of which suggests it to be ectopic pregnancy. Also clinically , missing of periods , pain abdomen and beta hcG positive all indicate it to be ectopic pregnancy. Your second ultrasound shows ring of fire sign on doppler which is also present in ectopic pregnancy. A positive pregnancy test is not possible in corpus luteal cyst.
You have to follow it up with serial serum beta hcG levels. This is because your sonologist is still not sure.
An abnormal rise in blood beta hcG levels may indicate an ectopic pregnancy. The threshold of discrimination of intrauterine pregnancy is around 1500 IU/ml of β-hCG. A high resolution, transvaginal ultrasound showing no intrauterine pregnancy at this level indicates that you have pregnancy elsewhere that is ectopic. You have not mentioned your beta hcG levels.
An empty uterus with levels higher than 1500 IU/ml may be evidence of an ectopic pregnancy, but may also be consistent with an intrauterine pregnancy which is simply too small to be seen on ultrasound. If your are more than 6weeks and still no gestational sac is visualized, it suggests ectopic pregnancy.
Since your diagnosis is uncertain, it may be necessary to wait a few days and repeat the blood levels of beta hcG. This can be done by measuring the beta hCG level approximately 48 hours later and repeating the ultrasound. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy.
Falling levels of beta hcG in ectopic pregnancy could be due to spontaneous abortion or rupture. In this case you can have intra-abdominal bleeding and shock if bleeding is severe. Deteriorating vitals (pulse rate, BP) are indicators of severe bleeding. So your gynecologist is right that falling levels can be due to resorption though its very rare. So you have to be under observation in the hospital in that case.
A laparoscopy or laparotomy can also be performed to visually confirm an ectopic pregnancy. But these are surgical procedures.
The advantage you have is your adnexal mass is very small. Provided you do not have other containdications of medical management of ectopic pregnancy, you can go for it. You can discuss it with your gynecologist and she would let you know the drug and dose. This drug has to be taken in the hospital under supervision and so I cannot mention it here.
You should follow your gynecologist advise rather than the sonologist as she is correlating your things clinically and its she who is going to manage. You should mention her about your self medication with misoprostol. Do not keep anything classified as it may prove detrimental to your health.
Wishing you all the best.
Above answer was peer-reviewed by
Follow-up: Noticed light cramps and light diarrhoea after taking misoprostol. What to do? 15 hours later
Dear Dr. Asra,

Thank you for your reply. As a matter of fact, I just got the results right now from my latest B-HCG test. The result is 2772 mIU/ml, from a previous 1931 mIU/ml taken last thursday, with interval of 6 days in between blood extractions.

You mentioned an "advantage" due to a very small adnexal mass. Can you please explain what my options are because of this advantage?

To be honest, I want to be treated as an out-patient as much as possible, possibly without having to go through surgery because I don't want my parents to know about this. What option would be the quickest for me in this case?

Will wait for your advise. Thank you
Answered by Dr. Asra Ishtiaq Ahmed 2 hours later
Hello there.

Your beta hcG report is beyond the discriminatory level of 1500mIU/ml. At this level if there was an intrauterine pregnancy , it would be seen on scan. But since there is no visualization of intrauterine pregnancy , it suggests that adnexal mass is an ectopic pregnancy. This is because positive beta hcG is seen in ectopic alone and not in corpus luteal cyst.
Your management has to be under supervision of a doctor , be it medically or surgically. The medical management can be used to in small size mass (<3.5cm)with no heart beat and there should be no associated renal or liver disease. Although there is an advantage of the size in your case but medical management has a failure rate too. Once failed, it has to be treated surgically. You cannot take treatment as an outpatient in ectopic pregnancy. You have to be monitored even under medical management. Surgical management can be laparoscopically or by open surgery (laparotomy)
Quickest option would be go to your gynecologist and do what she says. Get yourself admitted and get the right treatment at the right time before you land into any complications. Your diagnosis and managment would be best made and clear only when you confide in your doctor.You tell everything to your gynecologist and let her decide if she can keep your parents unaware about it.

Wishing you all the best.
Please do not delay and do not take any more decisions on your own.
Follow your doctor's advice.

take care.
Above answer was peer-reviewed by
Follow-up: Noticed light cramps and light diarrhoea after taking misoprostol. What to do? 6 days later
Dear Dr. Asra,

Just to update, I will be undergoing a XXXXXXX laparotomy to take care of my ectopic pregnancy. One question I have, will my previous smoking habit be a cause of concern? I used to smoke for about a year, until February 12,2012. Ever since then, I have not have a single stick of cigarette.

Kindly advise.

Answered by Dr. Asra Ishtiaq Ahmed 3 hours later

Thanks for writing back. Its really good to hear from you again.

Smoking is no doubt INJURIOUS to health.
Women smokers have the risks of early menopause, infertility, cervical cancer, osteoporosis, lung cancer and heart disease
Cigarette smoking has an independent and dose related effect on the risk of ectopic pregnancy. It affects the motility of fallopian tube by damaging the ciliary action of the tube which leads to failure of movement of the egg to the uterus. This promotes the pregnancy to remain in the tube and hence ectopic pregnancy.
Also if you continue to smoke after your surgery, it would stress your body and can impair healing of tissues.
Past history of smoking affecting your surgery depends on how much your lungs and heart have been damaged by smoking. If you get fitness for surgery by anaesthesia doctors, you need not worry.
Its good that you have quit smoking.

Wishing you all the best for your surgery. I pray and hope that you recover soon.

Take care.
Above answer was peer-reviewed by
Share on Facebook
Share on Twitter
Share on Google+
Question is related to
Diseases and Conditions
Medical Procedures

The user accepted the expert's answer

Ask an OBGYN

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor