To the Editor: Since my article on medical abortion was published in the Journal,1 I have received some information from colleagues, and from women who have undergone abortions, about the current practice of medical abortion in Australia. I believe this may be of interest to readers of the MJA.

More than a dozen practitioners have informed me that they have used misoprostol or methotrexate/misoprostol combinations to induce early abortion (before 9 weeks’ gestation) outside of hospitals, and a number of women have reported undergoing such abortions. The number of cases involved in this anecdotal sample is at least several hundred annually.

Induced abortion using methotrexate/misoprostol was practised in the United States up until the introduction there of mifepristone/misoprostol regimens in 2000.2,3 There is wide experience of this drug combination reported in the medical literature, and the consensus is that, in the short term at least, it is safe and effective, although less effective than the mifepristone/misoprostol combination.2-4 Both drugs are licensed for purposes other than abortion in Australia, as elsewhere (misoprostol for treatment of gastric ulceration; methotrexate as a cytotoxic agent, and for psoriasis and rheumatoid arthritis), but the use of drugs “off-label” is an acknowledged medical practice.5 Misoprostol in particular is widely used in obstetrics for cervical ripening and treatment of postpartum haemorrhage.5

These early abortions take place “under the radar” in the sense that there is no specific Medicare item number; the administration of the drugs occurs in the course of a standard consultation. There is nothing irregular about this, but it does mean that the inaccurate data we currently have on the number of abortions performed in Australia are even more inaccurate than initially thought. It should be noted also that misoprostol alone or in combination with other prostaglandins is being used in Australian hospitals, as overseas, in a more evident manner for the induction of late abortion in cases of severe fetal abnormality detected after 13 weeks’ gestation.5 As well, methotrexate is commonly used in the treatment of early, unruptured ectopic pregnancy, in doses well below those used in oncology.

The communications I have received on the subject lead me to believe that medical abortion is currently extensively practised in Australia.