Letrozole and misoprostol for early pregnancy loss: A pilot prospective cohort study
Awarded 2024
Uta Landy Complex Family Planning Scholars
Melissa Montoya, MD, MA
University of Pennsylvania

I am a first-year Complex Family Planning fellow at the University of Pennsylvania. I was raised in the Los Angeles area and obtained my undergraduate degree from Stanford University where I majored in Human Biology. I subsequently received my medical degree from Northwestern University Feinberg School of Medicine, where I also earned a master’s in bioethics and medical humanities. I then completed my obstetrics and gynecology residency at Duke University. In addition to pursuing sub-specialization in complex family planning, I am also obtaining my master’s degree in health policy at the University of Pennsylvania. My research interests include exploring how health policy impacts abortion access and care for underserved, marginalized communities. The politicization of abortion has resulted in policies and regulatory practices that are incongruent with existing evidence. This is exemplified by the unnecessary restrictions impacting the routine use of mifepristone for both abortion care and miscarriage management. Access to mifepristone is further threatened by restrictive abortion legislation and is currently being disputed in the Supreme Court of the US. Recent studies have identified letrozole, an aromatase inhibitor, as a potentially safe and accessible candidate to replace mifepristone; however, estimates of efficacy for uterine emptying vary. To date, no studies have been conducted in the US assessing letrozole plus misoprostol for treatment of early pregnancy loss (EPL). We propose a pilot prospective cohort study to generate preliminary data on the combination regimen of letrozole followed by misoprostol for medical management of EPL.