Objective: To report the management of an early pregnancy with a large myomatous uterus. Case Report: A 34-year-old woman, with an unwanted pregnancy of 6 weeks' gestation and a large myomatous uterus, desired to terminate her pregnancy. She was first given three tablets of mifepristone 200 mg and three tablets of misoprostol 200 μg 48 hours later. However, this regimen did not produce an abortion, so five tablets of misoprostol 200 μg were placed into the posterior fornix of the vagina. The abortion was thus completed by the vaginal administration of 1,000 μg of misoprostol. Conclusion: Supplementary use of high-dose vaginal misoprostol may be considered as an alternative to terminate an early pregnancy in association with a myomatous uterus when the conventional combination of mifepristone and misoprostol fails.