Background: It is essential to ascertain and diagnose the optimal ‎treatment protocol for medical abortion. Consequently, it is necessary to ‎evaluate the efficacy of combining letrozole with misoprostol compared ‎to the administration of misoprostol alone in the termination of missed ‎abortions occurring in the first trimester. Methods: The study was done ‎on a total of 88 patients; Group A consisted of a total of 44 individuals ‎who were administered a combination of Letrozole and Misoprostol. A ‎pre-treatment regimen consisting of 5 mg of letrozole administered ‎every 12 hours for a duration of three consecutive days was ‎administered. This was followed by the administration of four tablets of ‎vaginal misoprostol, each containing 200mcg of the active ingredient. ‎An additional dose of misoprostol was administered after a period of ‎three hours, if deemed necessary. Group B consisted of 44 patients who ‎were administered "Misoprostol." A single tablet of folic acid was ‎administered as a placebo every 12 hours for three consecutive days in a ‎home setting, followed by the administration of four tablets of vaginal ‎misoprostol (200mcg). Results: The results indicate that 70.4% of the ‎studied women in Group A experienced complete abortion, whereas ‎‎63.6% of the studied women in Group B achieved the same outcome. ‎Group A had a reduced length from induction to abortion in contrast to ‎Group B, as well as a lower requirement for curettage when compared to ‎Group B (6.8% against 9.1%, respectively). Conclusion: letrozole ‎pretreatment with misoprostol increase the effectiveness of misoprostol ‎without increase side effects.‎