Reproductive Choice / Abortion

Medical Abortion: The “abortion pill”

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Medical Abortions (RU486, Mifepristone – “The Abortion Pill”) – conception to 63 days

In 2000 the FDA approved the so-called abortion pill—mifepristone–for use in the United States.  Since then, many women have undergone successful medically-induced abortion.  Here are some frequently asked questions about medical abortion.

What is a medical abortion?

A medical abortion is a two-step procedure. In the first step, a medication called mifepristone (Mifeprex), is taken. Mifepristone causes the demise of the embryo/fetus that is less than 7 weeks old—49 days from your last menstrual period.  Following this, a second medication, misoprostol (Cytotec), is taken sometime during the following day. Misoprostol causes uterine contractions and allows all pregnancy-related tissues from the uterus to be passed.

Why do some womPretty Pink Flowers - Medical Abortionen choose medical abortion?

Women choose a medical abortion for a variety of reasons.  Women often prefer that their “procedure” can be carried out in the privacy of their home.  Some women prefer that medical abortion allows a “miscarriage” rather than a physician intervening with an “invasive” surgical procedure.  There is the perception that medical abortion is less painful—this is a complex issue and will be explained below.  In other cases women feel that the use of medications put them in greater control and prefer it for that reason.

Is mifepristone (Mifeprex)—the abortion pill–safe?

Mifepristone (Mifeprex) had been extensively studied in China and in Europe before it was licensed by the FDA in 2000.  The FDA allows its use during the first 7 weeks of pregnancy — 49 days since the first day of your last menstrual period.  To date millions of women have used mifepristone (Mifeprex) and from all the evidence that’s been collected it appears to be extremely safe.

How does mifepristone work?

Mifepristone works by interfering with the hormone progesterone.  Progesterone promotes the growth of the uterine lining tissue which is necessary to sustain the embryo and fetus throughout its development.  When the hormone is medically-blocked a medically-induced miscarriage occurs.

How is mifepristone administered?

Mifepristone is generally given as a single tablet that will be dispensed in our office.

What about the second medication used in medical abortion?  What is misoprostol?

Misoprostol (Cytotec) is a prostaglandin. Misoprostol acts to soften the cervix and also causes uterine contractions that expel the early pregnancy.  A woman considering medical abortion must understand that is this medication that causes most of the undesirable side-effects including cramping and bleeding.  Other side effects may include headaches, nausea, vomiting, diarrhea, fever, chills or fatigue.  Most of these symptoms only last a few hours before they subside.  If you have a fever that lasts more than 24 hours you should call us immediately.

How is misoprostol administered?

Pretty Pink Flowers - Medical Abortion

Misoprostol is supplied in tablet form—each one containing 200 micrograms of the drug.  You will be asked to take 4 of them and insert them in the vagina sometime the following day.  Your health care provider will review the instructions for insertion with you.

How effective is the combination of mifepristone and misoprostol?

95% of women who are less than 49 days pregnant (from the last menstrual period) and receive this two-drug combination will have a complete abortion. About 1% will have ongoing pregnancies and 4% will require an additional surgical procedure to manage retained tissue.  This is generally managed with a suction curettage—which is a minor surgical procedure.  The failure rate between 49 and 63 days is slightly greater.

Are there women that should absolutely not take the mifepristone and misoprostol?

Certain women should not take this two-drug regimen. They include women with an allergy to either of these medications, women who use steroids, have bleeding disorders, or who are taking anticoagulants (blood thinners). Other contraindications include women with porphyria or pregnancies that are greater than 63 days. You should be aware that the FDA has only approved this drug for use in pregnancies less than 49 days. Our experience suggests that it can be safely used on properly screened women until 63 days. Women with ectopic (tubal) pregnancies cannot take mifepristone.

What are the advantages of a medical abortion?

Mifepristone requires no anesthesia, no mechanical dilation, and no use of suction to accomplish an abortion. The abortion happens in the privacy of your own home.

Is a medical abortion painful?

Medically-induced abortion cause uncomfortable uterine cramps in some women and relatively severe contraction-like pain in others.  This varies from one woman to the next and depends on a number of factors including gestational age (number of days since your last menstrual period), anxiety and a history of painful periods.  This issue of abortion-related pain is definitely something you will wish to discuss with your health care provider.  You will be supplied with a prescription for pain medication.

Are there disadvantages of a medical abortion?

As we mentioned, the failure rate is about 5% during the first 7 weeks of pregnancy. This is significantly greater than with than with surgical abortion.

Contrary to what most women believe, “the abortion pill” is not the most painless way to terminate a pregnancy.  Unfortunately with a   With the mifepristone and misoprostol regimen, the most painful part occurs while you’re at home – away from a doctor’s care. During a surgical abortion, a short-acting sedative/hypnotic and a narcotic can be given intravenously to make the procedure completely painless.

With mifepristone, the actual abortion occurs 1-2 days after you take it.  In some cases a medical abortion can take up to a week.  However, the majority of medically-induced abortions occur within 24 hours. By contrast, surgical abortions take several minutes to complete.  When you leave the office your procedure is complete.

With surgical abortions, the heaviest vaginal bleeding occurs in a physician’s office, while you are under observation. With mifepristone and misoprostol, the heaviest vaginal bleeding occurs when you’re at home.

How does the “abortion pill” compare to surgical abortion for pregnancies less than 63 days?

Comparison of Medical versus Surgical Abortion

Surgical Medical
Where it occurs Doctor’s office Home
Failure rate Less than 1%* 1%*
Length of time 5 minutes 1-7 days
When pain occurs During the procedure 1-7 days after misoprostol
Risk of perforation Less than 1/5000 None
Risk of infection 1% 1%

*In a small percentage of cases (4%) both medical and surgical abortions may require a re-suction procedure to remove retained products of conception.

In addition, there are women who undergo both medical and surgical abortion that will require a suction procedure for tissue which did not pass spontaneously.  This is called “retained tissue” and should be addressed with your health care provider.

Summary

The decision to terminate a pregnancy is a difficult and often heart-wrenching one.  Consider your options carefully and definitely consult with one our health care providers.  By clearly communicating your needs we can generally offer you a wealth of insight and advice.