http://www.isad.org More on Mifepristone or Mifegyn ®

Mifepristone (or RU-486) is a newer medication that was developed and tested specifically as an abortion inducing agent. It has been used by over 500.000 women in Europe and millions of women worldwide, especially in China.

Mifepristone is taken in the form of a pill. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy. Without this hormone, the lining of the uterus breaks down and bleeding begins.

A few days after taking mifepristone, a second drug misoprostol, is taken. Misoprostol tablets of 200mcg each, can be taken buccally, orally or put into the vagina, cause the uterus to contract and empty. This ends the pregnancy.

Medical abortion can take anywhere from 3 days to 3-4 weeks, and requires a minimum of two visits to the clinic or medical office. These return visits are very important since there is no other way to be sure that the abortion has been completed. With mifepristone, 95-97% of women will abort within two weeks, if the antiprogesteron is combined with misoprostol. About 1 in 20 women who try medical abortion will need to have a surgical abortion anyway, because the medication does not work for her.

Some women will have vaginal bleeding after the mifepristone. This bleeding may be light, or it may be like a heavy period. The abortion provider may have the woman stay at the clinic for several hours after taking the second drug (misoprostol). The uterine contractions caused by this medication may lead to immediate cramping that will expel the embryo, thus ending the pregnancy. A high proportion of women, however, will expel the uterine contents later, after they have left the medical facility. Many women insert the misoprostol at home and pass the tissue later. A woman considering medical abortion will need to be prepared for this possibility. The clinic staff can answer questions about what to expect.

The most common side effects of medical abortion are caused by misoprostol. The side effects may include: cramps similar to those with a heavy menstrual period, headache, nausea, vomiting and diarrhea. When the abortion is completed heavy bleeding can be controled by taking a 200 mcg misoprostol tablet every six hours for three days.

The amount of bleeding that a woman has will be greater with medical abortion than with surgical abortion. Most women have cramps for several hours, and many pass blood clots as they are aborting. In some cases, the blood clots will be larger than the embryo and other tissue from the pregnancy which will also be passed, and the embryo will probably not be seen among the blood clots. For example, at 49 days LMP, the size of the embryo will be about one-fifth of an inch. In an earlier pregnancy, it might be much smaller than that. Cramps and bleeding usually begin to ease after the embryonic tissue has been passed, but bleeding may last for one to two weeks after medical abortion.

DANCO, the distributor of mifepristone in the US who buys chinese Mifepristone for 1 $ a tablet and sells them for 60 $$ gives the following warning for doctors in the hospitals emergency departments: "Vaginal Bleeding Vaginal bleeding occurs in almost all patients during the treatment procedure According to data from the U.S. and French trials, women should expect to experience vaginal bleeding or spotting for an average of nine to 16 days, while up to 8% of all subjects may experience some type of bleeding for 30 days or more. Prolonged heavy bleeding (soaking through two thick full-size sanitary pads perhour for two consecutive hours) may be a sign of incomplete abortion or other complications and prompt medical or surgical intervention may be needed to prevent the development of hypovolemic shock. Patients should be counseled to seekimmediate medical attention if they experience prolonged heavy vaginal bleeding following a medical abortion. Excessive vaginal bleeding usually requires treatment by uterotonics, vasoconstrictor drugs, curettage, administration of saline infusions, and/or blood transfusions."

Some women report that their first regular menstrual period after a medical abortion is heavier, or longer, or in some other way different from normal for them. By the second period after the abortion, their cycles should be back to normal.

Possible Complications

Medical abortion is irreversible once the mifepristone has been taken. Deciding to continue the pregnancy to term is not an option at any point after taking the first medication. If the embryo is not expelled after using these medications, a suction procedure (surgical abortion) must be done to empty the uterus and complete the abortion.

The most common immediate complication of a medical abortion is heavy bleeding. For this reason, a woman must have access to a telephone and transportation in case emergency treatment is needed. Rarely, just like with surgical abortion, treatment for very heavy bleeding might require a D & C or a blood transfusion.

There do not appear to be any long-term complications associated with use of these drugs to induce a medical abortion.

 Follow-up Care

 Because there is no way to know for sure that the abortion is complete without an examination by a health care professional, keeping appointments with the clinic for follow-up care is very important! In addition, a woman must report any problems she has during the medical abortion to a health care professional.

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reviewed 12-8-2005