Sunday, June 7, 2009

Mifepristone (RU486), the medical abortion pill

Go to Health – Mifepristone – the Medical Abortion pill – RU486
Women have been using herbs, poisons, soap solutions, sticks and pointed roots for millennia to try to get rid of an unwanted pregnancy. Illegal, unsafe abortion is a nightmare for women and their health-care providers. Surgical abortion, legal in the US since 1973 (since 1969 in California) has made the process safe, effective and much less traumatic.

In the 1980’s, French doctors began to work on a pill that would induce abortion – it was licensed there in 1988 and called RU486, or mifepristone (Mfp). In the US, it underwent clinical trials in the 1990’s and was approved in 2000. It is legal and available in all 50 states, Washington D.C., Guam and Puerto Rico.

Medical abortion with Mfp can be used as soon as a woman confirms that she is pregnant, and up to 8-9 weeks from the beginning of her last menstrual period. It is most effective if done early. The pills are effective about 95% of the time. In 3% to 5% of cases women will need a suction abortion due to continued pregnancy, prolonged or excessive bleeding.

Mfp works by blocking the action of progesterone, a hormone needed for the continuation of pregnancy. After taking the Mfp pills, in a clinic or doctor’s office, the woman is given a medicine called misoprostol (MSP) to use in a few days. MSP is taken by mouth or inserted into the vagina – clinics differ in their instructions on this. It causes the uterus to contract and expel the pregnancy, often with bleeding that resembles a heavy, crampy period. Infection is a rare side effect of medical and surgical abortions. Women should always be under the care of their clinic or doctor while undergoing an abortion and should follow instructions carefully.

The University of California San Francisco has a helpful website explaining the procedure and comparing medical and surgical abortions:

Medical Abortion with Mfp is legal throughout Europe (not in Ireland and Poland), and in many Asian countries including India, China, Vietnam and Japan. In Africa, only South Africa and Tunisia allow abortions. In Latin America abortion is legal only in Cuba and Mexico City. The World Health Organization estimates that 21% of all pregnancies in Latin America end in unsafe abortions. MSP, which causes strong uterine contractions, is available over the counter in many areas, sold as Cytotec, a drug designed for preventing stomach ulcers. It is widely used – without Mfp - by women seeking abortion, with very little information on how to use it or handle problems of heavy bleeding, cramping or infection.

The recent murder of Dr George Tiller, a doctor who performed late abortions in Kansas, is a terrible reminder of the passions on both sides of the abortion debate. I had an abortion when it was illegal in this country; I took care of women after illegal abortions, and I performed many thousands of legal procedures. My conclusions – keep it safe and legal; remember contraception.
Sadja Greenwood, MD


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