The Abortion Pill:
Medical Abortion with Mifepristone and Misoprostol

What is the Medical Abortion?

Medical Abortion (brand name Mifeprex) is a form of early abortion caused by the combination of two medications, mifepristone and misoprostol that is an option for women who are 8 weeks pregnant or less. Also known as RU486 or medication abortion.

During the first appointment at the clinic you receive the mifepristone pill to take orally. Then 24 to 72 hours later, in the privacy of your own home, you take the the second medication, misoprostol. Misoprostol causes contractions resulting in a miscarriage. When used in combination, mifepristone and misoprostol are 95-97% effective within two weeks. Mifepristone and misoprostol are FDA approved.

How Does It Work?

Mifepristone blocks the hormone progesterone needed to maintain the pregnancy. Because this hormone is blocked, the uterine lining begins to shed, the cervix begins to soften and bleeding may occur. With the later addition of the second medication, misoprostol, the uterus contracts and the pregnancy is usually expelled within 6 to 8 hours.

Because the woman chooses when she takes the second medication within the time frame of 24 to 72 hours after the first medication, she has some control over the timing of when she expels the pregnancy and experiences the side effects of bleeding and cramping. Some women choose the Medical Abortion because of the privacy it offers. Some women feel empowered by taking an active role in the process.

Use

At your first appointment at the clinic, an ultrasound is performed to confirm you are less than 8 weeks pregnant. You then speak with an experienced counselor who explains how mifepristone and misoprostol work and makes sure you get answers to all of your questions. Your health history is carefully reviewed and if you meet the criteria, the doctor will give you the mifepristone to take orally. You are also given one bottle containing four tablets of misoprostol to be used 24 to 72 hours after taking mifepristone. If this first dosage fails to induce a miscarriage, please call the clinic to receive instructions on using your back-up misoprostol tablets.

What To Expect

Upon taking mifepristone at the clinic you may begin to bleed. As each woman's body is different, bleeding varies from woman to woman. Some may experience light bleeding much like spotting towards the end of a menstrual period. Others have heavier bleeding like their regular menstrual period, or like a heavy period. Some women do not experience any bleeding until taking the misoprostol.

Upon taking the second medication misoprostol tablet, cramping, bleeding, and clotting may begin as soon as 20 minutes. Within the next 6 to 8 hours, most women will miscarry. Cramping may come in waves with increasing and decreasing intensity. You can expect bleeding heavier than a menstrual period with large clots. During this time, you will pass the embryo although you may not see it since it is very small. The amount of bleeding when using the Medical Abortion is greater than with aspiration abortion.

Aftercare

A follow-up exam is scheduled for two weeks later to make sure the process is complete. If you have not yet miscarried, we will perform a aspiration abortion. A very small percentage (5%) of women do not pass the pregnancy tissue and need a suction procedure to complete the process.

Side Effects

Most of the side effects when using this early abortion option are caused by the second medication, misoprostol. Side-effects may include heavy bleeding, headache, nausea, vomiting, diarrhea, and heavy cramping.

Risks

Vaginal bleeding with medical abortion could be extremely heavy. In rare situations it could require a aspiration abortion and very rarely, a blood transfusion. You will be given our 24-hour hotline number to call if you have any problems. Medical staff are on call at all times to answer your medical questions and concerns.

If pregnancy is continued after taking these medications, there is a high risk of fetal deformities.

Criteria

Abortion Medication may be an option if you:

• Are less than 8 weeks since your last menstrual period.
• Are willing and able to give informed consent.
• Have the support you need such as access to reliable transportation and ability to communicate with the clinic by telephone.
• Live no more than 2 hours away from emergency medical care (a hospital).
• Are able to come back to the clinic for 1 to 3 follow-up appointments.
• Agree to have a surgical abortion if the misoprostol does not induce termination.

Your Health

Due to the risk of serious health problems, mifepristone and misoprostol may not be recommended if you:

• Have had a blood clotting problem or are taking anticoagulant medicine.
• Have severe anemia.
• Have adrenal failure.
• Are taking long-term systemic corticosteroids.
• May have an ectopic pregnancy.
• Have a mass in the tubes or ovaries.
• Have inherited porphyria.
• Have an allergy to mifepristone, misoprostol or other prostaglandin medicine.
• Have severe diarrhea.

Future Fertility

According to studies of the FDA (Food and Drug Administration) and the National Abortion Federation, there are no known long term risks associated with using mifepristone and misoprostol. Therefore, women may pursue another pregnancy whenever they feel the time is right after having a Medical Abortion.

Other Options For Early Abortion

If you are at least 6 weeks by ultrasound, you can choose to have a surgical abortion, in which the cervix is dilated and suction aspiration is used to remove the tiny pregnancy.

No Confusion

Do not confuse Medical Abortion with the "Morning After" Emergency Contraception Pills (brand name Plan B). They are completely different medications taken for different purposes.

• Emergency Contraception Plan B contains the same hormones as in regular birth control pills; Plan B prevents pregnancy after sex when taken within days after unprotected intercourse. Emergency Contraception will not harm an existing pregnancy. You can get Plan B Emergency Contraception at your local pharmacy. You don't need a prescription if you are 17 or older. If you are under 17 you need a prescription but in Washington State you can get the prescription right at the pharmacy: call ahead to check if they have a trained prescriber on shift.
• The Abortion Pill Mifeprex is ONLY sold to physicians. (You cannot get it at a pharmacy in the USA.) A physician or nurse-practition will first make sure that you are pregnant, that you want an abortion, that you understand how to take care of yourself and what to expect during the medical abortion, and then will give you the Abortion Pill which causes the pregnancy to end.

more:

• Comparison of Medical and Surgical Abortion
• 10 Facts You Must Know about Non-Surgical Abortion - published by AlterNet
• On Their Own Terms - by Anna Quindlen
• www.womenonweb.org - will mail medications to women in countries where abortion is legally restricted (run by Rebecca Gomperts of Women on Waves)
• Gynuity - http://www.gynuity.org/ - Instructions for Use of Misoprostol for Women's Health in Arabic, English, French, Portuguese, Russian and Spanish
• www.medicationabortion.com - In English, French, Spanish and Arabic - a multi-language website provides accurate information about medication abortion to health service providers including physicians, nurse practitioners, physician assistants, counselors, and office staff as well as educational information for women considering the option of medication abortion. Sponsored by Ibis.
• http://www.prochoice.org/education/cme/online_cme/default.asp
• Feminist Majority Foundation's info on RU 486.
• UCSF - University of CA at San Francisco patient education page - medical vs surgical abortion

last update: October 19, 2010

The life of a fetus cannot be separated from the life of the pregnant woman. This is unique in medicine and law. No one can create a set of medical principles or legal principles giving a right to life to the fetus, because by doing so, inevitably the woman's rights become limited.

Feminist Women's Health Center