'Medical Abortion' Regimen Is Not a Simple One
Sept. 28, 2000 -- It's private and noninvasive, but by no means a single-step way to end a pregnancy. Those are the facts behind the newly approved mifepristone, better known by its experimental designation RU-486.
Women who choose this new form of "medical abortion" will likely find the find the regimen easy to follow and, researchers say, the physical side effects tolerable. But it may not be so easy to find a doctor who prescribes it, a pharmacy that will dispense it, a hospital where a follow-up procedure can be done, and the money to afford it.
The process begins, as with all abortion procedures, with counseling. It's an especially important component in medical abortions, because they take place in two parts, using two different drugs.
"Once you commit to this decision you do need to follow through, because you're taking a drug that is going to harm the fetus," says Kirsten Moore, MS, project director for the Reproductive Health Technology Project in Washington.
The drug she's referring to is mifepristone. It doesn't directly kill the embryo, but instead changes conditions inside the uterus to make further growth of a fertilized egg nearly impossible. "Mifepristone begins to break down the lining of the uterus so the embryo begins to detach from the uterine walls," Moore says.
That causes up to half of women who take the drug to experience vaginal bleeding, says Mitchell Creinin, MD, an associate professor of obstetrics and gynecology at the University of Pittsburgh.
Taken alone, mifepristone induces abortion about 80% of the time, research has found. But its effectiveness jumps to an estimated 95% (some experts believe the rate is even higher) when a second drug, misoprostol, is added two days later.
Medical-abortion regimens require the use of this drug, which ulcer patients have long known as Cytotec. While misoprostol protects the lining of the stomach, it wreaks a small measure of havoc on the uterus. "It causes uterine contractions," Moore says. "And that's when she'll experience bleeding and pain. ... For some it's like a normal period, for some it's closer to a miscarriage."
The Population Council, the New York-based organization that holds the patent on mifepristone, says the bleeding can sometimes linger in a spotty fashion for up to three weeks, and patients may experience nausea, vomiting, and diarrhea, as well. But for most, those side effects will be short-lived.
"Within 24 hours after misoprostol, almost 90% of women have their abortions," says Vicki Saporta, executive director of the National Abortion Federation.
While many abortion providers will probably opt to administer both drugs under office supervision, Moore says some will allow patients to take the misoprostol at home. Suzanne Trupin, MD, medical director of Women's Health Practice in Champaign, Ill., says many patients will abort within four hours of using misoprostol and may be kept in the office for that period of time. If sent home, she says, the patient must be accompanied by someone and should have access to emergency transportation.