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.
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
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
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
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.
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.
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.
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
- Agree to have a surgical abortion if the misoprostol does
not induce termination.
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
- 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
- Have severe diarrhea.
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.
Do not confuse Medical Abortion with the "Morning After" Emergency Contraception
Pills (brand name Plan B). They are completely different medications taken for
- 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.
- 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
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.
Majority Foundation's info on RU 486.
- UCSF - University of CA at San Francisco patient education page - medical vs surgical abortion
October 19, 2010
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