Abortion Pill

Mifepristone, also known as RU486 or ‘the abortion pill’, is a drug that induces miscarriage if taken in the first three months of pregnancy. It can also be used as emergency contraception following unprotected sex. RU486 offers a safe, reliable and non-surgical means of abortion.

RU486 is not currently available in Australia for the purposes of inducing abortion. It is available in about 33 countries, mainly in Europe.

Most abortions in Australia are performed using what is called suction aspiration. The woman’s cervix is dilated (stretched open) and a tube is inserted into the uterus to vacuum out the foetus and placenta. Afterwards the uterus is scraped with a special instrument (curette) to make sure that no products of conception remain. This is known as a ‘surgical abortion’.

RU486 explained
RU486 can be used to induce abortion in pregnancies that are about nine weeks or less. A successful pregnancy needs high levels of the hormone progesterone. RU486 works by blocking the action of progesterone.

In some cases, RU486 can be taken by itself. The woman can go home from the doctor’s surgery or clinic about one hour after swallowing the pill. It is important that she have a telephone at home so that she can contact the doctor or medical staff if needed.

In most cases, RU486 is supplemented with another drug, prostaglandin (to soften the cervix and help the uterus contract). About two days after the RU486 tablet is swallowed, the woman returns to the clinic and the doctor administers prostaglandin. This may be taken orally or suppositories may be inserted into the vagina.

What to expect
The doctor gives the woman a pregnancy test and a physical examination. A review of her medical history helps the doctor to decide if the woman is a suitable candidate for RU486. Counselling is offered. The woman signs a consent form. The woman is given the RU486 pill in the doctor’s office or clinic and must wait at least one hour before going home. The woman will typically experience:

* Feelings of queasiness or faintness for a short time
* Vaginal bleeding after about 12 hours
* Bleeding and cramping similar to a bad period – women who usually experience painful periods are more likely to have severe cramping
* Headache, dizziness, nausea, diarrhoea and chills (these may be experienced by some women who require the additional treatment with prostaglandin).

Taking care of yourself at home
Pads rather than tampons should be used. Over-the-counter paracetamol should be enough to manage the cramps – if not, the doctor may prescribe pain-killing drugs.

It is important not to smoke, drink alcohol or use herbal supplements or illegal drugs for at least 48 hours after the procedure. Women should avoid sex for about two weeks to reduce the risk of infection. Follow-up appointments with the doctor or clinic should be kept. The doctor may give the woman blood tests or other tests (such as ultrasound) to make sure that all products of conception have been passed.

Some women should not take RU486
RU486 isn’t recommended for all women who would like an abortion. The procedure may be unsuitable for:

* Smokers aged 35 years or older
* Women with certain medical conditions such as heart disease, asthma, diabetes, bleeding problems or hypertension
* Patients taking long-term steroid medications or blood-thinning medications
* Ectopic pregnancy
* Pregnancies more than about nine weeks gestation
* Women who have experienced prior allergic reactions to drugs containing mifepristone
* Women fitted with an intra-uterine device (the IUD must be surgically removed before taking RU486).

Advantages of RU486
The World Health Organization (WHO) believes that RU486 is an important treatment that should be made available to women in developing countries. Some of the advantages of RU486 include:

* About 95 women out of every 100 who take RU486 in the first nine weeks of pregnancy achieve a complete abortion.
* Unlike a surgical abortion, a sterile operating environment is not necessary. The risk of infection is very small.
* The risk of maternal death is extremely low.
* RU486 is a cheaper, less invasive option than surgical abortion.
* Anaesthesia is not needed.
* RU486 does not require the services of a skilled surgeon, unlike surgical abortion. This makes it an attractive alternative for women living in remote areas.
* Most women don’t need pain-killing drugs.
* Women who have used RU486 say that it is less stressful, clinical and emotionally charged than surgical abortion.
* Most women who use RU486 successfully abort without complications. No further medical or surgical treatment is needed.

Disadvantages of RU486
Disadvantages include:

* Bleeding may go on for weeks in some cases. The woman should seek advice from her doctor if the vaginal bleeding does not stop within a few days of the procedure.
* In about one woman in every 300, the bleeding is heavy enough to require medical intervention. A surgical abortion and sometimes a blood transfusion may need to be performed.
* Rarely, a woman may develop an infection. This can be treated with antibiotics. In a few cases, infection has been fatal. It should be remembered, however, that there is a small risk of death in any pregnancy.
* The pill does not work for about five women out of every 100 who take RU486. A surgical abortion is needed.
* RU486 can take days to work. A surgical abortion only takes about 15 minutes.
* If the administration of RU486 doesn’t work, and the woman changes her mind and decides to go ahead with the pregnancy, the baby is at increased risk of birth defects.

Where to get help

* Your doctor
* Family Planning Victoria
* Women’s health centre

Things to remember

* RU486 is an oral pill that induces medical abortion by blocking the action of the pregnancy hormone progesterone.
* RU486 offers a safe, reliable and non-surgical means of abortion but is not currently available in Australia for the purposes of abortion.
* RU486 isn’t recommended for all women seeking abortion.