The Abortion Pill

THE ABORTION PILL

What is the Abortion Pill (Mifepristone, RU- 486)?

The Abortion Pill, otherwise known as Mifepristone (U.S. trade name: Mifeprex) ⁽¹⁾ or RU-486, is a medical or drug induced alternative to surgical or vacuum aspiration abortion for women who elect to terminate an early pregnancy. ⁽²⁾

Two drugs are commonly used for medical abortion; the most effective regimen is the combination of Mifepristone and Misoprostol. ⁽³⁾

The first drug, mifepristone, inhibits and blocks the essential reproductive hormone progesterone that plays a critical role for the initiation and maintenance of pregnancy. ⁽⁴⁾

Mifepristone (U.S. trade name: Mifeprex) Tablets

Mifepristone blocks the hormone progesterone by interrupting pregnancy development and prompting the detachment of the implanted embryo.

Mifepristone terminates pregnancy by initiating endometrial erosion that causes the developing placenta and embryo to detach from the lining of the uterus. ⁽⁵⁾

The second drug, misoprostol, taken two days after the Mifepristone, causes dilation of the cervix and increases the frequency and strength of uterine contractions needed to expel the embryo and pregnancy tissue. ⁽⁵⁾

 Misoprostol (U.S. trade name: Cytotec) Tablets

Misoprostol stimulates uterine contractions to expel the embryo and placental tissue.

MIFEPRISTONE USE IN THE UNITED STATES

Mifepristone medical abortion is rapidly growing in the United States

Approximately 62% of all abortions occur in the first 9 weeks of pregnancy (from a woman’s last menstrual period). According to a 2008 report: ⁽⁶⁾

• Medical abortion (mifepristone) accounted for 17 % of all non-hospital abortions
• Medical abortion accounted for 22% of all abortions before 9 weeks’ gestation

The number of early medical abortions and the proportion of all abortions accounted for by this method have grown substantially. Mifepristone use has grown steadily since its introduction in the United States in 2000, and substantially in recent years. ⁽⁶⁾

Preliminary estimates indicate that mifepristone accounted for roughly 27% of eligible medical abortion abortions in 2009 in the United States and is continuing to grow as it promises to expand abortion services by going outside the domain of a typical abortion clinic. ⁽⁷⁾

Mifepristone has increasingly become an integral part of abortion provision in the United States and likely has contributed to a trend toward very early abortions. ⁽⁷⁾

INTERNATIONAL USE OF MIFEPRISTONE

What  kind of international growth is mifepristone medical abortion  experiencing?

Prior to discovery of the mifepristone for medical abortion, International agencies were looking for technologies and improved methods to stem global population growth in developing nations over concerns that population expansion would threaten the future availability of food, water, and other resources; thus threatening the well-being and survival of the human species. ⁽⁵⁾

Mifepristone is approved and marketed in over 40 countries. ^{(8) (9)}

In 2005, mifepristone was included in the World Health Organization’s (WHO) Essential Medicines List. ⁽⁹⁾

In recent years, several new mifepristone and prostaglandin analog (misoprostol) products have entered the international market increasing the availability and reducing the cost of both drugs. ^{(9) (10)}

In 2007, in Finland 64%, in Sweden 61%, and in the United Kingdom 35% of all abortions were performed using the medical method. The continuing increase in the number of medical abortions performed each year and the risk of major health complications is of great interest to patients and health care providers. ⁽¹¹⁾

WOMEN AT RISK

Can the increased use of mifepristone for medical abortion put women at greater risk?

Once a drug is marketed and used in thousands or even millions of individuals, it is more likely that rare adverse events or major complications can occur. ⁽¹²⁾

Adverse events can range in severity from complications that are serious and life-threatening to those that can lead to hospitalization or death. ⁽¹²⁾

The increased use of mifepristone/misoprostol for medical abortion may result in larger numbers of lethal infections from the clostridium sordellii bacterium. ⁽¹³⁾

ABORTION PILL DEBATE

The Abortion Pill Debate and Controversy

Contrary to popular misconception, medical abortion with mifepristone and misoprostol to induce abortion is neither simple nor inexpensive. ⁽¹⁴⁾

Medical abortion is associated with higher rates of prolonged bleeding, nausea, vomiting, and pain than is surgical abortion, and the rate of use of analgesic drugs is greater with medical abortion. ⁽¹⁵⁾

Moreover, medical abortion has a lower rate of success than surgical abortion and requires more clinic visits than surgical abortion. ⁽¹⁵⁾

There have been significant debates concerning the characterizations of medical abortion with respect to use of unapproved alternative regimen, the effectiveness of regimens, the accuracy of reported health risk data, and the systematic deficiencies of the FDA’s Adverse Event Reporting System. ^{(14) (16)}

The ability of mifepristone to induce medical abortion has generated considerable political, legal and religious controversy. ⁽¹⁷⁾

ABORTION PILL NAMES

What are the different names for the Abortion Pill?

• Common Name: Abortion Pill
• Original Research Name: RU-38486 shortened to RU-486 ⁽¹⁸⁾
• Generic Drug Name: Mifepristone ⁽⁴⁾
• Commercial Trade Names: ^{(19) (20) (21)}
  • Mifeprex (Mifepristone: United States)
  • Mifegyne, MTPill, Mifegest, Mifeprin, Mifyron, Mefipil, Mifebort (Mifepristone: Other countries)
  • Medabon (Mifepristone and misoprostol in a combined package: Other countries)
• Other Abortion Pill Names:
  • Medical Abortion
  • Medication Abortion
  • Non-surgical or non-aspiration abortion
  • Pharmacological Abortion
  • The Early Option Pill
  • MTP (Medical Termination of Pregnancy) pill
  • “A” pill
  • Antiglucocorticoid, Glucocorticoid Receptor Antagonist
  • Antiprogesterone, Antiprogestin, Progesterone Agonist, Progesterone Antagonist, Progesterone Receptor Antagonists (PAs)
  • Selective Progesterone Receptor Modulators (SPRMs)