- A medical history is taken and a clinical exam and lab tests are performed
- Counseling is completed and informed consent is obtained
- If eligible for medical abortion, the woman swallows the mifepristone pill(s).
Mifepristone (formerly known as RU-486) is a medication that blocks the action of the hormone progesterone. Progesterone is needed to sustain a pregnancy. Mifepristone has been used, in combination with other medications called prostaglandins, for medical abortion since 1988 in France and China, and since the early 1990's in the United Kingdom and Sweden. It has been licensed for use in 37 countries including the United States where it was approved in September 2000. Millions of woemn worldwide have safely used mifepristone regimens to end their pregnancies.
Mifepristone blocks the action of progesterone, which is needed to sustain a pregnancy.
In the U.S. mifepristone is used in combination with other medication, a synthetic prostaglandin called misoprostol. Misoprostol causes the uterus to contract, and helps the pregnancy tissue to expel.
Depending on the prescribing physician's protocols, mifepristone and misoprostol can be used for early abortion up to 63 days after the start of the last menstrual period. Approximately 95-98% of women will have a complete abortion when using mifepristone/misoprostol. Success rates may depend on the treatment regimen and the duration of the pregnancy. The remaining women will need a suction procedure, either because of ongoing or excessive bleeding, an incomplete abortion (tissue remains in the uterus but there is no growing embryo), or an ongoing pregnancy (a viable growing pregnancy, which occurs in less than 1% of cases).
Clinical studies have shown that several variations in mifepristone/misoprostol treatment regimens are safe and effective. Generally, howver, once a woman has decided to have a medical abortion, there are three steps in the process of a medical abortion.
Side effects, such as pain, cramping, and vaginal bleeding, result from teh abortion process iteself, and are therefore expected with a medical abortion. Other side effects may include nausea, vomiting, diarrhea, chills, or fever. Complications are rare, but may include infection, excessive vaginal bleeding requiring transfusion (occurs in approximately 1 in 500 cases), incomplete abortion or ongoing pregnancy which requires a suction abortion. In exceedingly rare instances, as with miscarriage, suction abortion and childbirth, death may occur. Reports of death after medical abortion are very rare - less than 1 in 100,000 cases - a rate comparable to that for early surgical abortion and for miscarriage.
If the medications fail to end the pregnancy, a suction abortion should be provided. For this reason, a woman who chooses medical abortion must be willing to have a suction abortion if needed.