Abortion Pill Facts
Medical Abortion / Non-Surgical Abortion / RU486 / Mifeprex / Mifepristone / Chemical Abortion / Abortion Pill / Abortion by Pill or Instrument-Free Abortion (3 to 9 weeks)
There are many ways to describe Medical Abortion. The different terms used are Abortion Pill, Abortion by Pill, early non-surgical abortion, non-surgical abortion, chemical abortion, or instrument-free abortion.
Abortion Pill What Is It?
It is a method of terminating pregnancy from 3 to 9 weeks. In the UK, there were extensive studies performed that showed the medical abortion procedure is effective and safe up to 14 weeks pregnant. Prior to approval of RU486 in 2000 in the United States, the medical abortion was being performed by our experienced Physicians with other medications to terminate pregnancy. Prior to 2000, when the FDA first approved RU486, non-surgical abortions were performed with medications that were found to stop the growth of early pregnancy, and it was then expelled in a manner similar to miscarriage. They were used “off label” which means that the medications are FDA approved for other indications besides abortion. In several European countries, nearly 50% of women choose to undergo abortion using the Non-Surgical Abortion process. Early abortions both surgical and medical are very safe and effective when supervised and performed by an experienced and skilled Physician.
Different medications are used to carry out medical abortion procedures (Mifeprex, Mifepristone, Abortion Pill, Early Option Pill, French Pill), which include RU486, Methotrexate, or Tamoxifen. RU486 is the only medication approved by the Food and Drug Association (FDA) to use specifically for medical abortion in the United States. The other two FDA approved medications used for other medical indications, were also found to be highly effective in terminating pregnancy. The abortion pill, tamoxifen, or Methotrexate (injection or pill) are used initially followed in 24 to 96 hours by misoprostol which causes the uterine contractions, vaginal bleeding and miscarriage. The benefits, side effects, and alternatives are thoroughly discussed with patients prior to administration.
RU486 (mifepristone, Mifeprex, abortion pill) is an anti-progesterone medication that binds to receptors on the uterus causing sloughing (shedding) of the uterine wall, increase in uterine pressure and cramping. This not only stops the growth of early pregnancy but can lead to spontaneous miscarriage.
Methotrexate has been FDA approved since the 1950’s. It is used to treat various cancers, arthritis, psoriasis, and in the 1990’s it was used to treat ectopic pregnancy (pregnancies outside the lining of the uterine wall) which most commonly occur in the fallopian tube. Methotrexate targets fast growing cells (trophoblasts) that are responsible for the maintenance and growth of the pregnancy and placenta. Methotrexate is not as effective in terminating early pregnancy as RU486, but still has nearly a 90% success rate.
Tamoxifen is used to prevent and treat breast cancer. It was found to be successful in terminating early pregnancy in small animals and was then also found to be effective in terminating human pregnancy.
Misoprostol (cytotec) is a drug used to prevent peptic ulcers for patients who are taking non-steroidal anti-inflammatory medications. When taken 24 to 96 hours after the initial abortion pill, or Methotrexate, it causes contractions of the uterus which cause the pregnancy to be expelled from the uterus in 92 to 99% of cases. The earlier in pregnancy the medical abortion procedure is performed, the higher the success of the procedure.
Abortion Pill - How is it Taken?
The medical abortion is an option for women who are no more than 9 weeks pregnant, although exceptions can be made in cases where a patient meets certain strict criteria. During the first appointment you will receive the Mifepristone pill to take by mouth, or the Tamoxifen pill which is also taken by mouth, or Methotrexate which can be taken by injection or by mouth. 48 to 72 hours later, in the privacy of your own home, you will insert Cytotec (Misoprostol) tablets into your vagina, which causes contractions resulting in a miscarriage. The Cytotec (Misoprostol) tablets can be inserted later than 72 hours if your schedule does not permit inserting them before then. When used in combination, there is a 90 to 98% rate of success. The success rate decreases with each number of gestational weeks. There is close to a 99.9% success rate for patients 6 weeks or less from their last menstrual period.
Abortion Pill Pros & Cons:
What occurs during the first visit?
During the first appointment a medical history is obtained to alert the staff and physician if any medical problems or allergies you may have. It is very important to determine if you meet the necessary criteria required for underging the abortion using the non-surgical procedure method. Lab tests will be performed to verify the pregnancy, check blood count and determine your Rh factor.
Each patient will undergo counseling and the abortion procedure will be explained in detail. The risks, benefits and alternatives to the abortion procedure will also be explained. More importantly, it will be determined if having an abortion is the right choice for you at this time. The decision to have an abortion is one of the most difficult a woman may have to make in her lifetime. The decision is based on age, family, religious, ethical, moral, financial, social, and personal values. No one truly wants to have an abortion. The question is whether or not it’s the right time for you to be a mother.
Abortion Pill Ultrasound
The most important part of a medical abortion after determining a patient’s eligibility is to perform an ultrasound (sonogram) to determine the length of gestation and whether the pregnancy is located within the intrauterine cavity to rule out an ectopic pregnancy; although heterotopic pregnancies (pregnancy in the uterus and another one outside the uterus simultaneously) can also occur. The Physicians at Legal Abortion by Pill are experts in performing sonograms. Once they confirm that a patient is 9 weeks or less from her last menstrual period the procedure can proceed. If more than 9 weeks and the option of undergoing an abortion pill procedure is desired, arrangements can be made to stay overnight in our office or to start the medications at a time which can allow for monitoring of the patient during office hours to monitor for any problems that may occur.
Abortion Pill - What to Expect
Upon taking the initial medication at our offices (RU486, or Methotrexate or Tamoxifen), a few patients may experience mild nausea, abdominal cramps or pressure, light headedness, dizziness, constipation, or diarrhea. Women who have not been vomiting since becoming pregnant do not usually do so. The side effects just mentioned do not occur in the majority of patients and if they do, are usually only mild and last for just a few hours.
There is a 1 to 5% chance that vaginal bleeding leading to miscarriage may occur before taking the second medication (Misoprostol) which is generally taken 48 to 72 hours after taking the initial medication in the office. Most women do not experience any bleeding until taking the Misoprostol. Misoprostol can be taken later than 72 hours if your schedule does not permit it to be taken before. Once the Misoprostol is inserted, you can expect to experience lower abdominal cramping, and have a range of bleeding from very light, to the same as a normal period. Some women experience very heavy vaginal bleeding but this is not common. Heavy bleeding becomes a concern if the patient's bleeding requires more than two pads an hour for two hours in a row. When this occurs, the patient needs to call the office to determine what steps must be taken and whether additional medication needs to be prescribed to help decrease the amount of bleeding, or the second dose of Misoprostol can be taken immediately, and the patient may be asked to come to the office facility to be evaluated for possible suction aspiration.
A combination of one or all three of the steps described above are a possibility depending on the individual. There is a small chance that no bleeding will occur in some patients. This generally means that there was a failure of the abortion pill procedure, but at times if the patient is very early and the follow-up sonogram showed no evidence of retained tissue or a sac. This means that the residual tissue not visualized will be expelled whenever the patient has her next menstrual cycle. In addition, ectopic pregnancy precautions may be explained to the patient and blood tests may be necessary to assure that the hormone levels are decreasing appropriately. The bleeding and cramping can start as soon as 20 minutes after taking the Misoprostol tablets. Most women miscarry within 6 to 8 hours of taking the Misoprostol pills, although at times it may take a few days. Bleeding usually lasts between 6 days and 2 weeks. A small percentage of patients can bleed for up to 30 days. Less than .5% can experience bleeding between 30 to 69 days.
Although extremely rare, a patient may require a blood transfusion (less than .5%) during the medical abortion procedure or 3 to 6 weeks after the procedure due to sudden onset of heavy vaginal bleeding.
Nausea, Vomiting and Diarrhea
This can occur after taking RU486 (Mifeprex, Mifepristone, Abortion Pill, Abortion by Pill) or the misoprostol (Cytotec) tablets. With the RU486, nausea can last for a few hours. With Misoprostol, the nausea, vomiting and diarrhea can last for several hours, but usually only lasts for one or two.
The use of RU486 is not associated with a fever, but Misoprostol may cause a low grade temperature that usually lasts only 3 to 4 hours. It can last up to 24 hours, but this is only seldom occurs. For a temperature of 100.4 that lasts more than 24 hours after taking Misoprostol tablets, we ask that the patient call the Abortion by Pill Clinic as this generally means that the patient may have a pelvic infection.
Abortion Pill Pain (Cramping and pelvic pain)
This occurs generally 20 minutes to 4 hours after taking the first set of Misoprostol (Cytotec) because Cytotec initiates uterine contractions. The cramps can occur after taking the RU486 as there is a 1 to 5% chance of miscarriage with taking the RU486 tablet alone. The cramps are usually mild to moderate and only 50% of patients need some form of pain medication. There are only 5% of patients that may require something stronger than acetaminophen (Tylenol) or non-steroidal anti-inflammatory medications (Motrin, Naproxen, Indocin, Advil, etc.)
It is necessary for the patient to return in one to two weeks for a sonogram to make sure that the medical abortion procedure was successful and complete. A small percentage of patients may have a failed abortion when all of the pregnancy tissue remains inside the uterus (viable or non-viable) or an incomplete passage of tissue with no evidence of uterine cramping, low grade temperature, or uterine or adnexal tenderness (ovaries and fallopian tubes). This can usually be resolved with an additional dose of the Misoprostol tablets. Upon returning in one week, if the patient still has a moderate amount of tissue visialized on sonogram, a surgical procedure should be strongly considered. If the patient has remaining tissue noted on sonogram, a delated cervix, bleeding, pelvic pain, or if here is uterine and adnexal tenderness, this indicates that there may be not only retained tissue, but possibly infection in the uterus. Antibiotics must be started immediately and a surgical aspiration procedure should be performed. This reduces the incidence of ongoing pelvic infection and or sepsis (bacteria getting into the patient’s blood stream). The surgical procedure will be carried out in our offices without an additional fee.
How Effective Is the Medical Abortion (Abortion Pill, Abortion By Pill, Chemical Abortion, Non-Surgical Abortion) Procedure?
Studies show the medical abortion procedure to be 92 to 99% effective. Surgical aspiration has less than a 1% chance of failure. Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications, such as continuous, profuse blood loss that may require a blood transfusion, or continuing a pregnancy with severe birth defects. The patient is given a 24 hour emergency number to call if there are any problems or questions. A medical staff person is always on call.
With the recent use of the non-surgical regimen to end the pregnancy, how long will the pregnancy test remain positive? Is there a possibility of still being pregnant?
The follow-up visit is extremely important. You must return to the office 7 to 14 days after taking the Mifeprex, Tamoxifen or Methotrexate to be certain the pregnancy has ended. To verify this, a sonogram will be performed. If the pregnancy has not ended, there is a chance of fetal birth defects. Therefore, in all cases, there must be an additional insertion of the Misoprostol or a surgical procedure performed to end the pregnancy.
A pregnancy test can remain positive up to 4 to 6 weeks after the procedure is complete in 3 to 6% of the patients.
A medical abortion is a safe and effective method of ending abortion from 3 to 9 weeks gestation in the U.S. It is used in the U.K and other parts of Europe up to 14 weeks gestation where it has been shown to be slightly less effective (92 to 94%) than for patients who are 9 weeks or less pregnant (96 to 99%). The further along the patient is in her pregnancy the higher the chance of increased pain requiring analgesic medications, and the higher chance of retained tissue where a surgical aspiration must to be performed. Even with this said, the medical abortion is the right choice for patients who fear surgery and want to be in a home environment with their support person. The disadvantage of the abortion pill is that a follow-up exam is required 7 to 14 days after the initial visit to determine if the procedure was successful, and the patient must be located within 90 to 120 minutes of the facility in case there is a complication or emergency that needs prompt attention.
Risks of the Non-Surgical Procedure (Abortion Pill Risks)
Cramping and bleeding are an expected part of ending a pregnancy. It is rare, but serious and potentially life-threatening bleeding, infection, or other problems can occur following a miscarriage, surgical abortion, medical abortion or childbirth. Prompt medical attention is needed in these circumstances. Serious infection has resulted in death in a very small number of cases in which Misoprostol was used in the vagina. There is no evidence indicating vaginal use of Misoprostol caused these deaths.
If you have any questions, concerns or problems, or if you are worried about any of the side effects or symptoms, you should contact our office immediately.
Be sure to contact our office immediately if you have any of the following Abortion Pill Side Effects:
Bleeding enough to soak through two, full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (Surgical Abortion/D&C) to stop it.
Abdominal Pain or “Feeling Sick”
If you have abdominal pain or discomfort, or you are “feeling sick,” including weakness, nausea, vomiting or diarrhea, with or without fever, more than 24 hours after taking Misoprostol, you should call our office without delay. These symptoms may be a sign of a serious infection or other problem (including ectopic pregnancy, a pregnancy outside the womb).
In the days after treatment, if you have a fever of 100.4F or higher that lasts for more than 4 hours, you should contact us immediately. Fever may be a symptom of a serious infection or other problem (including an ectopic pregnancy).
Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications such as continuous, profuse blood loss that may require a blood transfusion, or continuing a pregnancy with severe birth defects. All patients are given a 24 hour emergency number to call if there are any problems or questions. A medical staff person is always on call.
Eligibility for Medical Abortion (Abortion Pill Requirements)
- You must be 9 (nine) weeks or less from your last menstrual period
- You must have reliable transportation and a support person to take you to the hospital or bring you back to our medical offices if necessary
- You must live no more than an hour away from the hospital or our medical offices
- You must be able to make the follow-up appointments (possibly 2 or more)
- You must agree to have a surgical procedure performed if the medical abortion fails
The Medical Abortion is contraindicated in patients with the following problems:
- Severe anemia
- Blood clotting problem or currently taking anticoagulant medication
- Possible ectopic pregnancy
- Have a mass in the tubes or ovaries or ectopic pregnancy (pregnancy outside the uterus)
- Inherited porphyria
- Intrauterine Device (Must be removed before having a medical abortion procedure)
- Unable to get emergency medical help in the two weeks after taking the medications
- Allergy to Misoprostol or other prostaglandins, Mifeprex, Tamoxifen or Methotrexate
Other Options For Early Abortion (3 to 6 weeks) or if exceeds the Abortion Pill Time Limit
If you are found to be 6 weeks or less by sonogram, and there is a contraindication for you to undergo the Non-Surgical Abortion, a surgical abortion is still an option. The advantage of the early surgical procedure is that the abortion procedure is quick and over within a matter of minutes, and the pregnancy symptoms of nausea, vomiting, bloating, and breast tenderness can end within a few hours after the abortion procedure is performed.
If the Abortion Pill time frame is exceeded (above 9 to 10 weeks) the Abortion Pill Procedure may not be the best option as the abortion pill statistics show there is a higher incidence of failure, incomplete abortion, increased pain, increased bleeding, increased narcotic use, and a higher incidence of suction aspiration required. The patients and the Physician would need to discuss these issues and make the determination for the safest and most efficient method available to the patient.
Early Abortion: Abortion Pill vs. Surgical Abortion
Because our Physicians are highly trained to perform the early abortion procedures surgically and medically, both are equally safe and effective. More women are choosing the medical abortion method if 6 weeks or less pregnant because they feel it is a more natural choice and there is no need for the use of surgical instruments for this procedure. Women are very happy with the outcome of either method.
We encourage all women to start birth control on the day of the surgical procedure or the day of the follow up visit of the medical abortion procedure. You can become pregnant 7 days to 2 weeks after having the procedure performed. We also encourage patients to take home hormonal Emergency Contraception (morning after pill, day after pill, post coital contraception, day after contraception, plan b) just in case that they are exposed to unprotected sex in the future.
When can I have sex?
With the medical abortion procedure, you can have sex at any time. For the early abortion procedure, (6 weeks or less) we suggest you wait 24 hours before having sex again.
Other services we offer are reproductive healthcare and family planning which consists of physical examinations, Pap Smears, screening and treatment for sexually transmitted disease (STD), and selection of the birth control method that is best suited for each individual patient. These services are provided by our highly trained Physicians and Advanced Registered Nurse Practitioner who practices under a supervised protocol. We are pleased that you have taken the time to review our web site, and we look forward to serving you.