How the Abortion Pill Works
Not so simple
It is being called a dramatic step forward for women's health. But the real impact of the FDA's approval of mifepristone may be more modest.
This is the deal: Mifepristone works by blocking the hormone progesterone, which is crucial in the early stages of pregnancy. Taken in conjunction with another drug, misoprostol, which causes uterine contractions that expel the embryo, the regimen is about 95 percent effective in terminating pregnancies when used within seven weeks of a woman's last menstrual period. "We are very confident in our decision that this drug is safe and effective for its intended use," FDA Commissioner Jane Henney told U.S. News.
But the drug has its limits. Most notably: It takes longer than a surgical abortion, and it can only be used in the very early stages of pregnancy. "Medical abortion takes days, potentially weeks," says Mitchell Creinin, professor of obstetrics and gynecology at the University of Pittsburgh School of Medicine. "A surgical abortion is done, and you're over with it." Still, when given the choice, many women opt for the pills, which they consider less invasive and more private.
It generally takes three doctor's visits to complete a drug-induced abortion. During the initial visit a woman is examined; if everything is OK, she takes three mifepristone (brand name: Mifeprex) tablets. Two days later, she returns to the physician's office for a dose of misoprostol. Most women experience intense cramping and heavy bleeding soon after taking the second drug. Bleeding and spotting can last from nine to 16 days, and sometimes as long as a month. Nausea, headache, and diarrhea are also common side effects.
The embryo is usually expelled within 24 hours of taking the pills; a follow- up visit two weeks later confirms that the pregnancy has ended. In some cases, a surgical abortion is necessary because the abortion has not been completed or bleeding is too severe.
Same price. A chemical abortion is expected to cost about $300, roughly the same as a surgical abortion. Insurance companies that cover surgical abortions are also expected to pay the tab for this.
While it may not revolutionize abortion health care, advocates of mifepristone say there is cause to celebrate. Women in clinical trials report high levels of satisfaction: 96 percent say they would recommend it, and 91 percent say they would use it again if they needed an abortion. -S.S.
This story appears in the October 9, 2000 print edition of U.S. News & World Report.
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