The Mifepristone Pill – The Safe and Private Option For An At-Home Abortion.

The Mifepristone Pill – The Safe and Private Option For An At-Home Abortion.

The Medication pill or Abortion pill (non-surgical abortion) procedure is the safest private in-home abortion performed in the first trimester of pregnancy. There have been millions of Medical Abortions performed in many parts of the world. Mifepristone (RU486, Mifeprex, French Abortion Pill) is the only medication approved for first trimester terminations of pregnancy. The combination of Mifepristone with Misoprostol was approved by the FDA in Sept. 2000 in the U.S. Since that time, over 3.1 million abortions have been performed using this abortion procedure. Women find it highly safe, private and effective method in ending a early or unexpected pregnancy in the comfort of their home.

Mifepristone can be used alone to end a pregnancy. The incidence of completion of the abortion procedure in women who are 8 weeks or less pregnant is 40 to 50%. When Misoprostol is used alone the success rate is 85 to 90% effective in ending pregnancies. The combination of Mifepristone and Misoprostol is 96-100% effective in terminating pregnancies up to 13 weeks gestation.

Millions of women have undergone a first trimester abortion using the in home abortion with Mifepristone and Misoprostol method. Complications occur less than 0.5 to 1%. It is a process that should be done under medical supervision. Serious complications such as the need for hospital admission, surgery or blood transfusion are rare. The chance of maternal death is 0.0063%. Maternal death is 10 times higher with a term live birth or C-section in comparison with undergoing a in-home medical abortion procedure. Complications including death in men using Viagra is much higher than women undergoing a in-home abortion pill procedure in the first 10 weeks of pregnancy.

How Does Mifepristone Work?

Mifepristone works by blocking progesterone receptors on the uterus. Progesterone is required to maintain the pregnancy. Whenever there is a sudden drop in the level of progesterone, it may lead to a spontaneous miscarriage. Just prior to labor beginning in a term pregnancy (38 week r greater) there is a sudden drop in the progesterone level which causes the uterus to become sensitive for labor to begin. In the first trimester of pregnancy, Mifepristone causes the uterine lining to shed within a few hours of taking the tablet by mouth. This detaches the pregnancy and gestational tissue from the uterine wall. Mifepristone also increases the intrauterine pressure, softens and opens the cervix and also increases the sensitivity of the uterus to prostaglandins. Increasing the level of prostaglandins leads to uterine contractions.

Women frequently ask if Mifepristone harms or kills the baby when a late second or third trimester of pregnancy is performed. It does not. Mifepristone is not toxic to the fetus. It does not cause fetal abnormalities or congenital birth defects. Mifepristone does not contain acetaminophen or a Non-Steroidal Anti-Inflammatory medication.

The abortion pill method can be used to terminate pregnancies in the first trimester, second trimester and third trimester. Generally; medical abortions are completed in-clinic for patients further than 12 to 14 weeks pregnant. There is a slightly highly chance of heavy vaginal bleeding or retained pregnancy tissue in women who undergo the medical abortion procedure after 14 weeks. A surgical Dilation & Curettage (D&C) may be required to stop heavy vaginal bleeding or remove the placenta or tissue in the intrauterine cavity. Women are never encouraged to review or examine the pregnancy tissue that passes through the vagina.

Mifepristone is not required to end a first trimester pregnancy. Due to its high failure rate, Misoprostol should not be used alone. The 50% or higher chance of failure is the reason for adding Misoprostol as the second pill. The combination helps to expedite completion of the abortion procedure. It also reduces the rate of complications and side effects.

Side effects of Mifepristone are rare. They may cause headaches, nausea, vomiting, bloating, uterine cramping, lower abdominal pain, vaginal bleeding, constipation and diarrhea. Vaginal yeast infections occur but are rare.

Is Mifepristone A Controlled Substance?

Mifepristone only comes as a 200 mg tablet in the United States. It is not able to be purchased over the counter. It cannot be obtained by a prescription written by a Physician in the U.S. It has been under a restrictive program since being approved in the US for first trimester abortions. There are only 3 ways for women to legally get Mifepristone in the US:

  1. seek out an experienced Physician who performs abortions
  2. get them from a Abortion Clinic or
  3. a Hospital.

Thus obtaining a medical abortion in the U.S. may be highly restrictive. Numerous areas of the country do not have abortion clinics. Many women must travel more than two hours to have access to abortion services. Mifepristone is not available in liquid form so cannot be injected. It may be taken on a empty stomach with only water or juice. It may also be taken with food.

There are studies that show that Mifepristone begins working almost immediately or within a few hours of taking the pill.

Is Mifepristone Reversible?

There are Physicians and isolated reports that after taking the Misoprostol tablets, the abortion process may be reversed using high doses of progesterone. There are no randomized prospective studies that confirm this to be true. Mifepristone alone only works about 50% of the time to end pregnancies in patients who are 8 weeks or less. With such a high failure rate, it is difficult to know whether or not the effects of high progesterone will reverse the effects that Mifepristone has on the Uterus.

Is Mifepristone the Morning After Pill?

Mifepristone is approved to be used as the Morning After Pill (Emergency Contraception) in China, Thailand and other Asian Countries. Mifepristone in 10 mg tablets are highly effective in preventing or delaying ovulation and creating a local environment that prevents the sperm from penetrating the egg.

Mifepristone prevents the lining of the uterus from thickening which theoretically may prevent the blastocyst from attaching to the uterine wall. The definition of a woman being pregnant is when the latter occurs and the pregnancy test becomes positive. It is because of this reason that Mifepristone will probably never be studied or approved in the US as a Morning After Pill Regimen.

What Are Misoprostol (Cytotec) Pills?

Misoprostol is the second drug used in the abortion pill process. It was approved for prevention of gastric and peptic ulcers in patients who chronically take Non-steroidal anti-inflammatory medications. Misoprostol is a prostaglandin E1 (PGE1). It is contraindicated in women who are pregnant because it causes uterine contractions, cramps, bleeding, miscarriage and induces labor in patients in their second trimester and third trimester of pregnancy.

Misoprostol is a tablet that comes in a dosage of 200 micrograms (ug). It is not injectable. They may be swallowed with water or juices. The tablets can also be placed buccally (between cheek and gum), sublingually (underneath the tongue) or inserted vaginally to achieve a medical in-home abortion.

The route of administration determines how fast the onset of contractions or bleeding start. Common side effects associated with taking Misoprostol are headaches, nausea, vomiting, may cause gas, fever, shivering, skin rashes, urticaria, lower abdominal pain, back pain, constipation, diarrhea, uterine cramps and vaginal bleeding. The incidence of shivering and diarrhea is higher in women who abort by placing the tablets sublingually verses vaginally.

Whether the Misoprostol tablets are taken the same day or up to 72 hours later does not seemingly make a difference regarding the success or failure of the procedure. There is a small percentage of patients where the medical abortion process does not work. It may have to take a second or third dose of Misoprostol to complete the process. If the pregnancy continuous or if pregnancy tissue remains in the uterus, a surgical dilation and curettage (D&C) after the medical abortion is performed. The medical abortion failure rate where surgery is required is 0.3 to 1%.

If Mifepristone is unavailable, Misoprostol has and may be used alone to terminate pregnancy. The use of Misoprostol alone to terminate first, second and third trimester pregnancies started in the 1980’s in countries such as Africa and Brazil. In small doses, Misoprostol is used to soften and open the cervix for patients where induction of labor is indicated. Misoprostol also may be used to induce labor at term.

In countries where abortion is illegal or restricted, millions of women confronted with a unwanted pregnancy choose Misoprostol to terminate their pregnancy. The use of Misoprostol tablets to carry out medical abortion procedures is safe and not dangerous. The medication cannot be detected in routine blood work or urine. They may take days to dissolve if inserted vaginally. Taking the tablets orally is favored for women in countries where abortions are illegal. If medical personnel suspect that a woman self-induced her abortion, they are obligated to report it to police personnel for possible prosecution. Women place the Misoprostol tablets underneath their tongue or between their cheek and gum and retain them for 30 minutes. The residual is swallowed thereafter. Misoprostol tablets have a bitter taste and are chalky in texture. Some women are unable to tolerate the taste and remove them from their mouth. The pills are effective when swallowed whole. They may be taken with water, juice or soda. For women who are not able to swallow whole tablets, they can be crushed before consumption.

Misoprostol does not contain hormones. It is not a sulfa drug. It does not stop uterine contractions (tocolytic). Misoprostol is a uterotonic (stimulates uterine contractions). The fetal tissue on average passes 3 to 6 hours after taking Misoprostol in patients who are 8 weeks or less pregnant. The majority of patients pass the fetal tissue in 24 hours or less. Studies show when a sonogram is performed 10 days after the abortion, only 23% of patients have passed all pregnancy tissue.

Medical Abortions using Misoprostol works at 12 weeks, 16 weeks, 20 weeks, 24 weeks or further in pregnancy. It is generally not advisable for women to undergo a in-home medical abortion if further than 13 weeks pregnant. This is due to a higher complication rate and incidence of medications needed to control pain, manage heavy vaginal bleeding or remove retained pregnancy tissue by Vacuum Curettage.

Below is a brief video on the use of Mifepristone and Misoprostol:

What abortion pills do?

When one asks about the “abortion pill” in the U.S., the only pill method FDA approved for first trimester abortions, is the combination of two pills; Mifepristone (RU 486, Mifeprex, French Pill) and Misoprostol (Cytotec). The combination is highly efficient and safe. Over 80% of women would recommend having a repeat medical abortion if required in the future. Women feel more in control when choosing to undergo the in-home abortion pill process. It is private and no one else needs to know that she is terminating a unwanted pregnancy. Most women view a in-home procedure as having a bad menstrual period or a spontaneous miscarriage.

1) People living in the US who wish to have an in-home abortion under medical supervision will be given the combination of Mifepristone and Misoprostol tablets to take. The tablets work to terminate. pregnancies in the first trimester of pregnancy. There is a higher chance of incomplete abortions, continued pregnancies, pelvic infection and maternal morbidity when the pills are used individually rather than in combination as previously described.

Mifepristone taken orally can be swallowed or placed sublingually in women who find it difficult to swallow pills. This is generally followed 24 to 48 hours later by taking Misoprostol. Recent studies show that vaginal insertion of Misoprostol 6 hours after taking Mifepristone is just as effective in terminating pregnancy as compared to sublingual placement of the tablets at 24 and 48 hours apart.

1 Day Abortion Pill

The advantage of using the one day abortion pill method cannot be underestimated. By law in certain States, the giving of the second pill (Misoprostol) requires it to occur at the Abortion Clinic facility. It may be inconvenient for women to take off from work or school a second day. Transportation issues, babysitting costs, hotel and food expenses are just some of the challenges that make a second visit impossible to do. Having the flexibility of when and where to take Misoprostol allows more women the choice of using the medical abortion method for termination.

In most countries, Mifepristone is unavailable to use for Abortion. Misoprostol can be purchased over the counter in many countries. The World Health Organization (WHO) approves the usage of Misoprostol alone to terminate pregnancies. In the US, pharmacies such as CVS, Walgreens or Walmart are able to dispense Misoprostol only by a prescription through a Physician. If a Pharmacist suspects or believes a woman is buying Misoprostol to terminate her pregnancy, he/she can refuse to sell them due to moral conscientious objection reasons. Pharmacists can refuse to sell Emergency Contraception (Morning After Pill) based on similar reasoning. The Pharmacist is obligated to refer these women to other Pharmacist on staff to fill their prescriptions. Many times this does not happen.

The one day abortion pill method gives women the flexibility to remain in the office from a few minutes to several hours. There can be many reasons a woman chooses to do so. It may be that someone dropped her off at the office and will not return for several hours, she may be homeless, there is inadequate privacy at home or she may feel more comfortable to complete the procedure around supportive medical personnel.

Combined Use of Mifepristone and MisoprostolAKA: “The Abortion Pill”

The combination of the two pills of Misoprostol alone are more effective and safe than undergoing back-alley illegal methods of medical termination. The use of sewing needles, glass, coat hangers, wood and caustic chemicals are all examples of methods used in the past and are presently used to end unwanted pregnancies. The high maternal morbidity and mortality caused by illegal methods are immoral, wrong and shameful. The number of Abortions do not decrease when abortions are made illegal. It only increases the number of maternal deaths by hundreds of thousands fold. This is not acceptable and is disgraceful.

The Abortion pill method has been safely used in the US for nearly 20 years. Complications are rare, but can happen. They include the following:

1. Mifepristone and Misoprostol abortion pill method fail to work. The incidence of this is between 0.5 and 1%. The pregnancy doesn’t end. There may be a continuation of the pregnancy (fetal growth continues and active fetal heartbeat observed). It may also mean the fetus is no longer alive and no vaginal bleeding or cramping has happened. A pelvic sonogram is performed to evaluate and determine the diagnosis. Repeat doses of Misoprostol tablets or surgical suction curettage may be offered as options to end the pregnancy.

2. Incomplete Abortion (Pregnancy tissue remains in the uterus). The incidence is 0.05 to 1%. Patients present with prolonged lower abdominal cramps and vaginal bleeding that may be heavy. A pelvic exam may show the cervix being open with pregnancy tissue noted in or around the cervix. Uterine or adnexal tenderness upon examination may be signs of infection. Depending on individual circumstances and the patient’s clinical presentation, giving additional Misoprostol tablets or performing a vacuum suction curettage may be required. Antibiotics may be given to possibly prevent (prophylaxis) or treat an infection

3. Heavy Vaginal Bleeding. This is defined as bleeding more than 2 pads an hour for 2 hours in a row. Aggressive treatment with giving more Misoprostol tablets or surgical intervention may be necessary to stop the vaginal bleeding.

Are abortion pills safe and in what ways are they risky?

The abortion pills are extremely safe up to 91-days (13 weeks) pregnant. A recent study done in Ireland found that women who ordered pills online and used them at home had similar safety and successful outcomes compared to women who obtained services under medical supervision. The women followed the medical instructions and had 24 hour access to a professionally trained individuals who not only answered their questions, but provided support throughout the process. There are clinics in Australia set up to supervise medical abortions without women having to visit their medical facilities. A sonogram is performed and lab work are done at a nearby location where the woman lives. A local courier distributes the abortion medications to the patient’s address of record. The in-home abortion is carried out in the privacy of the woman’s home. A follow up exam is scheduled 2 to 4 weeks after taking the second pills to assure the process is complete. Several studies show that if the pregnancy test is negative at 3 weeks, the follow-up sonogram visit is not required.

Ectopic Pregnancy: Mifepristone and Misoprostol

Ectopic pregnancy is defined as any pregnancy that occurs outside of the uterus. The most common site is the fallopian tube. Other sites include the ovary, abdomen, cervix, liver and diaphragm. An ectopic pregnancy cannot be treated or aborted using either Mifepristone or Misoprostol alone or in combination. A diagnosed ectopic pregnancy or undiagnosed pelvic mass are contraindications to performing an abortion using this abortion pill method. Ectopic pregnancies occur in 1 to 2 % of pregnancies. The incidence is lower in women who present for and request the abortion pill procedure. The reason for this lower incidence is not understood.

An ectopic pregnancy should be suspected when no vaginal bleeding or cramps happen after the Mifepristone or Misoprostol are given. Cramps and bleeding normally last from 5 to 16 days. Eight percent of patients may bleed up to 30 days after their menses. Approximately 1% of women may have off and on bleeding up to 60 days. Over 99% of the time, women experience vaginal bleeding when undergoing the medical abortion procedure. If the procedure is performed on the day of or within a few days after a missed period, there is a small chance that bleeding may not occur. Ectopic pregnancy precautions should always be given to women who have absence of vaginal bleeding after taking the Misoprostol tablet. Patients who suddenly develop severe lower abdominal pain localized either to the right or left lower pelvic area should seek medical attention immediately.

Complications: All medical procedures have some risks involved. These have been mentioned earlier. At times, a potentially fatal fulminant sepsis may occur. Systemic multi-organ failure and maternal death can transpire within a 24 hour period of time. The bacterium Clostridium Sordellii appears the be the sole culprit. Women present with listlessness, unresponsive, severe lower abdominal pain, foul and smelly vaginal discharge, a high white count, rapid heartbeat (tachycardia) and dehydration. A high index of suspicion must be maintained with aggressive IV fluid replacement and antibiotics started immediately. These infections occur just as frequent in women who undergo surgical abortions, spontaneous abortions, term baginal deliveries or C-sections or other Gyn surgeries. In essence, there is no evidence that Mifepristone or Misoprostol cause this infection.

Why Does The Abortion Pill Hurt?

The most common complaint and side effect of the medical abortion procedure is pain. A study done in France a few years ago attempted to correlate the criteria that was associated with a higher level of pain. Higher pain scores were noted 1) in women who had never had children (nulliparous), 2) women who had no other choice except the abortion pill procedure and 3) lack of information regarding the amount of pain a woman may have. Another study found women who have high menstrual pain scores and higher anxiety scores have higher pain scores.

The Abortion Pill procedure causes bleeding and uterine contractions. There is no way to get around this fact. The uterine contractions are responsible for the majority of the pain during the abortion pill process. There should be minimal to no pain or bleeding prior to taking the Misoprostol tablets. Once taken, uterine cramping and bleeding may begin within 30 to 45 minutes. Over 50% of women do not need any pain medication after taking the second pill (Misoprostol). Approximately 40% of women require a Non-Steroidal Anti-Inflammatory medication like Advil, Motrin or Naproxen to help reduce the discomfort. Approximately 8% of women will need a narcotic to reduce the pain and discomfort.

After the pregnancy tissue passes, the pain is reduced almost instantaneously. The average time the pregnancy tissue passes is 3 to 6 hours. With women knowing the pain is for a short period of time (though it may be intense) and millions of women having gone through the process allows women to get through the procedure without much difficulty. Just before the tissue passes, the bleeding may significantly increase and then slows down after it passes through the cervix. The cramps may be constant or may come and go for the first 24 hours and slowly subside.

Where I can get the abortion pills?

There are a numbers of ways to obtain the abortion pills though limited means in the United States and around the world:

1. Through a medical provider: In the United States, both Mifepristone and Misoprostol can be received through Physicians who have significant experience with the medical abortion procedure. Hospitals may elect to carry Mifepristone on their pharmacy formulary but this is rare. The most common place to obtain Mifepristone is through Medical Abortion Pill Clinics. Not every Abortion Clinic performs medical abortions so women may need to make several calls to inquire and make an appointment.

There is an ongoing study in the United States in the States of Hawaii, New York, Maine, Oregon, and Washington. Patients who are 8 weeks or less pregnant by sonogram and has acceptable lab work are sent the abortion pills by mail. Patients do not have to travel to a abortion clinic. There is 24 hour access where women call if they have questions. Otherwise; the abortion facility may never physically see the patients. A similar program in Australia was implemented several months ago. Patients follow up with a local physician or medical facility 3 to 4 weeks after second pill is taken. This is how abortions will be performed in the future. All first trimester abortions should be able to be carried out in this manner. On the rare event there are side effects or complications, women will be able to go to a medical facility and evaluated.

2. Other Ways: There are many people in the US who choose to self-induce their abortion without medical supervision. This is never suggested or encouraged. As discussed previously; countries where abortions are restricted or illegal does not reduce the incidence of abortions. It only increases the maternal morbidity and mortality. With over 89% of the counties in the US void of abortion clinics and State legislatures passing more restrictive abortion laws the incidence of obtaining unsupervised medical abortions will invariably increase. The medications may be purchased or found in the following ways:

1. Buy Online (On the internet): There are various online resources where the pill can be purchased. The FDA discourages this method because the cannot guarantee that Americans are get true drugs or proper dosage. Patients may be further along than what they believe. This may lead to a higher complication rate.

2. Locally: Some people have found Misoprostol available for sale in bodegas, farmacias, and other local community medicine sellers. Particularly on the Mexican and US borders. There are no abortion clinic facilities in South Taxes due to restricted abortion laws passed. Women must travel more than 4 hours North to an abortion facility. They must wait 24 to 48 hours after signing consent papers to obtain the abortion. The travel back to south Texas and hope there are no security checkpoints. If they are illegal immigrants, they are subject to arrest and deportation. They may be separated from their families forever. One can see why some women may turn to the black market for the abortion pill. Why take the chance of being thrown out of the country?

3 Internationally: Some people obtain these medicines while traveling or from friends who have traveled. Mifepristone plus misoprostol abortion “kits” are sold over the counter in some countries at the pharmacy without requiring a prescription. Those who travel to Europe, Asia, Mexico or other Latin American countries have discovered that Misoprostol is available over-the-counter. Other countries such as Brazil have banned the over-the-counter purchase of Misoprostol. It is now sold on the black market at a much higher price.

4. At home: Many elderly people have aches and pains and are prescribed Non-Steroidal Anti-Inflammatory medications to reduce their discomfort. Misoprostol is commonly prescribed with those medications to reduce the incidence of gastritis, ulcers and gastrointestinal bleeding.

When Should these Abortion Pill Be Taken?

Abortion pills are approved by the FDA, for in-home medical termination of pregnancies up to 10 weeks. Numerous studies show the procedure can safely be performed on a outpatient basis up to 13 weeks. According to health risks of the abortion procedure and Physician experience, the medical abortion procedure can be performed further than 13 weeks but completion of the procedure in a in-clinic or hospital based facility should be strongly considered.

A short video on Mifepristone and Misoprostol Use after 10 weeks for in-clinic medical abortion:

Will abortion pill show in blood work?

The pills and their contents will not show up in blood or urine. Doctors cannot distinguish between a spontaneous miscarriage and induced abortion unless there ìs traces of physical evidence that most often occurs after inserting Misoprostol vaginally. In countries where abortions are restrictive or illegal vaginal insertion of tablets are strongly discouraged. The residua from the tablets may take several hours to days to dissolve. Swallowing the pills or placing them between the check and gum or sublingually is preferred way to induce the abortion.

Instructions before taking these pills:

1. It is advised to be under medical supervision when undergoing the abortion pill procedure at home.

2. The abortion pills unfortunately are not legal for women in most countries to use. There are medical facilities in countries that use Misoprostol to end pregnancies. Local governments recognize that medically supervised abortions decrease the expense on the medical system for having to care for women who undergo illegal unsupervised medical abortions.

3. No health provider can recognize whether or not the abortion pills have been taken.

4. Medical abortion is similar to a miscarriage. The way complications are treated and the follow-up required are the same.

Can Abortion Pill Not Work?

Usually the medication abortion works. A follow-up appointment in two to 4 weeks after the abortion is done to assure that the abortion process is complete.

Wrapping up:

Abortion pills are safe and a trouble free way for women to undergo a in-home abortion. It maintains a woman’s privacy and she is able to receive support from the individual that is meaningful in her life. On the other hand, some women choose to undergo the procedure without anyone else being aware. It may be the person who the woman conceived the child by does not know about the pregnancy. This certainly is within the right of the woman to not discuss the pregnancy or abortion with anyone. If possible, it may behoove to ask a neighbor or close friend to call in a few hours to check and see if things are well. This assures that in the rare event something goes wrong, a individual may be nearby to help. Following the discharge instructions and returning to the office in 3 to 4 weeks is important. It confirms that the abortion procedure is complete and there are no problems. Undergoing medical abortions with Mifepristone and Misoprostol at home is here to stay. It allows the highest level of privacy. There is no negative effect on future fertility.

Dr James S Pendergraft Orlando Abortion

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