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What is it?  RU-486 is called the Abortion Pill, M&M, medical (or non-surgical) abortion, and by its medical name Mifeprex (mifepristone) & misoprostol.  It is an abortion that can be done up to 7 weeks (49 days) from the first day of your last period, although some doctors do use this method through 9 weeks (63 days).  It consists of a 2-step process.  The first step is taken at the abortion clinic, and the second is usually taken at home.

What happens?  First, a thorough exam should be given to be sure that your pregnancy is not ectopic  (tubal) and that there is no IUD in place.  Three pills (600 mg) of Mifeprex (mifepristone) are then taken by mouth at the abortion clinic. To understand how this pill works you must understand a little bit of female anatomy.  The uterine lining (endometrium) holds little receptors (think of them as electrical outlets) all over it.  Progesterone is a hormone secreted by your body, and it fits perfectly into these receptors.  Progesterone keeps the uterine lining thick and well-supplied with blood vessels that are essential for maintaining the pregnancy, and it stops the uterus from contracting while the baby is developing.  When the Mifeprex pills are taken, a new chemical plugs itself into the progesterone receptors in the uterine lining. Since the progesterone has no place to go, it stops being produced. The uterus, being deprived of progesterone, is now free to shed its lining and contract even though the baby is still attached to it. 

Two days later you are instructed to insert misoprostol suppositories into your vagina. (Alternatively you may take 2 pills orally.)  Misoprostol produces uterine contractions and causes your cervix to dilate, and this will cause you to expel the baby, placenta, and lining. 

Some women will begin to bleed after taking the Mifeprex, but most will not start bleeding until the misoprostol suppositories are administered. In these women, bleeding will occur between 4-24 hours after the suppositories are inserted and will continue for approximately 8-16 days, with anything over 30 days warranting a call to the doctor.

A follow-up exam will be scheduled for approximately 14 days after the misoprostol was taken in order to confirm that the abortion has been completed.  An ultrasound or a pelvic examination should be done to verify that everything has been expelled.

What does it cost?  The cost varies from clinic to clinic, but Mifeprex's manufacturers have set the price of the 3 pills at $270.  Misoprostol suppositories should cost around $10.  You also have to factor in the cost of doctor fees and counseling services, which can put the cost at around $600 total. 

What should I consider? 

• RU-486 can be more expensive than a surgical abortion due to multiple visits.
• It is only effective during the first 7 weeks of your pregnancy, which is dated from the first day of your last period.  Some doctors may offer this option past this point, but you should know that this jeopardizes you and will not be as effective.
• There is no risk of infection from tools, uterine puncture, or cervical damage like there is with surgical abortion. 
• RU-486 is a drawn-out process, taking 3 days to complete.  During this time, the emotional tension can get quite high. 
• While it may seem easier to deal with since the majority of the abortion occurs at home, it can be more difficult to go through it without the care of medical professionals.  Some women report seeing the form of the baby after they pass it, and this can be difficult emotionally. 
• Between 1-2% of women have excessive bleeding that requires emergency medical attention.
• Incomplete abortions (where the heartbeat stops but the baby does not get expelled) occurs in 5-10% of cases. 
• In 8% of the cases, RU-486 does not work at all in the first 7 weeks, and the pregnancy continues unaltered.  The likelihood of this happening increases to 13% if it is taken between the 7th and 9th week of pregnancy.
• No testing has been done on long-term effects of this medication on women's health. 

What are the side effects?  (Listed in order of most common to least.)  Bleeding, abdominal pain, uterine cramping, nausea, headache, vomiting, diarrhea, dizziness, fatigue, back pain, uterine hemorrhage, fever, viral infections, vaginitis, chills, indigestion, insomnia, weakness, leg pain, and  emotional distress.

What if I change my mind?  Sometimes a woman takes the first dose of pills, gets home,and then doesn't want the abortion any more. The abortion clinic will most likely tell you that you need to continue.  However, this is only to protect them - not you. You can decide to stop the abortion. Simply throw away the misoprostol and contact a pregnancy center to help you find an OB/GYN that will examine you. You have less than a 50% chance that the baby is still developing after the Mifeprex is taken, but sometimes the peace of mind that comes from following your heart is more important than procedures and statistics.

Likewise, if the abortion fails and the baby is found to be developing normally at the 2-week check up, the clinic might insist that you need a surgical abortion. This also is untrue, and the decision is still in your hands. They cannot force you to have a surgical abortion. 

The clinic will most likely warn you that birth defects will occur. However, in a study done on women who continued their pregnancies due to a changed decision or a continued pregnancy despite a medical abortion, out of 82 women only 1 baby was born with a cleft palate, which is correctable and could be totally unrelated to the medication.  The rest of the babies were born alive and healthy. Misoprostol has been associated with Mobius syndrome, which causes facial paralysis, but statistics say that this happens very rarely. You deserve to know the truth and have all the information concerning this procedure - let the clinic know that you are aware of the studies and statistics.  The best course of action to take if you would like to continue a pregnancy after one or both medications is to contact a pregnancy center who can give you the name of an OB who is trained in dealing with this kind of situation. You can read more about continuing a pregnancy after a failed medical abortion here.

RU-486