The abortion pill (mifepristone)

Originally Published: April 27, 1995 - Last Updated / Reviewed On: September 28, 2012
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Alice,

I remember reading about RU-486. Could you explain how it works and what, if any, side effects are linked to it? Thank you.

—Options

Dear Options,

Providing an option to surgical abortion, mifepristone (formerly known as RU-486), is a medication that causes early medical/chemical abortion in pregnant women by blocking receptors of progesterone, a hormone needed to maintain pregnancy. In this case, early means within 63 days (9 weeks) from the first day of the last menstrual period. The pill is usually combined with misoprostol, a low-dose prostaglandin (a chemical substance found in the body) that causes the uterus to empty. It appears to increase effectiveness without increasing side effects. The pill is very effective, inducing a complete early abortion successfully in 97 out of 100 women. Side effects of the drug combination may include bleeding, cramping, nausea, vomiting, short-term fatigue or weakness, and occasional diarrhea. These are often abated by taking ibuprofen, though aspirin should be avoided.

Mifepristone was available in Europe for many years before it was approved by the FDA in the U.S. in September of 2000. It has been shown to be a safe and effective alternative to surgical abortion. As per the FDA ruling, women interested in getting the pill receive a medication guide that details who should and should not use the drug and potential side effects. Eligible women who choose mifepristone need to visit a specially-trained health care provider for the procedure. There are four main steps:

  1. Visit with your health care provider to discuss your options, get a physical, and have lab tests.
  2. Next, you will return to your health care provider to take the pill and usually some antibiotics to help reduce the risk of infection.
  3. Misoprostol, a prostaglandin, will be taken two or three days later (your health care provider will give you instructions on when and how to take this).
  4. Finally, you will return in approximately two weeks to your health care provider to be certain there was a full abortion.

Bleeding and cramping usually begin after you take second medication, though for some people, bleeding begins after the first one. It may be helpful to have a trusted loved one with you throughout the process. It is recommended to wear pads instead of tampons during the process so you can keep track of the bleeding. You should only be experiencing discomfort for 24 hours after taking the second medication, misprostol. If you are still experiencing nausea, cramps, diarrhea, or fever after that point, do not wait for your two week follow-up to return to your health care provider — you should go immediately.

Mifepristone is administered under a health care provider's close supervision because in a small percentage of women for whom the combination of medical drugs is not effective to produce complete abortion, a follow-up surgical procedure is sometimes needed. The reason for this regimen is to ensure that mifepristone is used correctly, safely, and effectively.

By the way, the abortion pill is not the same thing as emergency contraception (also known as "the morning after pill" or EC). Emergency contraception is available to women who have had unprotected intercourse and are concerned that they could become pregnant. It is a hormonal medication that is taken within 120 hours of intercourse and acts to prevent pregnancy. For more information, check out Emergency contraception? In the Go Ask Alice! archives.

If you're considering your abortion options, Columbia students may speak with a health care provider at Medical Services on the Moringside Campus or Student Health Services on the CUMC Campus. Although the abortion pill is not prescribed on campus, information on medical (as well as surgical) abortion and referrals are available. 

Alice