In September 2000, the U.S. Food and Drug Administration approved mifepristone, known as RU-486, after a 20-year odyssey. RU- 486 is a steroid hormone that induces abortion by blocking the action of progesterone, a hormone produced by the ovaries and placenta that maintains the lining of the uterus. Similar in structure to progesterone, RU-486 binds to cell receptor sites normally occupied by progesterone, causing the breakdown of the uterine lining. As a result, the uterine lining and the embryo are expelled from the uterus, and the pregnancy is terminated.
Treatment consists of the ingestion of three pills of RU-486 A dose of prostaglandins must be administered 48 hours later to encourage contractions of the uterus. Ninety-six percent of women who take these two drugs during the first nine weeks of pregnancy will experience a complete abortion. The side effects of this treatment are similar to those reported during heavy menstruation and include cramping, minor pain, and nausea. Approximately 1 in 1,000 women requires a blood transfusion because of severe bleeding. The procedure does not require hospitalization; women may be treated on an outpatient basis.
While RU-486s nickname, “the abortion pill,” may imply an easy process, treatment does involve more steps for the woman than does a traditional abortion. A traditional abortion takes about 15 minutes followed by a physical recovery of about one day. A first visit to the clinic involves a physical exam and a dose of three mifepristone tablets, which may cause minor side effects such as nausea, headaches, weakness, and fatigue. The patient returns two days later for a dose of prostaglandins (trade name: misoprostal), which cause contractions of the uterus. These contractions expel the fertilized egg. Women are required to stay under observation at the clinic for four hours. A return visit is required 12 days later because the pills fail to expel the fetus completely in 4 percent of cases. In such an event, a clinical abortion becomes necessary. The new FDA approval of general use of RU-486 in the United States stipulates only a few restrictions on how the pill can be dispensed.
*17/277/5*
