New Options for Your Body
Part I: RU
486
by Tamar
Love
RU 486 is the first of a new
generation of drugs called "antiprogestins," which bind the
progesterone receptors in the uterus and block the action of
progesterone, the "pregnancy hormone," which women's bodies produce
during pregnancy.
Marketed as
Mifeprex, RU 486 (also known as mifepristone) is a steroid
hormone similar in structure to progesterone. RU 486 is different
than the "morning
after pill," which is essentially a high-dosage birth control
pill that works by preventing ovulation for up to three days after
intercourse and blocking implantation of a fertilized egg in the
uterus.
How Does
it Work?
Progesterone
normally works to stimulate uterine glands to prepare the uterus for
pregnancy. Without progesterone, a woman's uterus returns to its
normal pre-pregnancy state, disrupting the development of a
fertilized egg or embryo.
Taking RU 486 is
a two-step process: mifeprex causes the uterine lining to break down
and shed, as it does during a normal menstruation cycle, then, a
second drug, misoprostol, opens the cervix, which promotes uterine
contractions and brings on a miscarriage. When used up to 49 days
after the start of a woman's last menstrual period, RU 486 is 95
percent effective in causing an abortion.
Three visits to
a physician are needed to terminate a pregnancy with RU 486: one
visit to diagnose the pregnancy and receive mifeprex, a second visit
48 to 72 hours later to be given misoprostol, and a third in two
weeks to be sure the abortion is complete.
A Brief
History
RU 486 was
invented in 1980 by Dr.
Etienne-Emile Baulieu for the French pharmaceutical company Roussel-Uclaf—RU
486's name comes from Roussel-Uclaf's initials plus a serial number.
The "French abortion pill," as RU 486 has been known for years, has
been offered in Europe for more than ten years.
An estimated
500,000 European women have used RU 486 to terminate their
pregnancies; in France, about ten percent of abortions are performed
using RU 486. RU 486 has neither replaced surgical abortion nor
increased the number of abortions in any European country where it
has been used. However, a recent
report by the United States Embassy in Beijing states that
widespread availability of the RU-486 pill has led to a huge
increase in abortion among unmarried women in China. RU 486 is not
available in Canada, where pressure from Canada's anti-choice
movement has made the legalization of RU 486 doubtful, despite the
support the drug has had from two provincial governments, the
Canadian medical associations, and women's groups throughout the
country.
Women's health
advocates have attempted to legalize RU 486 in the United States
since 1988, but pressure from pro-life groups slowed FDA approval.
The agency first declared RU 486 to be safe and effective in 1996,
but final approval was delayed by another four years by antiabortion
activists, political lobbyists and White House conservatives. Use of
RU 486 in the United States was finally legalized in September 2000.
However, pro-life groups are hoping that President-elect George W.
Bush will reverse the approval.
What Are
the Advantages and Disadvantages of RU 486?
Nothing is
perfect, though many women feel that RU 486 is far better than many
of the other alternatives to pregnancy termination. After extensive
clinical testing, scientists have been able to state the
following:
Pros
- Pregnancy
termination with RU 486 is non-surgical, requires no anesthesia
and puts women at no risk of uterine perforation, damage to the
cervix, or infection from instruments.
- RU 486 can be
administered to a woman as soon as she knows that she is pregnant
and wants to have an abortion. By contrast, a woman must wait
until the sixth to eighth week before she is able to have a
surgical abortion.
- RU 486 allows
greater psychological control over the termination of pregnancy
because it is less physically invasive and appears more similar to
a miscarriage than to an induced abortion.
- RU 486 can
make abortion a more private experience, as women are usually
alone when they abort.
- RU 486 has
the potential to be less expensive than a surgical abortion.
- RU 486 has
tremendous potential for use in developing countries where
hundreds of thousands of women each year are injured or die from
unsafe abortions.
- RU 486 is
metabolized quickly and soon leaves the system after termination
of the pregnancy, which limits the probability of long-term
adverse physical effects.
- The medical
community is investigating the use of RU 486 to treat the
following women's
conditions: certain breast cancers, ovarian cancer,
meningioma, endometriosis, Cushing's syndrome, adrenal cancer,
glaucoma, uterine fibroid tumors, and many others.
Cons
- RU 486 is
only effective during the earliest weeks of pregnancy.
- RU 486 takes
longer than a surgical abortion; a vacuum aspiration abortion is
done in 15 minutes, whereas RU 486 takes two days or more and
requires two trips to the clinic for the abortion itself.
- Common side
effects include bleeding, menstrual-type pain, and cramping
comparable to those of surgical abortion. Some women also
experience nausea, vomiting or diarrhea.
- About one
percent of women who take the drug experience heavy bleeding which
requires further treatment.
- In clinical
studies on RU 486, incomplete abortion occurred in two to three
percent of cases, and pregnancy persisted in one percent. These
women then required surgical abortions.
- Women who
have received long-term corticosteroid therapy, who have a blood
clotting disorder, chronic adrenal gland failure, an ectopic
pregnancy, or any contraindication to prostaglandins are not able
to use RU 486.
- While
extensive clinical tests have not revealed any evidence of adverse
long-term effects, RU 486 is still a relatively new procedure.
Scientists do not know how a woman's body will respond decades
after she has taken the drug regimen.
How Do I
Get It?
The RU 486
regimen is currently available and can be provided only by physicians
or their supervised assistants in offices or at clinics. RU 486 is
not available at pharmacies, nor can most primary care physicians
prescribe it.
The FDA has
restricted RU 486 prescription to doctors trained to perform
surgical abortions, unless the administering physician has made
arrangements in advance for a surgeon to care for their patient if
necessary. The reason for this requirement is that surgery is needed
in a small percentage of cases where RU-486 fails to terminate a
woman's pregnancy, or when bleeding is excessive.
The FDA has also
limited RU 486 prescription to doctors who can diagnose ectopic
pregnancies (pregnancies that occur outside a woman's uterus), and
who can accurately determine how long a woman has been pregnant. In
practice, this means that the drug can only be offered by physicians
who have an ultrasound machine available to them.
How Much
Does it Cost?
While prices
vary from clinic to clinic, the drug's producer, Danco
Laboratories, has set the price of the three-pill regimen at
about $270. The price does not include the cost of the second drug,
misoprostol, which is needed to complete the medical abortion, or
doctor's fees, counseling fees or other expenses. Surgical abortions
currently cost between $300 and $700.
Pro-choice
groups are currently trying to negotiate a lower price for
not-for-profit abortion clinics, and many providers believe the
price will decrease as the treatment grows in popularity.
What
Kind of Response Has RU 486 Received?
While pro-choice
groups are elated that women have another option for terminating
pregnancy, pro-life groups have responded negatively, necessitating
additional precautions for disseminating the treatment.
Doctors &
Scientists
The
international medical and scientific community has formally
recognized the importance of RU 486 as a viable method of
controlling unwanted pregnancy and its related complications. Dr.
Baulieu, the drug's inventor, won the respected Lasker Prize in 1989
for his work with RU 486.
Pro-Choice and Feminist
Groups
Pro-choice groups see RU 486
as a significant medical breakthrough that has the potential to
improve the health of women worldwide. A few feminists have
criticized RU 486 as a cumbersome and risky medication, but
according to feminist supporters of RU 486, these criticisms seem to
be premised on a ideological opposition to all hormone-related drugs
and new reproductive technologies. Most groups contend that RU 486
offers a safe, effective, non-intrusive and non-surgical
means of early pregnancy termination that is acceptable to
women.
Pro-Life Groups
The
international pro-life
lobby has reacted strongly against RU 486, and has been
effective in curtailing its availability, even for medical research
into the drug's other applications. In October 1988, after some
company employees had received death threats, Roussel abruptly
withdrew the new drug from the market in France, although the French
government promptly forced its return. Opponents
of abortion have organized boycotts against Roussel-Uclaf, its
German parent company, Hoechst A.G., as well as their American
affiliates, and have threatened to boycott any other pharmaceutical
company which would make RU 486 available.
In the US,
pro-lifers were able to forestall the FDA approval of RU 486 from
its invention in 1980 to its legalization in 2000. While no violence
has yet erupted over the use of the treatment, clinics
and medical facilities expect some form of violent protest or
antiabortion terrorist attack similar to pro-life methods of the
last decade. In fact, upon approving the treatment, the FDA did not
release the names of the medical officers who reviewed the drug,
fearing that they'd be targeted by antiabortion terrorists. For the
same reasons, the FDA also increased security around its offices
after approving RU 486.
Read
More
New
Options for Your Body, Part II: The "Morning-After"
Pill
New
Options for Your Body, Part III: IUD Update
RU 486: Non-surgical Abortion
RU
486: Dangers and Risks
Abortion
Issues: A Bibliography
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