Abortion pill - RU486 (mifepristone)

Medical (non-surgical) abortion offers an alternative to surgery for women in the early weeks of pregnancy. The most well known method of medical abortion uses mifepristone in combination with another drug, misoprostol, to end a pregnancy up to nine weeks. Mifepristone is also known as RU486 or the ‘abortion pill’.

Medical abortion is a low-risk, non-invasive way to terminate (end) a pregnancy. The success rate is up to 98 per cent, which is only slightly lower than that of surgical abortion. However, access to medical abortion is limited in Australia.

Doctors must apply to the Therapeutic Goods Authority (TGA) for ‘Authorised Prescriber’ status to be able to prescribe mifepristone to patients seeking the procedure. Mifepristone is also used to treat a range of medical conditions, including endometriosis and cancer of the uterus (womb).

Medical abortion explained

Medical abortion involves using medication instead of surgery to end a pregnancy. It can be done as soon as pregnancy is detected and the gestational sac is identified. In Australia, a woman must be less than nine weeks pregnant and in good health to have a medical abortion.

Before you can have a medical abortion, you will need to:

• Have an ultrasound to check the stage of your pregnancy
• Talk with a nurse or counsellor
• See a doctor who will also ask about your medical history.

The most well known form of medical abortion uses mifepristone. Some alternative methods might be available and your doctor can talk about these with you if needed.

The procedure for medical abortion

A pregnancy needs high levels of the hormone progesterone to continue. Mifepristone works by blocking the action of progesterone to cause a miscarriage early in the pregnancy.

If your doctor decides that medical abortion is right for you and you decide to have the procedure, you will be asked to sign a consent form. You will then:

• Take a tablet of mifepristone at the clinic
• Go home and 24 to 28 hours later, take the second dose of tablets either orally or by inserting it in the vagina (this dose contains the drug misoprostol to soften the cervix and help the uterus contract and expel the pregnancy)
• Have stomach cramps that feel like a painful period.

The pregnancy will usually terminate within four to 24 hours. You will then:

• Go back to the clinic in two weeks for a follow-up appointment to make sure the pregnancy has ended (this might involve blood tests or an ultrasound)
• Have telephone contact with the clinic throughout the procedure in case you have any questions or concerns.

What to expect after the procedure

After you have taken mifepristone, you might have:

• Nausea or dizziness for a short time
• Bleeding from the vagina about 12 hours after treatment
• Bleeding and cramps that feel like a painful period (women who usually have painful periods are more likely to have severe cramping, but these symptoms usually lessen once the abortion is complete)
• Headache, diarrhoea and chills (women who need further treatment with prostaglandin are more likely to have these symptoms).

The follow-up appointment

You will need to have a follow-up appointment with your doctor or healthcare provider to confirm the pregnancy has ended. At this appointment, you will have an ultrasound (and possibly a blood test) to make sure the termination is complete. If the ultrasound shows that the pregnancy has stopped growing but the tissue hasn’t passed, a surgical termination will be needed. This happens in about two per cent of cases.

Taking care of yourself at home

You should take care of yourself in the 48 hours after having the procedure by following the advice of your doctor or healthcare provider. This can include:

• Using over-the-counter anti-inflammatory medications to help manage the cramps (if this isn’t enough, your doctor can prescribe stronger medication)
• Not smoking, drinking alcohol or using herbal supplements or illegal drugs.

To lessen the risk of infection during the week after having the procedure, you shouldn’t:

• Insert anything into your vagina, including tampons (don’t use tampons until your next period)
• Have vaginal sex
• Perform any strenuous activity, including sport or heavy physical work, until the bleeding stops
• Go swimming or have a bath (you can shower).

You should see your doctor if the vaginal bleeding doesn’t stop within a few days of having the procedure.

Some women shouldn’t take mifepristone

Mifepristone isn’t recommended to all women and might not be suitable for you if you:

• Smoke and are aged 35 years or older
• Have certain medical conditions such as bleeding problems, adrenal failure or high blood pressure
• Are taking long-term steroid or blood-thinning medications
• Have an ectopic (tubal) pregnancy
• Are more than nine weeks pregnant
• Have had allergic reactions to medications containing mifepristone
• Are fitted with an intrauterine device (the device needs to be removed before taking mifepristone).

Advantages of medical abortion

The World Health Organization (WHO) believes that mifepristone is an important treatment that should be made available to all women. Advantages of taking mifepristone include the following:

• For at least 95 per cent of women up to nine weeks gestation, taking mifepristone with misoprostol results in complete abortion within a few hours.
• Unlike a surgical abortion, a sterile operating environment isn’t needed, meaning the risk of infection is very small.
• The risk of maternal death is extremely low.
• Mifepristone is a cheaper and less invasive option than surgical abortion.
• Mifepristone acts quicker than other drugs used in medical abortion, such as methotrexate.
• Women who have used mifepristone have said the procedure is less clinical and stressful than surgical abortion.
• The abortion happens at home.
• Anaesthesia isn’t needed.
• Unlike surgical abortion, medical abortion doesn’t need a surgeon, making it a suitable alternative for women living in remote areas.
• Most women don’t need pain-killing medications.

Disadvantages of medical abortion

Disadvantages of taking mifepristone include the following:

• You might have excessive bleeding, which could mean you need to have a surgical abortion or, in rare cases, a blood transfusion.
• You might get an infection, but this is rare and can usually be treated with antibiotics.
• The procedure fails in around two to three per cent of women, in which case a follow-up surgical abortion might be needed.
• Though rare, mifepristone can take days to work, whereas a surgical abortion only takes about 15 minutes.

Where to get help

• A doctor
• Family Planning Victoria (FPV) Tel. 1800 013 952 or (03) 9257 0100 or FPV’s youth Action Centre (for people aged under 25 years) Tel. 1800 013 952 or (03) 9660 4700
• Dr Marie Australia 24 hour helpline Tel. 1800 003 707
• Women’s health centre

Things to remember

• Medical abortion offers a safe, reliable and non-surgical means of abortion, but availability in Australia is extremely limited.
• Mifepristone (RU486) is an oral medication that’s taken to end a pregnancy by blocking the action of the hormone progesterone.
• Mifepristone isn’t suitable for all women seeking abortion.

You might also be interested in:

• Abortion.
  
• Abortion - counselling options.
  
• Abortion - emotional issues.
  
• Abortion procedures.
  
• Abortion services in Victoria.
  

Want to know more?

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This page has been produced in consultation with and approved by:

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Family Planning Victoria

Last reviewed: November 2011

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Medical (non-surgical) abortion offers an alternative to surgery for women in the early weeks of pregnancy. Mifepristone (RU486 or the ‘abortion pill’) can be used to terminate (end) a pregnancy up to nine weeks. However, access to mifepristone is limited in Australia.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

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