Medication or medical abortion is the use of drugs to end an early pregnancy. There are different drugs available for this but the most effective and best-known is mifepristone, also known as RU486.
Mifepristone (also sometimes called 'the abortion pill') is a medication that blocks the hormone progesterone, which is needed to sustain a pregnancy. Mifepristone has been used in combination with other medications called prostaglandins for medical abortion since 1988 in France and China and since the early 1990s in the United Kingdom and Sweden. In September 2001 mifepristone was approved for distribution in New Zealand, and is under limited but increasing availability in Australia. Millions of women worldwide have safely used mifepristone regimens for termination of pregnancy and it is named in the World Health Organisation Model List of Essential Medicines.
Mifepristone is only available in Australia for terminations on pregnancies less than nine weeks gestation. If you are further along than nine weeks and are considering abortion, you'll need to look at a surgical procedure.
If you're under nine weeks gestation, feel comfortable with having a miscarriage at home, can access a clinic that provides mifepristone and are keen to avoid a surgical procedure if possible, then a medication abortion may be a suitable option for you.
How mifepristone works
Mifepristone blocks the hormone progesterone, which is needed to sustain a pregnancy. This results in:
- Changes in the uterine lining and detachment of the pregnancy;
- Softening and opening of the cervix; and
- Increased uterine sensitivity to prostaglandin.
Mifepristone is used in combination with another medication, a prostaglandin analogue called misoprostol. Misoprostol causes the uterus to contract and helps the pregnancy tissue to pass.
How effective is the combination of mifepristone and misoprostol in terminating an early pregnancy?
Approximately 95% of women will have a complete abortion when using mifepristone/misoprostol in pregnancies less than nine weeks gestation. The remaining women will need a suction abortion either because of ongoing or excessive bleeding, an incomplete abortion (tissue remains in the uterus but there is no growing embryo), or an ongoing pregnancy (which occurs in less than 1% of cases).
Where can I get a medication abortion?
Medication abortion is under limited availability in Queensland, although an increasing number of providers are beginning to offer it as an option. Our Queensland clinics page includes info on which clinics offer medication abortion; for other states please call your closest provider or family planning organisation.
Why can it be so hard to get?
Until August 2012, no drug company had successfully applied to import and distribute mifepristone in Australia. This meant that doctors wishing to use it needed to individually apply to the Therapeutic Goods Administration to be permitted to prescribe it, and needed access to an ethics committee to do so - a condition which automatically eliminates most GPs. Most doctors authorised to use mifepristone in Australia are based in hospitals or abortion clinics.
It is hoped that now a successful application to import the drug is approved by the TGA, doctors will be able to prescribe it as they do other medication and access to it will expand.
What will happen?
Clinical studies have shown that several variations in mifepristone/misoprostol treatment regimens are safe and effective, and procedures may vary from clinic to clinic. The info below is intended as a guide only; for more detail or if you have any further questions, call the clinic you're considering attending.
Step One (at the doctor's office or clinic)
- A medical history is taken and a clinical exam and lab tests are performed, to confirm the gestation of the pregnancy and ensure there are no medical reasons for not proceeding with the mifepristone.
- Counselling is completed and informed consent is obtained.
- If eligible for medication abortion the woman swallows the mifepristone pill(s).
Step Two (at the office/clinic or at home depending on the treatment regimen)
- This step takes place about two days after Step One.
- Unless abortion has occurred and has been confirmed by the clinician the woman uses Misoprostol. Misoprostol tablets may be swallowed or inserted into the vagina depending on the treatment regimen.
Step Three (at the office or clinic)
- This step takes place approximately 11-17 days after Step Two.
- The clinician evaluates the woman to confirm a complete abortion. This step is essential. Women must return to the office/clinic to confirm that the abortion is complete.
- If there is an ongoing pregnancy a suction abortion should be performed.
- If the abortion wasn't successful and some tissue still remains in the uterus the clinician will discuss possible treatment options with the woman. These may include waiting and re-evaluating for complete abortion in a number of days or performing a suction abortion.
Possible side effects of a mifepristone abortion
Side effects, such as pain, cramping, and vaginal bleeding, result from the abortion process itself and are therefore expected with a medical abortion. Other side effects of the medications themselves may include nausea, vomiting, diarrheoa, chills or fever. Complications are rare but may include excessive vaginal bleeding requiring transfusion (occurs in approximately one in five hundred cases), incomplete abortion or ongoing pregnancy which requires a suction abortion (see above).
What women can expect from a mifepristone abortion
- Medical abortion with mifepristone/misoprostol requires at least two visits to a doctor's office or clinic.
- Approximately 95% of women using mifepristone/misoprostol under nine weeks gestation will have a complete medication abortion.
- Approximately two-thirds of women will have a complete medication abortion within four hours of using the misoprostol (the second medication).
- Approximately 90% of women will have a complete medication abortion within twenty-four hours of using the misoprostol (the second medication).
- Complete abortion generally occurs more quickly when misoprostol is used vaginally rather than orally.
- On average women may expect to have bleeding and/or spotting for nine to sixteen days.
- Women may pass clots ranging in size.
- Some women may see grayish pregnancy tissue.
- If the medications fail to end the pregnancy a suction abortion will have to be performed. For this reason, a woman who chooses medical abortion must be willing to have a suction abortion if needed.