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Contraception Quagmire: Making Sense of the Options


WebMD Health News

Sept. 28, 2000 -- Today's approval of the French abortion pill RU-486 adds yet another option to women's reproductive choices, but it may also add to the confusion surrounding the various methods of medical abortion and/or emergency contraception that are currently available.

When it comes to medical abortions -- abortions caused through drugs, as opposed to surgery -- there are currently two methods available to women. The newest is mifepristone, or RU-486, which induces an abortion when given early in pregnancy -- up to 49 days after the beginning of the last menstrual period. Two days after taking RU-486, the woman takes two tablets of another drug called misoprostol, which causes the lining of the uterus to be expelled along with the embryo. To date, over 500,000 women in Europe have used RU-486, as have thousands of women in the U.S. as part of research studies.

The other method of medical abortion involves a combination of two widely available prescription drugs, methotrexate and misoprostol. Studies have shown that this method is up to 96% effective at ending pregnancies, depending on the regimen used and the time it's given. Both these pills are FDA-approved and are widely used to treat other conditions. While doctors can legally prescribe this drug combination for abortion, the drugs are not FDA-approved for this purpose.

"We already have a medication that is used widely in this country for cancer -- methotrexate -- and it is also used to produce an abortion," Robert Hatcher, MD, author of Emergency Contraception: America's Best Kept Secret, tells WebMD. "There is no chance that this drug will be taken off the market because of its use in treating cancer. [In addition,] it is the gold standard in managing an ectopic pregnancy," a pregnancy that implants outside of the uterus, usually in the fallopian tubes. "This drug has paved the way for drugs like RU-486."

In a review article on medical abortion in TheNew England Journal of Medicine, a French research team reported that "medical abortion is associated with higher rates of prolonged bleeding, nausea, vomiting and pain than is surgical abortion and the rate of use of [painkillers] is greater with medical abortion." However, "an advantage of medical termination is its high rate of efficacy in women with early pregnancies."

Surgical abortion, by comparison, may fail when performed before the seventh week of pregnancy, they write. "In addition, medical abortion is safe and acceptable to women and it does not require anesthesia."

There's also emergency contraception, which can prevent pregnancy after unprotected sex with increased doses of certain hormones or by inserting a copper intrauterine device (IUD) within five to seven days after sex. The IUD is not a method of abortion because it acts by preventing the fertilized egg from implanting in the lining of the uterus, which is required for a successful pregnancy.

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