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    'Medical Abortion' Regimen Is Not a Simple One


    The Population Council, the New York-based organization that holds the patent on mifepristone, says the bleeding can sometimes linger in a spotty fashion for up to three weeks, and patients may experience nausea, vomiting, and diarrhea, as well. But for most, those side effects will be short-lived.

    "Within 24 hours after misoprostol, almost 90% of women have their abortions," says Vicki Saporta, executive director of the National Abortion Federation.

    While many abortion providers will probably opt to administer both drugs under office supervision, Moore says some will allow patients to take the misoprostol at home. Suzanne Trupin, MD, medical director of Women's Health Practice in Champaign, Ill., says many patients will abort within four hours of using misoprostol and may be kept in the office for that period of time. If sent home, she says, the patient must be accompanied by someone and should have access to emergency transportation.

    In any case, all patients are expected back for a follow-up appointment two weeks later to make sure the pregnancy is actually over -- something that is verified with an ultrasound.

    As for what the misoprostol expels, at seven weeks into a pregnancy -- which is the latest time at which a medical abortion is now recommended -- the embryo is about the size of a marble.

    Mifepristone's effectiveness wanes beyond that seven-week period because the placenta -- not the uterus -- begins secreting progesterone, and at levels that are potentially too high for mifepristone to block. But Creinin says there are plenty of data to justify the use of mifepristone nine and even 10 weeks into a pregnancy -- if the follow-up dose of misoprostol is inserted into the vagina rather than taken by mouth.

    Other possible alterations to the regimen include reducing the number of mifepristone tablets and shortening the interval between the two drugs. "There are tons of studies showing one tablet is effective" instead of the recommended three, Creinin says, adding that "if you could shorten the regimen, the woman has less time for the whole process to conclude, and less time to have side effects."

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