RU486 more complex than the pill


September 15, 1992|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

RU486, the French birth control method, has not been approved for use in the United States, despite considerable lobbying from women's groups and segments of the medical community.

It came to international attention again this summer when a woman was stopped from bringing it into this country in her luggage. She was seven weeks pregnant and planned to take "the French pill" to end the pregnancy, but the medication was confiscated at the airport. Her goal was to rally support for RU486, but the resulting publicity may have done more harm than good.

It did not provide all of the facts about a complicated and controversial subject.

* Q: What is all the fuss about RU486?

A: Unfortunately, there seems to be little understanding in this country about what RU486 is. It is primarily used as the first step in a course of treatment that ends pregnancy up to seven weeks after conception. The name is merely the manufacturer's identification code. The trade name is mifepristone.

Q: So it's not a pill that women carry around to take when they think they may have gotten pregnant?

A: Not at all. This is not self-medication. The first step in the process is a visit to a doctor or clinic to confirm that the pregnancy is at seven weeks or less. Then, the woman is counseled about the RU486 process and given the pill, after which she goes home. Within 36 to 48hours she returns for an injection or suppository of another medication (prostaglandin), and abortion usually occurs within 12 to 24 hours.

Q: What makes this whole process work?

A: The hormone progesterone is required for the embryo to be implanted in the uterus. RU486 works against that hormone. However, it is not effective enough to end the pregnancy without second hormone (prostaglandin) which causes contraction. So taking the RU486 pill is the first step. The second step is to take the prostaglandin, which causes the embryo to be expelled.

Q: How effective is it?

A: About 100,000 French women have used the RU486 method with a success rate of about 96 percent.

Q: Are there side effects?

A: Incomplete abortion or excessive bleeding occur in about 4 percent of cases. Also, there have been some cardiac problems associated with the prostaglandin stage. These potential complications are why a physician's supervision is mandatory. The other side effects are those normally associated with a spontaneous cessation of pregnancy.

Q: Will RU486 be approved for use in the United States?

A: It's impossible to foresee the future of the French method in this country. Although it is licensed for research here, the manufacturer has no plans to market the drug in the United States. The British use it and are considering expanding its applications into the second trimester of pregnancy. But there are complicated social issues to be dealt with first in the United States.

Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.

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