Learning more about the French abortion drug

May 24, 1994|By Linell Smith | Linell Smith,Sun Staff Writer

This fall, some American women seeking an abortion will be offered their first alternative to surgery: RU-486, the abortion drug widely used in Europe and China.

The Population Council, a nonprofit contraceptive research organization in New York, holds the American patent rights to the drug. It soon will select sites for clinical trials required by the Food and Drug Administration (FDA) before the drug can be made available to the public. The Population Council expects approval in two years.

RU-486, manufactured by the French company Roussel Uclaf, is also used outside the United States as a contraceptive "morning after" pill which prevents a fertilized egg from implanting in the uterus after unprotected sex. This usage of the drug is being tested now at the University of California, San Francisco.

As an abortion drug, however, RU-486 will be tested in conjunction with a prostaglandin pill; the RU-486, given first, makes the embryo detach from the uterus while the other stimulates the body to expel it. The treatment, given during the early weeks of pregnancy, is painful and usually takes two to three days. A woman visits a doctor several times over the course of treatment.

The benefits of using RU-486 include avoiding surgery and anesthesia, permitting women to terminate pregnancy at an earlier stage and affording them greater privacy. It allows women to obtain an abortion from any physician who is trained in pregnancy and its complications rather than requiring them to travel to centers where surgical abortions are performed. Some women also believe this non-invasive method gives them greater control over their bodies.

A surgical abortion, on the other hand, takes less time, is slightly more effective -- 99 percent compared to 97 percent -- and requires fewer office visits. In addition, women usually experience less cramping and notice a lighter blood flow than they do with RU-486.

The French manufacturer recommends women who are over age 35, who are smokers and who have any other cardiovascular risks should not take RU-486.

The Population Council will conduct its clinical tests on 2,000 women at as many as a dozen hospitals and clinics throughout the country. Women seeking an abortion at these sites will be offered a choice of RU-486 in lieu of surgery.

Until this new treatment becomes more widely used, misconceptions may remain. Dr. George Huggins, chairman of the department of obstetrics and gynecology at Johns Hopkins Bayview Medical Center, one of the institutions applying to serve as a test site, recently considered some basic questions about ++ the drug.

Q: What is RU-486?

A: It's a compound that blocks the functioning of the progesterone hormone. Progesterone is necessary for the maintenance of pregnancy.

L Q: Why is more than one pill necessary to cause an abortion?

A: Prostaglandins cause the uterus to contract and expel the pregnancy. Most of the protocols today include giving prostaglandins one or two days after RU-486.

Q: Must women always take prostaglandins in addition to RU-486?

A: If a woman just uses RU-486, the percentage completing the pregnan

cy termination by themselves is somewhere between 65 and 85 percent.

Q: How long does it take to expel the embryo after taking the prostaglandin pill?

A: Somewhere from six to 12 hours.

Q: How far into a pregnancy can a woman use this method?

A: Up to 54 days from the first day of her last menstrual period.

Q: What are the side effects?

A: There is a small incidence of prolonged bleeding of more than a day or so. Because of the prostaglandins, a fair number of women get nauseated, have diarrhea and headaches while they are going through the abortion process.

Q: What should a woman expect to feel physically?

A: This is a medical abortion, not a heavy period. A woman will have significant cramping and significant bleeding. It's painful enough so that, in one study, 37 percent of the women needed to take some kind of pain medication during the process.

Q: How much will this method cost?

A: I have no idea on cost yet.

Q: What are the benefits of RU-486 over surgical abortion?

A: In some countries, surgical abortions are very expensive. In France and in England, the health system requires that abortions be performed in hospitals and that patients stay overnight. That makes this method much more convenient and less expensive.

The major advantage to this method is in the developing world where many surgical abortions are not clean or are not done with good equipment or the skill of the provider might not be of very high caliber. This will be significantly safer for those women. But that's not true in the United States.

Fortunately in the United States today, surgical termination of early pregnancy is a very safe procedure and has a very low complication rate. Some 90 percent of surgical abortions are done in outpatient facilities and patients go home in a couple of hours.

This new procedure is going to be more time-consuming for the patients than a surgical termination. From a standpoint of cost and convenience, RU-486 is not going to have quite the same advantages as it does elsewhere. . . . I think it's going to be more complicated than surgical termination.

Q: Who do you anticipate will seek this treatment if it becomes available?

A: Most of the women seeking abortions in our [Hopkins Bayview] population are single. In the country, most of the women seeking abortions are married.

We have no idea who this is going to appeal to -- or even whether it will appeal -- to any specific segment of the population.

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