What You Need to KnowThe Difference Between Medical Abortion and
Emergency Contraceptive Pills
There is considerable confusion, even among experienced
oral contraceptives taken in increased doses also may be
health care providers, about the difference between
used as ECPs. Mifepristone has also been shown to be
medical abortion (also known as “medication abortion”)
effective for emergency contraception, but is not approved
and emergency contraceptive pills (also known as
“morning-after pills”). Emergency contraceptive pills helpprevent
pregnancy; medical abortion terminates
American College of Obstetricians and Gynecologists. Statement on Contraceptive
Methods. Washington, DC: ACOG; 1998.
US Department of Health and Human Services. Code of Federal Regulations.
According to general medical definitions of pregnancy
that have been endorsed by ARHP, the American College
Creinin MD, Aubény E. Medical abortion in early pregnancy. In Paul M,
Stubblefield PG, Grimes DA, et al, eds. A Clinician’s Guide to Medical and
Surgical Abortion. New York: Churchill Livingstone; 1999.
Department of Health and Human Services,2 pregnancy
Schaff EA, Fielding SL, Eisinger SH, et al. Low-dose mifepristone followed by
begins when a pre-embryo completes implantation into
vaginal misoprostol at 48 hours for abortion up to 63 days. Contraception2000;61(1):41-46.
Grimes DA, Creinin MC. Induced abortion: an overview for internists. Ann InternMed 2004;140(8):620-626.
What is medical abortion?
Wiebe ER, Dunn S, Guilbert E, et al. Comparison of abortions induced bymethotrexate or mifepristone followed by misoprostol. Obstet Gynecol
Medical abortion is the use of medications that can induce
abortion. Currently three treatment regimens are available
Peyron R, Aubény E, Targosz V, et al. Early termination of pregnancy with
in the United States for this purpose: mifepristone
mifepristone (RU 486) and the orally active prostaglandin misoprostol. N Engl JMed 1993;328:1509-1513.
combined with misoprostol, methotrexate combined with
Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with
misoprostol, and misoprostol by itself.3,4 Regimens that
mifepristone and misoprostol in the United States. N Engl J Med 1998;338:1241-1247.
contain mifepristone and misoprostol are more commonly
Aubény E, Peyron R, Turpin CL, et al. Termination of early pregnancy (up to 63
used because they are more effective and predictable.5,6
days of amenorrhea) with mifepristone and increasing doses of misoprostol. Int J
Mifepristone is also known as RU-486 or Mifeprex®. In the
Fertil Menopausal Stud 1995;40(suppl):85-91.
small percentage of cases in which medical abortions fail,
Kahn JG, Becker BJ, MacIsaac L, et al. The efficacy of medical abortion: a meta-analysis. Contraception 2000;61:29-40.
surgical abortion procedures are required to end the
el-Refaey H, Rajasekar D, Abdalia M, et al. Induction of abortion with mifepristone
and oral or vaginal misoprostol. N Engl J Med 1995;332:983-987.
Ellertson C, Evans M, Ferden S, et al. Extending the time limit for starting the
What are emergency contraceptive
Yuzpe regimen of emergency contraception up to 120 hours. Obstet Gynecol2003;101:1168-71.
Piaggio G, von Hertzen H, Grimes DA, et al. Timing of emergency contraceptionwith levonorgestrel or the Yuzpe regimen. Task Force on Postovulatory Methods of
Women may use ECPs as a means of preventing
Fertility Regulation (letter). Lancet 1999;353:721.
pregnancy after unprotected intercourse. ECPs are
von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimensof levonorgestrel for emergency contraception: a WHO multicentre randomized
especially useful in cases of unanticipated sexual activity,
contraceptive failure, or sexual assault. ECPs contain
U.S. Food and Drug Administration. Questions and Answers on Mifeprex
hormones that reduce the risk of pregnancy if started
(mifepristone). August 2007. Available at www.fda.gov/cder/drug/infopage/mifepristone/qa2007.htm. Accessed on February 26, 2008.
within 120 hours (5 days) of unprotected intercourse. The
Guillebaud J. Time for emergency contraception with levonorgestrel alone. Lancet
treatment is more effective the sooner it begins. Plan B® is
1998 Aug 8;352(9126):416-7. Erratum in: Lancet 1998 Aug 22;352(9128):658.
currently the only product marketed specifically as an
Van Look PF. Emergency contraception: a brighter future? Entre Nous Cph Den
emergency contraceptive pill in the United States. Certain
Bacic M, Wesselius de Casparis A, Diczfalusy E. Failure of large doses of ethinylestradiol to interfere with early embryonic development in the human species. Am JObstet Gynecol 1970;107:531-4.
Creinin MD, Fox MC, Teal S, et al. A randomized comparison of misoprostol 6 to8 hours versus 24 hours after mifepristone for abortion. Obstet Gynecol 2004;
Schaff EA, Fielding SL, Westhoff C, et al. Vaginal misoprostol administered 1, 2, or
Medical abortion (medication abortion) terminates
3 days after mifepristone for early medical abortion: a randomized trial. JAMA2000;284:1948-1953.
What You Need to Know is a publication of the Association of Reproductive Health Professionals (ARHP) for
health care professionals, educators, and researchers working in the field of reproductive health.
Emergency Contraceptive Pill
Medication Abortion, Methotrexate, Mifeprex®,
The FDA-approved regimen of mifepristone is 600 mg
orally followed 2 days later by misoprostol 400 µg
intercourse.12 Treatment should be initiated as
orally for women up to 49 days’ gestation. A small
soon as possible after intercourse, because
percentage (2% to 5%) of women may abort before
efficacy declines substantially with time.13,14
taking misoprostol,7,8,9 so it is reasonable to administer
Rh immune globulin to appropriate patients at the time
levonorgestrel in a single dose or in two doses
of 0.75 mg taken up to 12 hours apart.
Evidence supports the safety and efficacy for women up
to 63 days’ gestation with use of vaginal misoprostol.10
For women beyond 49 days’ gestation, the use of
vaginal, rather than oral, misoprostol increases the
Mifepristone ends pregnancy by blocking the hormones
Depending on the time during the menstrual
necessary for maintaining a pregnancy. Methotrexate is
cycle that they are taken, ECPs may inhibit or
a folic acid antagonist and damages the rapid growth
delay ovulation, inhibit tubal transport of the
of the chorionic villi, which, in turn, effectively dislodges
egg or sperm, interfere with fertilization, or
the pregnancy from the uterus. Misoprostol causes the
alter the lining of the uterus inhibiting
Millions of women around the world have used medical
Among the estimated 850,000 US women who have
used mifepristone for early abortion, seven deaths have
occurred - six from rare infections associated with childbirth
and abortion and one from a ruptured ectopic pregnancy.
ECPs will not induce an abortion in a woman
Six infection-related deaths have been reported to the US
who is already pregnant, nor will they affect
Food and Drug Administration; the death rate is comparable
to that of surgical abortion and miscarriage and lower thanthe death rate from a delivery. It is not known whether usingMifeprex® and misoprostol caused these deaths.15
Medical abortion regimens are highly effective at
Complete abortion will occur in 92-96% of women
who receive the methotrexate regimen. Complete
abortion will occur in 96- 97% of women who receive
intercourse, but the sooner the dosing begins,
Most common side effects are similar to those of a
spontaneous miscarriage (abdominal pain, bleeding,
irregular bleeding, abdominal pain,headaches, and dizziness may occur.Sideeffects are less common using progestin-onlyECPs than combination hormone ECPs.
In the United States, the price of medical abortion ranges
In the United States, the price of ECPs ranges
between $350 and $575, which may include two or
three office visits, testing, and exams.
The Difference Between Medical Abortion and Emergency Contraceptive PillsUpdated April 2008
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