Mifepristone_ecfactsheet.pmd

What You Need to Know
The 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 help
prevent pregnancy; medical abortion terminates an
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.
pills (ECPs)?
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.
Medical Abortion
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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