Last chance contraceptives and new abortion options: Update on RU486 & Methotrexate

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A fast and easy abortion pill?

To say that it's an abortion pill is a bit of a long shot, as a woman has to go in for at least two doctor's visits before the process is through. But as an abortion practice, RU486 and methotrexate have some advantages over surgical abortions and overall many of the women who have used it prefer this option.

Available in Europe and China since 1989, and scheduled for approval in the United States, RU486 hasn't even been put on the table for approval in Canada. But methotrexate (used commonly in chemotherapy), though not as effective as RU486, is approved for similar use in Canada.

What RU486 and methotrexate do

The steroid hormone progesterone is needed for a newly fertilized egg to become implanted and nourished in the uterus. RU 486 or methotrexate occupies progesterone receptor sites and if the egg has not yet implanted, it blocks implantation, if the embryo is implanted, that embryo is expelled. Implantation of the egg takes approximately six to eight days after fertilization and it takes six to eight days to complete the process. According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), if the methotrexate is given before implantation, it can be considered a "last chance" contraceptive, whereas if given after implantation, it acts as an abortifacient.

How does methotrexate work and what are the side-effects?

The process can be done in a doctor's private office or in a clinic. It should be carried out within the first nine weeks from the last menstrual period, but it is recommended that it is done within the first seven weeks.

Initially the woman gets an injection of methotrexate. Five to seven days later it is followed by a dose of misoprostol (a prostaglandin) taken in pill form or with a vaginal suppository, which she can do herself at home. If the abortion has not occurred after 24 hours, the misoprostol dose is repeated.

Two weeks after, the client must have a follow-up visit with her doctor, to make sure it was complete. If the abortion is incomplete (5% of the cases), a surgical abortion is then recommended.

Side-effects include heavy bleeding and cramping in 80% of the women, nausea, diarrhea, and vomiting in one-quarter to two-thirds of the women. Studies have shown that there are no adverse effects on future fertility.

Conclusions

While the SOGC believes that abortion should not be a primary means of family planning, they recognize there will always be a demand for abortion services. They recognize medical termination of early pregnancy using RU 486 or methotrexate and misoprostol as an effective alternative to surgical abortion. In fact, it is felt that wide availability of RU 486 or methotrexate as an emergency contraception would probably reduce the overall need for therapeutic abortions.

While methotrexate is effective, RU 486 still seems to be the best option for emergency contraception and first trimester abortions, with better success rates than methotrexate. RU 486 will most likely be approved in the US within the next few months, but there is no sign it will be up for approval in Canada in the near future.

As time goes on, demand for medical abortions is undoubtably going to rise. But unfortunately, until RU 486 is approved in Canada, women in this country will only have inferior forms of medical abortion available to them. The SOGC has encouraged medical professionals to support the rapid approval of RU 486 in Canada.

Kemlin Nembhard is a Health Educator at the Canadian Women's Health Network.