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THE ‘ABORTION PILL’: RU486
The fact that a tablet capable of inducing abortions has been produced should not be surprising. We have developed pills and devices for preventing pregnancies, and safe efficient operations for terminating them. Yet the concept of an abortion pill has stirred a great deal of passionate debate on both sides of the fence.
Those against the idea worry (among other things) about the easy availability of abortion and that if it was done with a pill, rather than an operation, then people may take the issue less seriously, and the value of human life would suffer. There is concern about its safety and long-term effects, as with all new medications. It is currently being trialled in several centres around the world to establish its best use. Those in favour of the abortion pill argue equally vehemently, saying that if it is safe it should be available as an alternative to surgical abortion.
The pill itself is a very potent anti-progestogen, which means it acts in the opposite way to the naturally occurring progestogens, such as progesterone. If there is a pregnancy in the uterus, the action of RU486 is to oppose the normal pregnancy hormones so the pregnancy cannot continue and the products of conception are expelled. This will usually happen two to three days after taking the pill. It is usually given together with another drug, a prostaglandin, which acts to help dilate the cervix and contract the uterus. It seems that some of the side-effects, in particular some of the more serious, rare, life-threatening problems encountered so far, have been related to the prostaglandin rather than RU486.
Although studies have shown it to be effective at producing abortion, the possible problems with a pill-induced termination are similar to those of a surgical termination, such as an incomplete emptying, or an ongoing pregnancy. There can occasionally be heavy bleeding. There are no anaesthetic risks, and less risk of introducing infection, but the risks involved with the accompanying prostaglandin need to be further evaluated, it seems.
The side-effects of RU486 include nausea, vomiting, breast tenderness, and cycle disturbance.
Studies are being done to see if RU486 may have a place as a morning-after pill, like the currently used regimen of the oral contraceptive pill. It is also being trialled as a menstrual regulator, which means that it may be taken once a month, or if the period is delayed, without a pregnancy being confirmed.
RU486 is widely used in several other countries. The role of RU486 in Australia is not (at the time of writing) fully defined. When the dust settles from the inevitable bunfight that accompanies any development in reproductive medicine, it will be interesting to see how we use it, if at all.
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