RU-486 (mifepristone), also known as the abortion pill, can end a pregnancy up to nine weeks from a woman's last menstrual period.  It stops the hormones of pregnancy from working and ends the pregnancy process.  During the following two days after taking the abortion pill, a woman will take a second medication, Cytotec (misoprostol), which causes a miscarriage by making the uterus contract.  Typically patients experience two to four hours of cramping and bleeding.  Over 95% of women who have chosen to end their pregnancies with this medication would choose it again or recommended to a friend.  RU-486 works the first time for up to 98 out of 100 women who take it. It was approved by the FDA in September of 2000.  The medication does not in any way hamper future pregnancies, because it passes quickly and completely from your body shortly after you take it.

Q: WHAT IS A NON-SURGICAL ABORTION?
A: A non-surgical or medical abortion is a method for ending a woman's pregnancy without surgery. In the United States, the conventional, more common method for performing an abortion is a surgical procedure called a dilation and curettage or D&C. A surgical abortion is simple and quick. In a very small percentage of surgical abortions, however, certain risks and complications can occur, which are related to the surgical procedure. With a medical abortion, however, there is no surgery, and therefore these complications are avoided. Instead of surgery, medications are administered which cause the body to abort the pregnancy, very like a miscarriage.

Q: WHEN IN PREGNANCY IS MEDICAL ABORTION POSSIBLE?
A: Medical abortion is recommended only in early pregnancy. Medical abortion can be done as soon as the pregnancy is confirmed up until 56 days (8 weeks) after the first day of the last normal menstrual period. It is important that a woman confirm a pregnancy as soon as possible if she wants to consider medical abortion.

Q: HOW LONG DOES THE MEDICAL ABORTION PROCESS TAKE?
A: Medical abortion involves several steps and requires at least two office visits. During the first visit, you will have an ultrasound examination to confirm the length of the pregnancy. If you qualify for the medical abortion you will  take the first medication (mifepristone). The second medication (misoprostol) is placed into the mouth between the gums and cheeks one or two days later. The abortion usually occurs within 4 hours after inserting the second drug, but it can take 24 hours or longer. In a very small number of cases, the woman may need to return to the office for another dose of medication. A final visit is required within the next 2 weeks for a checkup.

Q: HOW EFFECTIVE IS MEDICAL ABORTION?
A: Medical abortion is about 98% effective. This means that approximately 98 out of 100 women who take the medications will have a complete abortion with no further medical treatment. In the 2 out of 100 cases in which abortion does not occur or is not complete, a vacuum abortion procedure is required. Once a medical abortion has been started, it must be completed, because the drugs used for medical abortion could cause birth defects.

Q: WHAT WILL THE BLEEDING BE LIKE, AND HOW LONG WILL IT LAST? 
A: The amount and length of bleeding after medical abortion is different for each woman.  The amount and length of bleeding depends on how far along the pregnancy is. The length of the pregnancy is easily determined by ultrasound.  There is usually more bleeding and cramping than during a heavy period. Women typically report some amount of bleeding for about two weeks after taking the medications.

Q: WHAT HAPPENS AFTER A MEDICAL ABORTION?
A: Medical abortion has no long-term effects on a woman's health. Fertility returns quickly-ovulation is likely within the first two or three weeks after the abortion, or sooner, with a normal menstrual period expected about two weeks after that. Because fertility returns so rapidly is important to begin using an effective family planning method immediately.

Q: IS THERE AN ALTERNATIVE TO MEDICAL ABORTION?
A: Vacuum aspiration abortion, also called surgical abortion, is possible during early pregnancy and also can be used after the 9-week cut off point for medical abortion.

Q: IS MEDICAL ABORTION THE RIGHT CHOICE FOR ALL WOMEN?
A: Most women will have their own perspective on the advantages and disadvantages of different abortion options. Some women who choose medical abortion say that they wish to avoid surgery and anesthesia, have a more "natural" and less invasive" experience, and participate in the process more actively. Women who choose vacuum abortion say that they like the method's speed, simplicity, and effectiveness without out the need for the additional office visits.

Q: WHEN CAN THE NON-SURGICAL ABORTION BE PERFORMED?
A: In order to have a medical abortion with RU-486, you must be less than 9 weeks from the first day of your last normal period, or less than 7 weeks from the time of conception. Dr. Brandeis will do an ultrasound to confirm that you are early enough in the pregnancy to have a medical abortion and your medical history will be reviewed to be sure you medically qualify.

Q: WHAT MEDICATIONS ARE USED?
A: Mifepristone (Mifeprex) also known as RU-486 is the only FDA approved pill for ending early pregnancy. RU-486 is given at the time of the first visit. RU-486 is a hormone which works by blocking the action of progesterone, a hormone needed to maintain pregnancy.
Misoprostol is given either the same day or in the following two days. The misoprostol causes the cervix to open and the contents of the uterus to expel, thus effecting a miscarriage.

Q: HOW IS A MEDICAL ABORTION DONE?
A: After Dr. Brandeis confirms through lab work, a medical history, an examination and ultrasound that you are eligible for a medical abortion, the actual procedure for the medical abortion will proceed as follows:

Day 1:
You will receive the RU-486 pill.

Day 2 or 3:
The tablets can be inserted either on day two or three. The decision to use the misoprostol tablets either the same day or on day two or three is the patient's choice. The majority of patients will abort about four hours after the Misoprostol tablets are inserted.

Day 7 through 14:
A follow-up visit at the office is necessary to determine that the abortion is complete. This visit will include a pelvic exam, an ultrasound, and possibly a blood test to check the level of pregnancy hormone in your blood.

Q: DOES THE PROCEDURE ALWAYS WORK?
A: RU-486 is up to 98% effective in inducing abortion during the first 8 weeks of pregnancy. It has close to the same level of effectiveness as a surgical abortion performed during the early weeks of pregnancy. In the unlikely event that the medical abortion process does not satisfactorily terminate the pregnancy, the patient will talk with Dr. Brandeis about choices, including a surgical abortion to ensure the abortion is complete.

Q: WHAT ABOUT LONG-TERM HEALTH RISKS?
A: Extensive clinical tests since 1990 have not revealed any evidence of long-term health effects on women who use RU-486, and such effects appear unlikely given the very short time women are exposed to the drug. One of the reasons doctors like RU-486 is that it metabolizes quickly and is soon out of the system. Studies show that half the dose has left the body 20 hours after being taken.

Q: WHAT ARE THE ADVANTAGES OF THE NON-SURGICAL ABORTION?
A: Pregnancy termination with RU-486 is non-surgical, requires no anesthesia, and puts women at no risk of perforation (damage to the uterus) or infection from surgical instruments. Patient satisfaction is very high. According to a recent study, 96 percent of women who have used RU-486 would recommend the method to others.

Q: WHAT ARE THE DISADVANTAGES OF THE NON-SURGICAL ABORTION?
A: RU-486 is only effective during the first 9 weeks of pregnancy. RU-486 takes longer than a surgical abortion. A surgical abortion is done in 10-15 minutes. RU-486 requires two trips to the doctor's office.

Q: IS THE NON-SURGICAL PROCEDURE PAINFUL?
A: Approximately two to four hours after the insertion of the misoprostol into the vagina there is an onset of lower abdominal cramps and vaginal bleeding. In most cases, the discomfort of lower abdominal cramps is relieved by the administration of Motrin or a stronger pain medication such as Percocet.

Q: WHO DOES NOT QUALIFY FOR A MEDICAL ABORTION?
A: A medical abortion is not recommended if you:

. are more than 56 days pregnant
· take anti-clotting medication or have blood-clotting disorders
· have severe heart, liver, or active inflammatory bowel disease
· have certain severe kidney problem
· have a serious immune system problem, such as HIV
· have seizures more than once a week
· take any medicine that should not be combined with methotrexate, mifepristone, or misoprostol
· cannot return for follow-up visits
· have a tubal pregnancy
· have an intrauterine device (IUD) in place (it must be removed before taking RU-486)
· have problems with adrenal glands
· have been treated with certain steroid medications for a long time
· had an allergic reaction to RU-486, misoprostol, or similar drugs
· are unwilling or unable to have a surgical abortion if the medical abortion is incomplete or not successful

Q: HOW MUCH DOES THE PROCEDURE COST?
A: The non-surgical procedure is $470. This includes the initial consultation, the preliminary ultrasound to determine the exact weeks and location of pregnancy, and the cost of the medications used in the office such as the RU-486 and the misoprostol. The $470 also includes all follow-up visits in the Brandeis Medical Center to ensure a completion of non-surgical abortion. The $470 also includes any surgical procedure performed in the Brandeis Medical Center as a follow-up of the non-surgical abortion. The $470 does not include any services performed outside the Brandeis Medical Center or by any other provider other than Dr. Brandeis. If the initial consultation and preliminary ultrasound is not conclusive of the pregnancy in the uterus at an appropriate gestational age there might be an additional cost to determine the location of the pregnancy prior to administering the RU-486. There is a $65 additional charge for an injection of RhoGam, a medication prescribed for patients whose blood type is Rh negative.

Q: WHAT IS THE MORNING-AFTER-PILL?
A: The Morning-After-Pill refers to the use of high dosage birth control pills taken within 72 hours of unprotected intercourse to prevent the pregnancy from occurring.