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Religious Tolerance logo

The RU-486 abortion pill

How it works.
What the expelled embryo looks like.

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How it Works:

In the U.S. the FDA specifies that RU-486 is to be taken within 70 days (10 weeks) into a pregnancy. In Canada, its use is limited to seven weeks. Some countries limit it to nine weeks. 8 It is an antiprogestin. It binds itself to progesterone receptors on the wall of the uterus thus blocking the effect of the woman's natural progesterone. This triggers the shedding of the uterine wall, much like a normal period. RU-486 also opens the cervix, and causes mild contractions which help expel the embryo. The initial dose often causes some nausea, headache, weakness, diarrhea and/or fatigue. It is sometimes taken at home; other times it is taken at a medical clinic.

One or two days later, the woman takes a prostaglandin pill, typically misoprostol (a.k.a. Cytotec). This causes her cervix to soften and dilate. Contractions of her uterus begin. French studies showed that in 54% of the time, the embryo is expelled within 4 hours. In another 22% of cases, it is expelled within 24 hours. She is observed in a clinic for 4 to 6 hours. The medication causes bleeding and deep cramps. Some days later, she returns again for an examination to confirm that the abortion was complete.

There was a general agreement by the year 2000 that the treatment works about 95% of the time. However, after nine months of usage by the Planned Parenthood Federation of America (PPFA), its "success rate" has been found to be in excess of 99%. 1 It is most effective if taken during the first 7 weeks of pregnancy. After 9 weeks, it is less effective and the side-effects are more severe. Bleeding can last up to 9 days (compared with about 5 days for a surgical abortion). Approximately 1% of women will have heavy bleeding which requires additional treatment.

The medication totally fails to cause an abortion in about 1% of the women; about 2 to 3% of women experience an incomplete abortion. They require a follow-up surgical abortion. About 0.1 to 0.2% of the women experience excessive bleeding and require a blood transfusion. 2 Four women of the 2,100 who took part in the initial trials lost sufficient blood to require a transfusion. 3

It is not a simple procedure. It has unpleasant side effects. But many women find it more acceptable than an a conventional early-pregnancy elective abortion which involves surgical intervention and perhaps a one day recovery period. In mid-1998-JUL, the Population Council in New York NY released the results of a survey of 2,121 women who had taken RU-486. Half of the women had previously had a surgical abortion. 77% of those women rated RU-486 "more satisfactory." 90% would prefer the pill if they had another abortion and would recommend it to others. 

Author S. Boyd cited a report published in the Journal of the American Medical Women's Association. The report listed a number of reasons why many women interviewed from "various races, ethnicities, education levels and socioeconomic backgrounds" preferred RU-486 over a surgical abortion:

bullet It seemed more like a natural miscarriage.
bullet It was helpful to have a partner or friend with them during the procedure; this is not allowed at most surgical abortion clinics.
bullet Medical abortion counselors generally spend twice as much time with women as do the counselors for surgical abortions, giving women more time to ask questions and further solidify their abortion decision. 
bullet One study participant said: "The fact that you insert [misoprostol] yourself is a feeling like ... this is my choice ... my decision. There's so much more power in it." 4

It is important to note that Cytotec is being used "off label." That is, it was developed and approved for another purpose, not for use in conjunction with RU-486 to induce an abortion . This means that the woman cannot sue the manufacturer if she regards the medication to be the cause of serious side effects.

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What does the expelled embryo look like?

Part of the RU-486 induced abortion process is the expelling of the developing embryo from the woman's body. This typically happens at home.

As expected, pro-lifers and pro-choicers take different views on how upsetting this is to a woman:

bullet Linda Dean, executive director of the pro-life Women's Resource Center of Southern Nevada, said: "...women can actually pass a part of a fetus at home, when they're not in a clinic or directly under a doctor's care at that time. And psychologically, that can be very disturbing for women." 5
bullet Vicki Saporta, president and CEO of the pro-choice National Abortion Federation, said that women who take RU-486 receive counseling and know what to expect. "When they are prepared for it, most of them say it's like having a heavy period." 5

In an ideal situation, the woman will realize that she may be pregnant when the expected start of her period is delayed by a week or so. She might take a home pregnancy test at that time, find that she is pregnant, visit her doctor or clinic, and take the first RU486 pill. This would terminate the pregnancy, about three weeks after conception. The embryo would be about 1/12" long, the size of a pencil point. It most closely resembles a worm -- long and thin and with a segmented end.

If she delayed the procedure by an extra week, the embryo would have grown to a length of about 1/5", and would resemble a tiny tadpole. The structure that will develop into a head is visible, as is a noticeable tail. The embryo has structures that resemble the gills of a fish in the area that will later develop into a throat.

If she delayed the procedure by two weeks, the embryo would be about 5 weeks after conception. That is approaching the limit beyond which RU-486 is not usually taken. Tiny arm and leg buds have formed. Hands with webs between the fingers have formed at the end of the arm buds. The face "has a distinctly reptilian aspect." 

Another week later, about 6 weeks from conception, It is typically about 1/2" long. The face has two eyes on the side of its head; the front of the face has "connected slits where the mouth and nose eventually will be." 

At 7 weeks, the embryo has almost lost its tail. "The face is mammalian but somewhat pig-like." 6 That is the time limit beyond which RU486 is not generally used. A surgical abortion would normally be indicated at this stage of gestation.

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According to Wikipedia:

"In clinical trials, nearly all women using the mifepristone/misoprostol regimen experienced abdominal pain, uterine cramping, and vaginal bleeding or spotting for an average of 9–16 days. Up to 8% of women experienced some type of bleeding for 30 days or more. Other less common side effects included nausea, vomiting, diarrhea, dizziness, fatigue, and fever. Pelvic inflammatory disease is a very rare but serious complication. Excessive bleeding and incomplete termination of a pregnancy require further intervention by a doctor (such as vacuum aspiration). During clinical trials, between 4.5 and 7.9% of women required surgical intervention.

Mifepristone is contraindicated in the presence of an intrauterine device, as well as with ectopic pregnancy, adrenal failure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-term corticosteroid therapy.

The FDA prescribing information states no data are available on the safety and efficacy of mifepristone in women with chronic medical conditions, and 'women who are more than 35 years of age and who also smoke 10 or more cigarettes per day should be treated with caution because such patients were generally excluded from clinical trials of mifepristone'." 7

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The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. "Planned Parenthood reports widespread satisfaction among patients and providers," Yahoo! Politics, 2001-SEP-24, at:
  2. Tom Carney, "'Abortion pill' test goes awry for one patient," Des Moines Register, 1995-SEP-21. Online at: 
  3. "FDA approves abortion pill in United States," MSNBC, 2000-SEP-28, at:
  4. S. Boyd, "Give us liberty: The approval of RU-486 isn't about morals, it's about optons," at:
  5. Kate Silver , "Abortion pill slips under radar," Las Vegas Weekly, 2002-MAY-16, at:
  6. Carl Sagan, "Billions and Billions", Random House, New York NY (1997), Pages 163-179.
  7. "Mifespristone," Wikipedia, as on 2015-JUL-31, at:
  8. "What is the abortion drug RU 486, and how does it work?," Women's College Hospital, Toronto, at:

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Copyright © 1997 to 2020 by Ontario Consultants on Religious Tolerance
Latest update: 2020-AUG-04
Author: B.A. Robinson

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