the Challenges of Ru486: What to Expect and Next Steps

RU486 failure

Hello Doctor, I took Ru486 on January 13 (Thursday) at 11:20 AM, and then I took the second dose (three tablets of Cytotec) at 12:30 AM on January 15.
The next day, I only passed one blood clot and then nothing else, and the amount was minimal.
Today, January 16, I visited an obstetrician-gynecologist, and it was confirmed that I have not fully expelled the contents, and the embryo is still inside.
The doctor prescribed Misoprostol for me, to be taken four times a day.
I would like to ask if Misoprostol is more effective than the previous contraction medication? Is it more harmful to the body than the previous one? Additionally, I would like to know how long it typically takes for this medication to facilitate a complete expulsion.
After taking these medications, will it affect future pregnancies? Thank you for your assistance, Doctor.

Zhen, 20~29 year old female. Ask Date: 2022/01/16

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the success rate of medical abortion is approximately 95%, while the failure rate is about 5%.
The effectiveness of various medications can vary significantly from person to person, and their effects on the body are not always comparable or predictable.
The treating physician will adjust the approach and select the appropriate methods and medications based on the patient's condition.
It is recommended to follow up with your physician for check-ups as scheduled.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2022/01/16

More Info

When considering the use of RU486 (mifepristone) and its subsequent management, it's essential to understand the medication's mechanism, the expected outcomes, and the follow-up steps to ensure safety and efficacy. RU486 is primarily used for medical abortion and works by blocking the hormone progesterone, which is necessary for pregnancy continuation. Following the administration of RU486, a prostaglandin (such as Cytotec, or misoprostol) is typically given to induce uterine contractions and facilitate the expulsion of the pregnancy tissue.

In your case, it appears that after taking RU486 and Cytotec, you experienced minimal bleeding and retained some pregnancy tissue. This is not uncommon, as the effectiveness of these medications can vary among individuals. The follow-up with your obstetrician is crucial, as they can assess the situation and recommend further treatment options.

You mentioned that your doctor prescribed "意如宮錠" (likely referring to a medication like misoprostol or a similar uterotonic agent) to help with uterine contractions. Misoprostol is indeed effective in promoting uterine contractions and is often used in conjunction with RU486 to ensure complete expulsion of the pregnancy tissue. The effectiveness of misoprostol can be higher than that of RU486 alone, as it directly stimulates the uterus to contract.

Regarding the safety and potential side effects of misoprostol, it is generally well-tolerated, but like any medication, it can have side effects. Common side effects include cramping, diarrhea, nausea, and vomiting. The concern about whether misoprostol is "more harmful" than RU486 is context-dependent; both medications have their risks, but when used appropriately under medical supervision, they are considered safe for the intended purpose.

As for the timeline for expulsion after taking misoprostol, it can vary. Many women will experience significant bleeding and cramping within a few hours to a day after taking the medication. However, in some cases, it may take longer for the uterus to expel all the tissue. Your healthcare provider will likely schedule a follow-up appointment to ensure that the process is complete and to check for any complications.

Regarding future pregnancies, the use of RU486 and misoprostol for medical abortion does not typically affect a woman's ability to conceive in the future. Most studies indicate that women can safely become pregnant after a medical abortion without any increased risk of complications. However, it is essential to allow your body some time to recover, and your healthcare provider can give you personalized advice on when it might be best to try for another pregnancy.

In summary, while RU486 and misoprostol are effective for medical abortion, individual responses can vary, and follow-up care is crucial. If you have concerns about the medications, their effects, or your future fertility, do not hesitate to discuss these with your healthcare provider, who can provide tailored guidance based on your specific situation.

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