RU486: Who Should Avoid It and Its Side Effects

RU486 issue

Hello, doctor: May I ask what medical conditions should avoid taking RU486, and what are its side effects? Is palpitations considered a heart disease? Can someone with palpitations take RU486? What is prostaglandin? Thank you for your response.

Xiao V, 20~29 year old female. Ask Date: 2008/04/29

Dr. Dai Qihan reply Obstetrics and Gynecology

RU486 is a multipurpose medication, but current discussions primarily focus on its side effects when used as an abortifacient.
These side effects can be categorized into two types: those related to the abortion process and those associated with the medication itself.

1.
Pain: Reports from studies conducted in the United States indicate that over 90% of women experience lower abdominal cramping after using RU486, particularly following the administration of prostaglandins.
Women who are more than 7 weeks pregnant tend to report more severe pain, although most women describe their pain as only slightly more intense than menstrual cramps.
Generally, the pain caused by RU486 and prostaglandins can be managed with oral analgesics; however, if oral pain relief is insufficient, it is important to investigate for potential complications such as incomplete abortion, ectopic pregnancy, or uterine inflammation.
2.
Bleeding: This is a significant concern for both women and healthcare providers.
Current data from various studies on RU486 show considerable variability in the timing and volume of bleeding.
Large-scale studies indicate that less than 1% of women may experience excessive bleeding requiring blood transfusions or surgical intervention.
Therefore, women should be advised to seek immediate medical attention if they experience heavy bleeding or symptoms such as rapid heartbeat, dizziness, or confusion after taking RU486.
3.
Failure or Incomplete Abortion: Research indicates that while the success rate of RU486 is between 80% and 90%, some patients may still experience failure.
Reasons for failure may include advanced gestational age or insufficient dosage of prostaglandins.
Surgical curettage is the standard response to such failures.
4.
Gastrointestinal Discomfort: Gastrointestinal side effects are primarily attributed to the use of prostaglandins, with oral administration causing more discomfort than vaginal suppositories.
Symptoms may include nausea, vomiting, and diarrhea, which typically resolve on their own without special treatment.
5.
Headaches or Dizziness: Headaches or dizziness are generally mild and do not require special treatment unless they are due to significant blood loss.
6.
Endometritis: Both surgical abortion and the use of RU486 can lead to endometritis; however, the incidence of endometritis is lower with RU486 compared to surgical methods.
If prolonged pain and fever occur, endometritis should be suspected, and appropriate antibiotics should be administered.
7.
Ectopic Pregnancy: This is not classified as a "complication" but rather a critical consideration; RU486 should not be used unless a confirmed intrauterine pregnancy is established.
Careful medical history and examination by a healthcare provider are essential to avoid ectopic pregnancy.
The use of RU486 (in conjunction with prostaglandins) for medical abortion must be monitored by a qualified obstetrician-gynecologist throughout the treatment process to manage complications or side effects and ensure complete abortion, thereby safeguarding the patient's health and safety.

Reply Date: 2008/04/29

More Info

RU486, also known as Mifepristone, is a medication primarily used for medical abortion. It works by blocking the hormone progesterone, which is necessary for pregnancy to continue. While RU486 can be an effective option for terminating a pregnancy, it is essential to understand its contraindications, potential side effects, and the specific health conditions that may preclude its use.

Who Should Avoid RU486?
Certain medical conditions and situations may contraindicate the use of RU486:
1. Ectopic Pregnancy: RU486 is not effective in cases of ectopic pregnancy, where the embryo implants outside the uterus. This condition can be life-threatening and requires immediate medical attention.

2. Adrenal Insufficiency: Individuals with adrenal insufficiency may experience severe complications when using RU486 due to its hormonal effects.

3. Bleeding Disorders: Those with bleeding disorders or those taking anticoagulants should avoid RU486, as it can increase the risk of excessive bleeding.

4. Severe Anemia: Women with severe anemia may be at higher risk for complications from bleeding associated with the abortion process.

5. Intrauterine Device (IUD): If a woman has an IUD in place, it should be removed before administering RU486, as it can interfere with the medication's effectiveness.

6. Allergy to Mifepristone: Any known allergy to Mifepristone or any of its components is a clear contraindication.

7. Certain Heart Conditions: While mild heart palpitations (心悸) may not be classified as a serious heart condition, individuals with significant cardiovascular issues should consult their healthcare provider before using RU486. Heart conditions can complicate the use of medications that may cause changes in blood pressure or heart rate.

Side Effects of RU486
RU486 is associated with several side effects, which can be categorized into those related to the abortion process and those directly related to the medication:
1. Abdominal Pain: A significant number of women experience abdominal cramping, especially after taking the second medication, prostaglandin. This pain is usually manageable with over-the-counter pain relievers.

2. Vaginal Bleeding: Heavy bleeding can occur, and while it is common, women should be aware of the signs of excessive bleeding, such as soaking through two or more pads in an hour for two consecutive hours.

3. Nausea and Vomiting: These symptoms are often associated with the use of prostaglandins, which are typically administered after RU486 to complete the abortion process.

4. Diarrhea: Gastrointestinal upset can occur, particularly after taking prostaglandins.

5. Headaches and Dizziness: These symptoms are generally mild but can occur as part of the body's response to the medication.

6. Infection: There is a risk of infection following the use of RU486, especially if the abortion is incomplete.

7. Emotional Responses: Some women may experience emotional side effects, including feelings of sadness or anxiety, which can be exacerbated by the circumstances surrounding the abortion.

Prostaglandins
Prostaglandins are a group of hormones that play a crucial role in the abortion process when used in conjunction with RU486. They help to soften the cervix and induce uterine contractions, facilitating the expulsion of the pregnancy. Commonly used prostaglandins include Misoprostol, which can be administered orally or vaginally.

Conclusion
In summary, while RU486 can be a safe and effective option for medical abortion, it is crucial for individuals to consult with a healthcare provider to assess their medical history and any potential contraindications. Understanding the side effects and the role of prostaglandins in the process is also essential for informed decision-making. If you have any concerns or specific health conditions, discussing them with a qualified healthcare professional is the best course of action.

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