Reversing RU486

Prior to the year 2000, the vast majority of women in the United States who had abortions underwent surgical procedures, the most common being the D&C (dilation and curettage) in the first trimester. In 2000, mifepristone (brand name Mifeprex, previously known as RU 486) was introduced in the United States and was touted as a safe, convenient, nonsurgical abortion option in the first 7-9 weeks of a pregnancy. In eight short years, 25% of the abortions performed prior to nine weeks gestational age were carried out with mifepristone.

Mifepristone is actually the first step in a two drug regimen. It is followed 24-72 hours later by another pill, taken orally or vaginally, misoprostol (brand name Cytotec).

Mifepristone is a progesterone antagonist; it blocks the action of progesterone in the body by binding to progesterone receptors, essentially blocking them from progesterone. Imagine a key that fits into a lock but does not open the lock. That “false key” blocks the true key from opening the lock.

Progesterone, as its name implies—“pro” means for and “gestation” means pregnancy—is the hormone essential for supporting a pregnancy. When the embryo and the placenta are deprived of the nurturing effects of progesterone, they die. The misoprostol finishes the job by causing the uterus to contact and expel the remains.

Mifepristone has been hailed as a great advance for the cause of “choice.” A physician trained in surgical abortion procedures, usually a gynecologist, is necessary to perform a surgical abortion. However, a nurse practitioner, physician assistant or any physician can prescribe mifepristone. Clinics lacking surgical abortionists can still offer medical abortions.

Fortunately, we have found a potential antidote to counteract the mifepristone. Since mifepristone exerts its effect by blocking progesterone receptors, increasing the circulating progesterone levels can allow the progesterone to out-compete the mifepristone. In a way, the army with more soldiers wins. Returning to the key analogy, the more “true keys” you have, the better the chance one will get into and open the lock.

Dr. Mary Davenport and I recently published a case series report in the peer-reviewed medical journal, Annals of Pharmacotherapy. In that article we describe six cases of pregnant women who had taken mifepristone but changed their minds prior to taking the second drug, misoprostol.

Four of the six patients who took supplemental progesterone delivered term, healthy infants. There were no birth defects and no complications. For these women, there was truly a second chance.

There were no significant side effects in the mothers or their babies. All of the women were satisfied and very happy to have had the opportunity to attempt to reverse the mifepristone.

In order to try to help more women, at Culture of Life Family Services (COLFS), we have established a program called Abortion Pill Reversal, under the direction of Debbie Bradel, R.N. Building on our experience with the initial series of women who took progesterone to reverse mifepristone, we developed a protocol that we and other medical professionals can follow in future attempts to reverse the effects of mifepristone.

Besides the protocol, the centerpiece of the program is an outreach website,www.abortionpillreversal.com. A woman who has taken mifepristone and who has changed her mind can visit the site and read about the use of progesterone as a potential antidote. If she wants more information, she can call our toll free number and speak to Debbie or one of our other counselors.

Time is of the essence. The next step is to quickly connect the woman with a pro-life doctor in her area who can start the progesterone treatment as soon as possible. That physician will typically assume care of the patient during the abortion pill reversal process. If the embryo survives, the progesterone can be continued throughout the first trimester of the pregnancy and then decreased, following the protocols of Dr. Thomas Hilgers, the founder of NaProTECHNOLOGY. After the first trimester the woman can stay with the treating doctor or transfer to an obstetrical professional of her choice.

We are currently trying to expand our roster so that we can have physicians from every area of the country registered in our network. Most of the physicians who have joined our network thus far are trained in NaProTECHNOLOGY and, therefore, have experience using progesterone in attempts to prevent miscarriages.

For physicians not as familiar with the use of progesterone, we are planning educational, web-based seminars to explain the progesterone protocol we have developed. Additionally, we will provide needed forms and details on supplies that are needed in the office. We will also offer consultative services until they are very comfortable with the protocol.

Our goals for the future are manifold. First, we want to help as many women as possible that have changed their minds. Second, we want to verify that progesterone is, indeed, effective at reversing the effects of mifepristone. Third, we want to educate as many medical professionals as possible so that a woman who has changed her mind can go to any women’s medical care office or emergency department and be treated rapidly and effectively.