The Month-After Pill

By Jamie Murphy.

It is being heralded as the long-sought, safe, morning-after pill. But there is a difference: it is really a month-after pill. A team of doctors from the Hopital de Bicetre near Paris reported in last week's New England Journal of Medicine that a substance known as RU 486, taken within ten days after a missed period, effectively terminates pregnancies without causing any major side effects.

In tests supervised by Dr. Beatrice Couzinet and Dr. Gilbert Schaison, 100 women volunteers who were less than a month pregnant were given RU 486. Of these, 85 aborted within four days, largely without the discomfort and psychological problems that can accompany other forms of abortion. Because of these remarkable results, the drug is expected to be approved for use in + France and Sweden as early as next spring. In the U.S., where abortion is hotly debated, the drug's future is less certain. John Willke, the president of the National Right to Life Committee, has already referred to the drug as "chemical warfare against the unborn."

RU 486 works by adhering to certain hormone receptors in the uterus that under normal circumstances accept progesterone, the substance that prepares the uterine lining to receive a fertilized egg. Because the presence of RU 486 blocks the action of progesterone, the uterine lining sloughs off, and the embryo is expelled, as an unfertilized egg is during a normal period. Although bleeding is usually heavier than during menstruation, only a pregnancy test prior to receiving the drug will tell a woman for certain whether she has actually conceived.

The psychological consequences of this uncertainty can be significant. "We call it contragestation, not abortion," says Couzinet. "Many women think of it as an induction of a menstrual period. Compared with classical abortion, the procedure is so much better tolerated emotionally by women." RU 486 is expected to be a boon to victims of rape and incest, and to women who cannot, or do not, take the pill -- "especially," says Couzinet, "young women and teenagers whose sexual activity is very irregular and infrequent."

Part of the reason RU 486 appears to cause so few side effects is that it remains in the body for less than 48 hours. In addition, it apparently does not impair fertility. One woman in the test group took RU 486 one month, aborted, then became pregnant again and came back for another dose the next month. No information is yet available on what effect RU 486 might have on the fetus if the drug fails to induce abortion; all of the 15 women who sustained their pregnancies after receiving the drug had clinical abortions. Dr. Couzinet hopes to improve the success rate of RU 486 even further by mixing it with small amounts of prostaglandins, biological compounds that cause the uterus to contract and help expel the embryo. That combination, the French researchers say, should provide a 100% effective form of after-the-fact birth control. "There are between 40 million and 50 million abortions performed annually around the world," Couzinet says. "If we have found a safe, convenient medical method of terminating pregnancy, I think it will turn out to be very important."

With reporting by B.J. Phillips/Paris