Excessive Uterine Bleeding Inevitable When RU486 Used

By Joel Brind, Ph.D.

Faced with the undeniable fact that there is often considerable bleeding among women who use RU486 to induce an abortion, those who successfully sought approval of this two-drug chemical abortion technique from the Food and Drug Administration (FDA) argued that bleeding always occurs after an abortion, even spontaneous abortions (miscarriages).

But this backhanded concession to the truth ignores the larger and for more significant point: women bleed much more heavily when they use the RU486 technique than they do with any other type of abortion. As one participant in the American clinical trials in 1994 told Time magazine: "it was like turning a water jug upside down." In fact, one participant almost bled to death, a serious "complication" that received scant attention.

This is not some rare idiosyncratic drug reaction. Rather, excessive uterine bleeding is not only a universal side effect of an RU486 abortion but it is also directly traceable to the known biological activities of both drugs. In other words, the bleeding that was found both in France in the early 1990s and in the closely monitored American trials in the late 1990s is not some unexpected "accident." It is an entirely predictable consequence.Why? This requires a brief examination of how RU486 works, bearing in mind that an "RU486" abortion includes the use of RU486 and a prostaglandin, typically Cytotec. (See story, page 13).

The artificial hormone RU486 blocks the action of progesterone, a naturally occurring hormone that is needed to maintain the connection between the uterus and the placenta - - the baby's life-support system. When RU486 is introduced into the mother's bloodstream, the result is the death of the baby by asphyxiation.

Please note that, structurally, progesterone is very similar to the hormone cortisol. Essential for life, cortisol is a hormone made by the adrenal glands.

Unfortunately, RU486 is just as effective in blocking the action of cortisol as it is in blocking the action of progesterone. When it temporarily neutralizes the effect of cortisol in the mother's body, RU486 causes problems which can become life- threatening to the mother, as we shall explain below.

The role of cortisol is most critical in times of stress. When any severe injury causes a substantial loss of blood, adrenalin (the fast-acting stress-response hormone) acts to constrict blood vessels. This restricts blood flow to the wound site and prevents a drastic fall in blood pressure.

What makes the muscular walls of the arteries responsive to adrenalin? You guessed it: cortisol.
To recapitulate: when RU486 disrupts the placental connection and kills the baby, a gaping hole is opened in the endometrium (uterine lining), resulting in massive bleeding. The adrenal glands' role is to produce adrenalin in response to this hemorrhage. However, because RU486 also neutralizes cortisol, its ability to slow the bleeding is substantially reduced.

Compounding the threat to the mother is that the second component of the RU486 procedure--the prostaglandin drug Cytotec (misoprostol)--also exerts an effect that is antagonistic to cortisol.
Misoprostol causes blood vessels to dilate, a widening of blood vessels known as vasodilation. This worsens the impact of the decrease in blood pressure caused by loss of blood.

In addition, misoprostol exacerbates the loss of fluid from the circulatory system. (In medical jargon this is known as an increase in capillary permeability.) Because of these dual actions, bleeding in an RU486 abortion usually remains profuse for days. Sometimes this loss of blood becomes life-threatening.

Thus it is not surprising that prolonged uterine bleeding is widely experienced by women who undergo RU486 abortions. In the French clinical trials of almost 900 women in 1991-92, the average bleeding time was 10 days, sometimes extending as long as 32 days.

One woman need surgery to stop the bleeding only four hours after the abortion. Another woman needed a transfusion when-- nine days after the abortion--she was found to have lost more than half her blood.

Hence, the near-death experience of one woman in the American trials was not some sort of rare anomaly but a side effect that could/should have been expected.

Joel Brind, Ph.D., is a professor of human biology and endocrinology at Baruch College of the City University of New York, and founder and president of the Breast Cancer Prevention Institute in Poughkeepsie, NY. The institute can be contacted toll-free at 1-86-NO CANCER. (1-866-622-6237).