Talk:Mifepristone

Querying the references list

I'm not sure this is the right place to ask this question, perhaps the WPMED Discussion Board is better? I am interested in running a query against the references list to see if any researchers from a specific institution are cited. Is it possible to query a reference list in a Wikipedia article for author affiliation? If yes, I'd like to do this to share the potential impact/reach of research published on this topic from researchers at this particular institution. Would appreciate suggestions! Mcbrarian (talk) 11:29, 20 June 2024 (UTC)

Was it ever called "the morning-after pill"?

A thesaurus I was using listed "morning-after pill" as a synonym for "RU-486." Obviously, what we now call the morning-after pill isn't RU-486 and doesn't have its abortifacient effects, but, supposedly, many people oppose it because they believe it is or does, respectively. If RU-486 had been known by that term, it may be a cause for the confusion about common emergency contraceptives' effects.

I don't even know where to start looking for an answer to this. OB/GYNs? Planned Parenthood? -Dan 04:07, 10 April 2007 (UTC)

It is now available in the U.S. up to 9 weeks (63 days) gestation, (That was changed perhaps in March of 2008, I don't remember exactly what the date was.) Maybe someone should add that update to the page? —Preceding unsigned comment added by 76.197.136.105 (talk) 02:14, 25 October 2008 (UTC)

I suggest this editor looks up his/her sources better, other than a thesauras. The "Morning after pill" is still very much an abortifacient as it does not allow the embryo to continue normal development. —Preceding unsigned comment added by 67.35.127.139 (talk) 11:40, 18 June 2010 (UTC)

Oh, for Christ's sake. The morning after pill doesn't prevent any embryo developing, since its whole intention is to prevent fertilisation or implantation to begin with. That's why you're not supposed to take it more than three days after unprotected sex — after that stage, any implantation that would happen has already happened, and the drug in most Plan B pills will not cause a miscarriage, which is what happens when an implanted embryo "dies" and detaches from the uterus. If you're going to talk about abortifacients, understand what an abortifacient is and how it acts, or else don't display your ignorance in such a manner. Nachturnal (talk) 14:35, 31 May 2011 (UTC)

Image is incorrect

There is a red oxygen in the structure drawn that should have a hydrogen attached to it. That is, it should be depicted as an -OH group, not an -O group. Careless mistake really. Brad219 01:59, 15 May 2007 (UTC)

I've uploaded a new, corrected image file of the correct structure. It is located at http://en.wikipedia.org/wiki/Image:Mifepristone_corrected.png but I do not know how to correct the page to show this image. Could somebody please help me out here? Brad219 02:23, 15 May 2007 (UTC)

New image swapped for old one. Thanks for catching this mistake! -Severa (!!!) 09:14, 15 May 2007 (UTC)

Misoprostol dosage should be in micrograms

Oral misoprostol following mifepristone should be in microgram amounts, not 400 milligrams (mg) as listed under "Approved Uses". Reference can be found at http://www.misoprostol.org/File/dosage_guidelines.pdf. Cpaulsinkhorn 14:43, 26 July 2007 (UTC)

Thank you. Corrected misoprostol dose from mg to µg.

68.255.31.235 15:53, 26 July 2007 (UTC)

Spelling of obstetrics

It can also be used as a treatment for obsetric bleeding.

So says the first para. Shouldnt it be "obstetric bleeding" ? 81.105.245.251 06:20, 31 August 2007 (UTC)

Addition to controversy section

An anonymous editor added the following section:

START QUOTE

Christian physicians Dr. Bruce Rusty Lang, M.D., and Dr. Denise K. Turner, M.D., of Houston's Baylor College of Medicine Department of Community Medicine, wrote in October 1991 BioScience that RU-486 is "less safe, and less effective than vacuum asperation abortion." They cited more than a dozen references from previously published international research data demonstrating that the drug was far less effective and less safe than proponents claimed in the media campaign to legalize the drug in the U.S. A 'Viewpoint' editorial had previously appeared in BioScience which included political framing of the issue as a pretext to legalizing the drug, allegedly for, "freedom of scientific inquiry" in the United States. The political debate over RU-486 had obfuscated the issue so that unfavorable reseach data was being ignored to promote it's legalization. RU-486 AND ABORTION POLITICS.http://links.jstor.org/sici?sici=0006-3568(199110)41%3A9%3C594%3ARAAP%3E2.0.CO%3B2-Q

END QUOTE

This seems to me like it is giving undue weight to one paper some years ago, and it needs cleaning up. Thus, I thought I'd bring it to the Talk page for analysis and have removed it from the main article. Bondegezou (talk) 10:12, 10 December 2007 (UTC)

I have removed this once, and I agree that it is giving undue weight to a rather old paper. It may be appropriate to condense this down to a sentence or two, max, but this much isn't helpful, and in fact harmful to NPOV. Can those who want to include the new content please join us here on the talk page and either help us reach a compromise we can all agree upon, or at the very least, try to defend its inclusion and convince us to change our minds. I'm sure we can work together, but edit warring is only disruptive and goes no where in the long run. Thanks.-Andrew c ^[talk] 04:07, 14 December 2007 (UTC)

I should add that this appears to be a letter to the editor, rather than a peer-reviewed article, from 16 years ago. I'm unable to find it on PubMed, which is odd since BioScience is indexed there and letters often end up on PubMed. Still, it would seem to fall well below the usability horizon, given how much peer-reviewed research is out there. MastCell ^Talk 19:14, 14 December 2007 (UTC)

MY QUOTATION ABOVE

Comment - The BioScience letter on RU-486 authored by myself and Dr. Denise K. Turner is as germane to the discussion of women's health and public health today as it was when the letter was originally published. It includes 16 references from the internationl literature that should not be overlooked by any serious student of the subject. Both the drug and the reseach data noted are unchanged and valid today. The edited QUOTATION should have been placed in the RU-486 "History" subsection. Please pardon my lack of Wikipedia expertise for misplacing it in the RU-486 "Controvery" subsection. I'm a novice Wikipedia contributor. Any editorial suggestions, questions, or criticisms are appreciated and welcome. Thanks. Dr. B. R. Lang (talk) 01:53, 15 December 2007 (UTC)

SUGGESTED INCLUSION for Mifepristone History Subsection ALTERNATE EDIT

In 1991 a "Viewpoint" editorial was published by the American Institute of Biological Sciences in BioScience (41: 370) promoting legalization and liberalized importation of RU-486 into the U.S., ostensibly for the sake of "Freedom of Scientific Inquiry." In response, Dr. Bruce Rusty Lang, M.D. of Houston, Texas' Baylor College of Medicine Department of Community Medicine (and Department of Microbiology and Immunology), and Dr. Denise K. Turner, M.D. of Baylor College of Medicine's Department of Community Medicine, co-authored "RU486 and Abortion Politics" BioScience (Oct. 1991, Vol. 41 No.9), which included sixteen previously published references of data from international researchers which emphasize that the drug is less safe and far less effective than suggested by the highly publicised favorable RU-486 efficacy rate promoted in the popular media. The primary focus of Drs. Lang & Turner's exhaustive study of the RU-486 research literature called for awareness that biased political framing of the social debate was conterproductive to women's health concerns and public health in general, and tends to obfuscate the true merits and dangers of the drug. Ultimately Lang & Turner concluded that the previously published international RU-486 research literature has already clearly established that, "RU-486 is less safe, less effective, and more painful than vacuum aspiration abortion." http://jstor.org/sici?sici=0006-3568(199110)41%3A9%3C594%3ARAAP%3E2.0.CO%3B2-Q

Editing input, suggestions, questions, help, and critique are welcomed. I'll FAX the publication free of charge to anyone interested. Dr. B. R. Lang (talk) 07:52, 15 December 2007 (UTC)

I don't have access to the article right now (I should later in the week). Was it a narrative review or a systematic review? It seems to me that there are subsequent reviews that warrant as much or more coverage, like Kulier et al. (2004, Cochrane Database). In terms of the wording of the suggest edit, it could be abbreviated by focusing on the conclusions of the paper and giving the citation as a footnote: that would make it less than half the above length. Bondegezou (talk) 10:37, 15 December 2007 (UTC)

It's neither a narrative nor a systematic review - the source being promoted here is a letter to the editor, from 16 years ago, and not particularly appropriate for inclusion here per WP:WEIGHT. MastCell ^Talk 06:00, 17 December 2007 (UTC)

I've now read the letter. It's 'on topic', but as a 2-page letter from 1991 in response to something else, which cites a number of papers along the way (some of which I think are already cited directly in the article) but does not present any new data and is not a systematic review, I don't see any reason to include it here. There are better, more recent reviews of both the medical evidence and the political debate. Bondegezou (talk) 12:04, 17 December 2007 (UTC)

The BioScience letter being discussed here was, indeed, a systematic review of the international scientific literature on the subject of Mifepristone. The "letter" cited sixteen INTERNATIONAL references (out of well over 100 references reviewed from reputable international publications) containing data which is currently valid and germane to understanding this drug and the U.S. politics related to it today. Dr. B. R. Lang (talk) 00:29, 29 January 2008 (UTC)

Systematic reviews generally cite well more than 16 references, particularly in a field where much research has been done, and are generally longer than 2 pages. In any case, even if the citation were a comprehensive systematic review from 17 years ago rather than a letter to the editor, it would no longer be presumed to be current or relevant - particularly as a 2004 Cochrane Library systematic review exists. MastCell ^Talk 00:37, 29 January 2008 (UTC)

NPOV

This article is written from an American point of view, it lacks international cohesion. Given that the substance was developed in France, seeing 'Uses outside the United States', 'Outside of the United States it is marketted as', and the heading 'Politics and use outside of the United States' is very, very odd. Perhaps we can have a revision of the article to try and write as though Wikipedia is the international entity it is, and not American? Jachin (talk) 21:55, 4 January 2008 (UTC)

• Comment - I agree completely! A NPOV on this subject would be refreshing, but it does not seem possible. Political framing of this issue in the U.S. has long obfuscated the true merits and dangers of the drug. Mifepriston entries here seem tainted through politically correct censoring and revisions by several U.S. Activist contributors intent upon bolstering their own unscientific personal consensus. It seems to be one of the inherent limitations of this information source. Dr. B. R. Lang (talk) 02:24, 29 January 2008 (UTC)

• Also: "It is a prescription drug, but it is not available to the public through pharmacies; its distribution is restricted to specially qualified licensed physicians." This statement doesn't even mention U.S. so one could guess it is like that in the entire world -- but I find it highly unlikely. I'll see if it fits any other section of the article and move it there, mentioning U.S. If I can't find one, I'll remove it entirely. --187.36.43.124 (talk) 11:35, 13 September 2009 (UTC)

Good article on RU-486 use

Good article in Washington Post on Ru-486 use that could be incorporated into this article - [1] Remember (talk) 18:10, 22 January 2008 (UTC)

Agreed; it references recently released data from Guttmacher (?) showing that the overall number of abortions in the U.S. is declining, while medical abortion is becoming a more common method compared with surgical abortion. While it is quite U.S.-centric, it's probably worthy of inclusion. MastCell ^Talk 18:16, 22 January 2008 (UTC)

The Guttmacher Institute was founded in 1968 as the "Center for Family Planning Program Development", a semiautonomous division of The Planned Parenthood Federation of America. Dr. B. R. Lang (talk) 02:38, 29 January 2008 (UTC)

revisions to pharmacology section

I moved all the chemistry to the bottom of the first paragraph and the mechanism of action above. I believe more people reading this article and looking to the pharmacology section care more about the mechanism of action than the specifics of the stereochemistry. —Preceding unsigned comment added by 76.102.118.102 (talk) 06:52, 5 December 2008 (UTC)

Modern excommunication

Mgr Elio Sgreccia, of the Pontifical Academy for Life, has declared that the canonical laws on abortion would also apply to anyone who takes the abortion pill, following the decision by Italy’s drugs regulation agency to authorise its use. [2] ADM (talk) 23:12, 31 July 2009 (UTC)

Causality of number of abortions and usage of mifepristone

The article states that "abortions [have increased] every year since the approval of mifepristone:" There needs to be a citation for whether actual causality or correlation was established by a peer reviewed scientific study/clinical trials or through meta-analysis. Right now it appears as if that correlation/causality is being established by virtue of the author/wikipedia saying so. But a layman's assessment cannot be allowed. It is like me saying "number of abortions went up as the hole in the ozone layer got bigger". That is not a scientific. Just because both increased in numbers over the same years, does not mean that a correlation or causality between the two exists. Please fully cite with valid resources or I suggest removal.CarrieBee (talk) 01:34, 13 May 2012 (UTC)

Redirect here from contragestion

If a reader looks up contragestion, it is almost certain that they are not actually looking for an article on mifepristone. I've restored to article from the redirect. — Preceding unsigned comment added by OckRaz (talk • contribs) 03:29, 27 August 2012 (UTC)

The terms contragestion and contragestive almost always refer to high-dose RU-486 (mifepristone) used as an abortifacient.
See extended reply at Talk:Contragestion#Contragestion Article Reinstated. BC07 (talk) 20:35, 27 August 2012 (UTC)

It’s been 10 years, and it seems most of the content moved from that page no longer exists here. Should this article still be redirected from there? Is this redirect still targeted to the most appropriate article (and section)?

Most of the content from the last non-redirected version of that article [3] does not seem to appear here anymore. Jim Grisham (talk) 23:44, 4 May 2022 (UTC)

Re: promotion of the term "contragestion"; intent and blurring

Quotes from some references on Baulieu's intent in promoting the term "contragestion" and blurring distinctions between contraception and abortion:

• Baulieu, Étienne-Émile (1989). "Contragestion with RU 486: a new approach to postovulatory fertility control. (Meet the experts — Antiprogestins, edited by Baulieu, É-É; Proceedings of a meeting held in Rio de Janeiro, Brazil, 27 October 1988)". Acta obstetricia et gynecologica Scandinavica. Supplement. 149: 5–8. ISSN 0300-8835 PMID 2694738.

  Why 'Contragestion'?
  Fertility control in general, and interruption of early pregnancy in particular are, and will remain, subjects of debate. Problems are naturally not only biological, but also highly cultural and social, not to mention metaphysical, for many people. Conception is a continuing process; in fact it is difficult to describe it temporally. Life certainly does not start with fertilization, and human life is not appropriately defined by the events which occur at the time of fertilization. The word 'abortion', is often used in an unpleasant context, and evokes both psychological and physical trauma... In the search for a neutral term for menstrual induction, minimizing emotional charge and at the same time recognizing the biological reality of the procedure, the term 'contragestion' has been proposed, with the hope of defusing the abortion debate...
  Use of RU 486 around the day of expected menses may be envisaged, first to reduce the irregularity of normal cycles, and second, to prevent unwanted pregnancies, just as present methods of contraception prevent pregnancy. Nature spontaneously eliminates a majority of fertilized ova so the use of a menstrual regulator, such as RU 486, is little more than an extension of a natural system.

• Greenhouse, Steven (February 12, 1989). "A new pill, a fierce battle". The New York Times Magazine. p. SM22.

  Nowadays Baulieu spends most of his time in what could be called a political campaign, hunched over the cream-colored telephone in his cluttered Paris office, arguing, cajoling and scheming. His crusade is aimed at winning acceptance for a revolutionary and highly controversial abortion pill known as RU 486...
  Sakiz and other Roussel officials…were outraged when he suggested publicly that RU 486 might be used as a once-a-month pill, which would have blurred the distinction between contraception and abortion. They felt he was feeding the right-to-life backlash...
  Baulieu is working feverishly to push these efforts to distribute the pill worldwide. And, as he campaigns week after week before television cameras and government panels to defend his discovery, he has embraced a second cause: to change abortion terminology as well. He rejects the term "abortion pill" to describe his discovery, asserting the word abortion is automatically negative and guilt-inducing.
  In his view, the process should be called "contragestation," and his pill a "contragestive," because it stops gestation. "I resent when people present the very early interruption of pregnancy as killing a baby, morally or physically," he said. "I think it's a crime to say that."

• Palca, Joseph (September 22, 1989). "The pill of choice?". Science 245 (4924): 1319–1323. doi:10.1126/science.2781280. JSTOR 1704254. PMID 2781280.

  RU 486 may also have a role as a drug not for abortion but for contraception. That raises the issue of what exactly RU 486 is. Although widely thought of as an abortion pill, its discoverer Baulieu questions that terminology. He calls it a contragestive, derived from contra-gestation just as contraceptives are contra-conception. Baulieu's neologism goes beyond newspeak. It is a genuine attempt to point out that popular attitudes about when life begins were formed at a time when not much was known about the process. He sees gestation as a continuum, from the meiosis that generates the eggs and sperm, to the birth of a baby. All steps are essential, and none is sufficient by itself. But "for society's sake" it has become vitally necessary to find better ways to control gestation. "My aim is to get rid of the word abortion," Baulieu says, because the word "is almost as traumatic as the fact itself." As far as he is concerned his research is not aimed at gaining women abortions. It is aimed at helping them control gestation.

• Chefras, Jeremy (September 22, 1989). "Etienne-Emile Baulieu: in the eye of the storm". Science 245 (4924): 1323–1324. doi:10.1126/science.2675308. JSTOR 1704257. PMID 2675308.

  For the past few years, Etienne-Emile Baulieu has been on a crusade. Ever since, the drug he helped create, popularly known as RU 486, was shown to be highly effective in putting an end to pregnancy without surgery, he has been arguing in every forum he can for its widespread medical use.

• Baulieu, Étienne-Émile (October 6, 1989). "The Albert Lasker Medical Awards. RU-486 as an antiprogesterone steroid. From receptor to contragestion and beyond". JAMA 262 (13): 1808–1814. PMID 2674487.

  'Contragestion'
  "Contraception" is an abbreviation for "contra-conception." Despite the broad meaning of the word "conception," "contraception," for the majority of people, is synonymous with prevention of fertilization. However, fertilization is not the unique determining event in the conception of a new human being. It is preceded by meiosis for the preparation of functional female and male gametes, fundamental to the determination of genetic uniqueness, and followed by the several-day process of implantation and several steps that are critical for the proper development of the embryo. Thus, the generation of life, and human life specifically, is a continuous process that involves interdependent, sequential events and that cannot be attributed uniquely to fertilization. Nature, in the absence of any human intervention and apparently according to mechanisms selected to ensure the continuation of the species, eliminates the vast majority of potentially unique individuals: this is the fate of nonfertilized haploid oocytes, millions of spermatozoa, and the vast majority of fertilized eggs that do not implant or that are aborted spontaneously, often because of chromosomal abnormalities, or that subsequently become chorioepitheliomas, and so on.
  Indeed, postfertilization interruption, which might be considered an abortion, is an everyday process. Almost all women have had or will have abortion(s), although they may not be aware of it, or "miscarriage," terminology for an event that is considered more natural than abortion. The concept of abortion has a violent and controversial connotation, as if collectively, consciously or not, we were preoccupied only by the occurrence of fertilization and forgetful of the multitude of steps that must occur for the development of a human being. Considering the process of generating life, in its globality and continuity, and the natural, selective mechanisms that determine existence, the use of the terms "murder" and "killing" in relation to abortion cloud the real issues pertaining to an existing health problem. We have proposed the word "contragestion" for this reason, a contraction of "contra-gestation," inclusive of most methods of fertility control, that it is hoped, will be helpful in containing the debate.

• Bonner, Staci (July 1991). "Drug of choice". SPIN 7 (4): 55–56, 88. ISSN 0996-3032.

  Since French approval of the drug in October 1988, Baulieu has become its foremost advocate…
  Abortion clinics, the doctors who work there and the women who enter, are all easy targets for protests, picketers and bombs, but RU-486 would change that forever. Abortion no longer has to be a public matter; it would be a private procedure in the hands of women themselves.
  That's exactly what scares antiabortion groups. They feel the pill blurs the line between contraception and abortion. Ironically, Baulieu acknowledges this distinction, calling his pill a contragestive because it stops gestation.

• Baulieu, Étienne-Émile; Rosenblum, Mort (November 15, 1991). The "abortion pill": RU-486: a woman's choice (translation of Génération pilule). New York: Simon & Schuster. ISBN 0-671-73816-X.

  p. 18:
  Headline writers labeled RU-486 the "abortion pill." But there is no surgical invasion, no traumatic shock to the unwilling mother. In a sense, RU-486 is an unpregnancy pill.
  More accurately, RU-486 is what I call a contragestive. Contraception prevents fertilization. Abortion excises a fetus. Contragestion works a middle range, countering gestation before implantation or in pregnancy's earliest stages. When used after implantation, RU-486 interrupts a pregnancy. If taken earlier, it has the same effect as a morning-after pill.
  pp. 26–27:
  There was some inevitable public confusion about RU-486, partly because I had not been clear enough and partly because reporters on deadline had to interpret a scientific paper for themselves. A few bestowed upon RU-486 a "morning-after" power: a quick fix, something a woman might take after lovemaking. Others hailed the end to a woman's need to saturate herself with hormones to ward off ovulation. Neither was quite right.
  Testing showed that RU-486 taken near the end of the cycle could trigger menstruation, washing away a fertilized egg before it implanted firmly in the uterus. A woman who suspected imminent pregnancy could interrupt the process. In a broader sense, one might call that a "morning-after" capability.
  But it is not so simple. Although RU-486 taken near the end of a fertile cycle is 80 percent effective in preventing pregnancy, the catch is that, in practice, it is reliable in this case only when used occasionally. RU-486 can affect the timing of the next cycle, lowering the chance of success in the following month. Even among women who are regular, vagaries in the menstrual cycle confound any systematic monthly hormonal method. Further research suggests promise that RU-486 eventually might be taken in ways that overcome this obstacle.
  As stated earlier, this new method of menstrual regulation, neither contraceptive nor abortive, is contragestive. It does not stop fertilization, but it can act before pregnancy, which begins only when the blastocyst attaches itself and begins to develop in the womb. Or just after.
  If the word contragestive is a mouthful for many people, it defines a little-understood range of birth control. This is shown by the accompanying diagram. Several existing methods, widely used but not well understood in how they actually work, correspond to the concept of contragestion. The intrauterine device, for example, is a double contragestive; it may prevent sperm from fertilizing the egg and a fertilized egg from implanting. Potentially, RU-486 could chemically replace all these methods.
  Menstrual regulation or menstrual extraction refers to bringing on a late period by vacuum aspiration. This is done after the zygote implants, but it can be termed contragestion. Doctors prefer to wait up to eight weeks after a woman's last menses (when she is four weeks late) to do this procedure; before then the embryo is difficult to locate. With RU-486, the process is more efficient; menstrual regulation can be done at any time through the ninth week, whether or not a pregnancy is confirmed.
  To me, using RU-486 to dislodge an implanted embryo in its first weeks is also contragestion. But semantics are a separate issue. In the clinical results presented in Comptes Rendus we defined the method as abortion by medical means, without the use of instruments.
  "Abortion" is a harsh term for a pill that eliminated the trauma of surgery. The word focuses on only a single dimension of RU-486's action. Still, "abortion" broke down all barriers of indifference. People reacted to the word. Our noisiest detractors helped us; in waving their flags they ensured that people would want to learn more.
  p. 28:
  Contraception, Contragestion, and Abortion
  The diagram also shows contragestion from day 15, when fertilization takes place, to day 63, the limit until which RU-486 has been used for voluntary interruption of pregnancy. It spans the time of other post-ovulatory methods.

• Beck, Joan (January 2, 1992). "RU-486 pill adds a new dimension to the abortion debate". Chicago Tribune p. 25:

  Efforts are also under way to soften the image of RU-486, to make it more acceptable, to create the impression that it is more like a new kind of contraceptive than an abortifacient.
  In his new book about the drug, "The Abortion Pill," Etienne-Emile Baulieu, the French scientist who developed RU-486, calls it a contragestive. He says, "it does not stop fertilization, but it can act before pregnancy," which he defines as beginning only when the developing cluster of new cells attaches itself to the uterine wall and begins to grow. Then he adds the significant words "or just after."
  "To me, using RU-486 to dislodge an implanted embryo in its first weeks is also contragestion," Baulieu says. Playing such word games won`t fool right-to-life advocates. But it could make the drug more acceptable and marketable to others in this country. So could the book`s description of it, not as an abortion pill, but as an "unpregnancy pill."

• Chesler, Ellen (July 31, 1992). "RU-486: we need prudence, not politics". The New York Times p. A27:

  RU-486 holds the promise of allowing us to distinguish the simple termination of an early pregnancy from later, more complicated abortion procedures, which understandably trouble so many people.
  Developed and marketed by the French pharmaceutical company Roussel Uclaf, for which it is named, the synthetic drug works by blocking the naturally produced hormone progesterone. It prevents the implantation of the fertilized egg in the uterus, and in this sense, then, no "life" is ever created.
  With this in mind, Etienne-Emile Baulieu, the inventor of RU-486, calls the pill a "contragestive," rather than an abortifacient, linking it to the routine and widely accepted prevention of pregnancy through hormonal contraception, which in many ways it resembles.
  If naming conveys ownership, as Margaret Sanger insisted when she invented the term "birth control" and later the even more user-friendly "family planning," then we may be able to add an important new dimension to the abortion debate...
  Further testing of RU-486, along with the opportunity to invent newly liberating language, may help us find the common ground that so many Americans seem to be seeking on the abortion issue this year.

• Baulieu, Étienne-Émile (April 13, 1993). "1993: RU 486—a decade on today and tomorrow". in Donaldson, Molla S.; Dorflinger, Laneta; Brown, Sarah S.; Benet, Leslie Z. (eds.) Clinical applications of mifepristone (RU 486) and other antiprogestins; assessing the science and recommending a research agenda (Committee on Anti-progestins: Assessing the Science; Division of Health Promotion and Disease Prevention; Institute of Medicine). Washington, D.C.: National Academy Press. pp. 71–119. ISBN 0-309-04949-0.

  Contragestive and Contraceptive Methods Using RU 486
  The word conception is generally understood as fertilization; this is wrong etymologically, since concipire (Latin) means to retain (originally retain sperm and mother blood in the uterus to make a child).
  Contraception is, therefore, commonly understood as a method to preclude fertilization, for instance, by suppression of ovulation or preventing sperm from reaching the ovum. However, physicians also designate as contraceptives methods that are applied before implantation is completed. They argue that a fertilized ovum that is not implanted after in vitro fertilization does not define a pregnancy. In fact, the available pregnancy tests are based on the measurement of human chorionic gonadotropin, produced by the embryonic chorion, which passes into the woman's blood and occurs only after implantation has been initiated... Note also that the process of implantation is not instantaneous and takes several days during the last week of the fertile cycle, just before the time at which menses would occur. Coincidentally, the development of the embryo is characterized by the streak (a marker indicating that an individual embryo has been formed, and there is no further risk of twins), which should occur at approximately the same time—about 15 days after fertilization. Before that time, not only may genetic abnormalities or defects of implantation stop the process leading to pregnancy, but the very definition of a single potential person cannot be rigorously applied. In short, during the period between fertilization and the time at which menses should occur, interrupting methods are contragestive, differing from both abortion and contraception as defined above, and not hiding the fact that they oppose pregnancy.
  In summary, contragestion includes all treatments that operate over a period of approximately four weeks post fertilization.

• Baulieu, Étienne-Émile (June 1994). "RU 486: a compound that gets itself talked about". Human Reproduction 9 (Suppl 1): 1–6. doi:10.1093/humrep/9.suppl_1.1. PMID 7962455.

  Contragestion: a new word for a new concept
  Abortion means, to lay people, the interruption of a proven, established pregnancy and the later it is, the more and more difficult it becomes both physically and psychologically. Everyone understands the difference between preventing a process from starting and interrupting its evolution once it has begun. It is difficult to 'draw the line' (McLaren, 1984) for oneself. The word abortion carries a traditional connotation of instrumental aggression, with the usual entourage of operating theatre, gynaecological table, hospital ward and so on, even in developed countries where the tragedies of perforations, infections, etc. are now avoided (this is not the case in most developing countries.
  Contragestion, whose use I propose, is neither contraception nor abortion. It openly designates 'contra-gestation', thereby not hiding that it precludes the development of pregnancy, and thus respecting, as scientific ethics command, 'what is' (Primo Levi). The word contragestion corresponds to several techniques applicable after ovulation which, temporally, may be somewhat superimposed (Figure 2)…
  I have mismanaged the launching of the definition of contragestion, and thus blurred the image of RU486 as a contragestive agent, distinct from a 'simple' abortion pill. When RU486 was discovered, I tried to explain its use as a contragestive, but I did not use the term soon enough, so for the public, it became a 'morning-after pill', a 'post-coital pill'…The only way to have RU486 used was by testing and registering it in the context of abortion law and by necessity it became 'the abortion pill'...
  In summary, because there is a medical problem with abortion, and because there was an opportunity to test the efficiency of RU486 in women 'easily' and it was necessary to register the compound, we were forced to start with abortion so that the concept of contragestion has not been widely taking up by the media up to now. It would have been preferable to start differently, i.e. firstly to present RU486 as a menstrual regulator, as suction is presented in Bangladesh where it is accepted by the government authorities.

BC07 (talk) 02:44, 9 September 2012 (UTC)

Introductory line doesn't make sense

"is a not synthetic steroid" - That introductory line doesn't make sense 129.180.175.45 (talk) 14:14, 18 October 2013 (UTC)

That appears to be the result of vandalism. I have restored the proper wording, "Mifepristone is a synthetic steroid..." Thanks for catching the problem and reporting it here. -- Ed (Edgar181) 16:41, 18 October 2013 (UTC)

Structuring the medical use section

We should talk about this! The medical uses of this drug are for abortion, emergency contraception, and Cushing's syndrome. Since abortion is controversial, there is all kinds of interesting regulation about how this drug can be used for abortion. that is all "society and culture" stuff, in my view. The Medical Use" section should just be about what evidence and medical guidelines discuss. Some research has crept into the "Other" subsection - I will move that to Research. Please discuss if you have different ideas about how regulation should fit into the Medical Use section. Thanks. Jytdog (talk) 00:27, 4 April 2016 (UTC)

The "'Medical uses" section should list the indications for which mifepristone has been approved.

Mifepristone 200 mg tablets are approved for first and second trimester medical abortion in Europe and Australia,

Mifepristone 300 mg tablets are approved for Cushing's syndrome in the United States,

Mifepristone 10 mg, 12.5 mg, and 25 mg tablets are approved from emergency contraception in Armenia, China, Russia, Ukraine, and Vietnam.

The only "regulations" about how mifepristone can be used for abortions—in countries were it has been approved for abortion—are in a few U.S. states where anti-abortion rights Republican legislatures have passed legislation to restrict access to medical abortion.

I also removed some redundant, inaccurate, and outdated content.

BC07 (talk) 01:21, 4 April 2016 (UTC)

I am too frustrated with your edit warring to reply now. I will reply later. In the meantime please 1) respond to what I actually wrote above and 2) read WP:MEDMOS about dosing. I've left a note at TW:MED to draw other comments here. Jytdog (talk) 01:34, 4 April 2016 (UTC)

I specified:
• mifepristone 200 mg tablets for abortion
• mifepristone 300 mg tablets for Cushing's syndrome
• mifepristone 10 mg, 12.5 mg, and 25 mg tablets for emergency contraception
because these are very different forms of mifepristone for very different indications.
This did not to violate the WP:WikiProject_Pharmacology/Style guide#Medications guidance to not provide detailed dosage information in the "Medical uses" section.
I specified the form, not the dosage, of mifepristone to take for the different indications (for the abortion and emergency contraception indications, the dose is a one-time, one-tablet dose, for Cushing's syndrome it is one to four tablets daily).
I did not specify the dose of the prostaglandins misoprostol or gemeprost for use in medical abortion, because the dose varies by route of administration and by gestational age.
I believe that specifying the different forms of mifepristone for different indications is appropriate and useful content for the "Medical uses" section, and does not violate WP:WikiProject_Pharmacology/Style guide#Medications.

I added the latest RCOG, WHO, and ACOG guidelines to the "Medical uses / Abortion" subsection.

I did not re-add:

There is good evidence supporting the effectiveness of mifepristone and misoprostol for abortions up to 63 days of pregnancy.^{Chen MJ, Creinin MD (July 2015). "Mifepristone with buccal misoprostol for medical abortion: a systematic review." Obstetrics & Gynecology 126(1):12–21. PMID 26241251}

to the "Medical uses / Abortion" subsection because it was a review of the literature by two authors through January 2015 of a specific dosing regimen—which was approved through 70 days gestation by the FDA on March 29, 2016 (the FDA had 15 additional months of published and unpublished data to review and make their decision).

In addition, mifepristone is approved for second trimester abortions in the European Economic Area and Australia, and recommended for first and second trimester medical abortions by the RCOG, WHO, and ACOG.

I did not re-add:

Mifepristone can also be used in smaller doses as an emergency contraception; if taken after sex but before ovulation, it can prevent ovulation and so prevent pregnancy. In this role, a small dose is not as effective as a large dose, but has fewer side effects. Mifeprex and Mifegyne are only available in 200-mg tablets.

A review of studies in humans found that the contraceptive effects of the small dose were probably due mainly to its effects on ovulation, and not inhibition of implantation, but "the knowledge of the mechanism of action remains incomplete". Treatment with 200 mg of mifepristone changes steroid receptor expression in the Fallopian tube, inhibits endometrial development, and effectively prevents implantation.

to the "Medical uses / Emergency contraception" subsection, because these paragraphs were inappropriate for the "Medical uses" section of this Wikipedia article. The topics in these paragraphs are better discussed in the "Emergency contraception" Wikipedia article.

I did not re-add:

It is approved for use up to 70 days after a woman's last menstrual period.

and

In the U.S., the Food and Drug Administration approved its use to terminate intrauterine pregnancies of up to 70 days following the last menstrual period.

to the "Society and Culture / Legal Status / United States" sub-subsection, because they are redundant to information in the earlier "Medical uses / Abortion" subsection.

I did not re-add:

Under the FDA-approved regimen, a dose is administered by a clinician following at least two counseling sessions. Two days later after the final counseling session, a clinician administers misoprostol to induce contractions.

because these sentences are false and unsourced.

I did not re-add:

In European studies, this method terminated 96- to 99 percent of pregnancies of up to 49-days' gestation, but in one large multicenter trial in the United States conducted from September, 1994, to September, 1995, the efficacy was lower (92%), which the authors of the study suggested may have been due to lack of experience with this method in the United States and/or the design of their study.

to the "Society and Culture / Legal Status / United States" sub-subsection, because discussing studies that are over twenty years old, using a regimen no longer in current use, is not relevant.

BC07 (talk) 06:08, 4 April 2016 (UTC)

I did not add anything regarding "regulation" of the use of mifepristone for abortion to the "Medical uses" section of this article.
I added approved indications for which mifepristone had received marketing authorizations.
I then added clinical guidelines from the RCOG, WHO, and ACOG, which include discussion of the use of mifepristone for abortion at gestational ages not explicitly mentioned in the marketing authorizations.
Pharmaceutical companies cannot advertise the use of pharmaceuticals outside the scope of their marketing authorizations, but physicians can and do routinely use approved pharmaceuticals following evidence-based clinical guidelines outside the scope of their marketing authorizations.
BC07 (talk) 06:38, 4 April 2016 (UTC)

• should be added to society and culture (in regards to [4])...IMO--Ozzie10aaaa (talk) 10:24, 4 April 2016 (UTC)
• I believe that the usual thing to do (e.g., per WP:MEDMOS#Sections and WP:PHARMOS#Sections is for actual/medically appropriate uses (including off-label) to be listed under ==Medical uses== and for information about exact marketing authorizations to go under ===Legal status===. (This is on the theory that "This government said we can sell this for ____" is a socio-cultural fact, not a biomedical one.) Is there a good reason to do something different this time? WhatamIdoing (talk) 15:59, 4 April 2016 (UTC)
• I agree with WAID's assessment of what the guidelines indicate -- Medical uses under that section, regulations under appropriate Society & culture subhead. Dosing information should not be in Wikipedia articles. Zad68 13:47, 6 April 2016 (UTC)
• Also agree with WAID. What each country approves it for belongs under society and culture. Specific doses should not be discussed generally regardless of what section it is in. Doc James (talk · contribs · email) 14:32, 7 April 2016 (UTC)

Per the above discussion, I removed discussion of marketing authorizations from "Medical uses" section, and added the forms available and marketing authorizations to the "United States", "Europe", and "Other countries" sub-subsections of the "Legal status" subsection of the "Society and culture" section. BC07 (talk) 16:24, 7 April 2016 (UTC)

I just want to be clear about what we are doing here, in this particular article. For this drug, because its use for abortion is so contentious and it is regulated differently in different countries, it is important to tease apart what the medical science is (what the drug is good for), from how the law says it may be used on a country-by-country basis. For most drugs this is not a big deal, and regulatory approvals and use co-exist without tension in the "Medical use" section. This is a topic-specific thing we are doing here. Jytdog (talk) 18:48, 7 April 2016 (UTC)

Content about outcomes

User:Doc James and User:Keilana - what is going on here? It seems that the two of you are edit warring over different things - why can the content here not say both that there is no known way to reverse it, and give the percentages on how often it works at each stage? Thanks. Jytdog (talk) 01:36, 10 June 2016 (UTC)

We're discussing the best way to summarize a source, definitely not an edit war or anything unfriendly. :) Keilana (talk) 03:19, 10 June 2016 (UTC)

I see, you are discussing it at User_talk:Keilana#Text_change Jytdog (talk) 03:35, 10 June 2016 (UTC)

Yes happy with both. Not sure why this was removed "If a woman changes her mind after taking the mifepristone, there is no evidence that anything can be done to change the outcome." Doc James (talk · contribs · email) 04:08, 10 June 2016 (UTC)

In my opinion, the study with high-dose progesterone had so few cases I'm hesitant to discuss it at all. And in my experience, patients who wish to change their mind about having a medication abortion do so prior to taking mifepristone (hence the low number of cases in the study). Keilana (talk) 22:28, 10 June 2016 (UTC)

Yes there is not enough evidence to say anything works to affect the outcome once one has taken mifepristone. Not sure what is wrong with stating what is unknown? Doc James (talk · contribs · email) 00:29, 11 June 2016 (UTC)

To me, it implies that there could be something to affect the outcome, we just don't know what it is, which given mifepristone's mechanism of action....seems unlikely. Today people were telling patients to drink a gallon of salt water to reverse mifepristone. Keilana (talk) 18:07, 11 June 2016 (UTC)

I do not read "there is no evidence that anything can be done to change the outcome" as there is something one can do to change the outcome. Doc James (talk · contribs · email) 23:51, 11 June 2016 (UTC)

Could we word it a little bit differently? Perhaps "there is no evidence that the effects of mifepristone can be reversed" or "there is no evidence that any treatment can reverse the effects of mifepristone". Keilana (talk) 16:38, 12 June 2016 (UTC)

Sure means the same to me. Doc James (talk · contribs · email) 01:24, 13 June 2016 (UTC)

Canada

Well approved it is restricted such that only docs with special registration can prescribe it.[5]

Not even sure if the training has begun yet. Doc James (talk · contribs · email) 04:14, 10 June 2016 (UTC)

Eep, didn't know it was restricted to docs with special registration, I thought the approval was the end of it. :/ Keilana (talk) 22:23, 10 June 2016 (UTC)

Yes we were discussing this at rounds just the other day. Not available in my community as far as I am aware. Doc James (talk · contribs · email) 00:30, 11 June 2016 (UTC)

Yikes, that's really unfortunate. I hope you get access in your community soon. Keilana (talk) 18:03, 11 June 2016 (UTC)

fewer vs less (fewer than six months)

The choice between "fewer" and "less" roughly follows the choice between "many" and "much". "Fewer" is used for something that is measured in integer units of measure, and the discrete nature of the unit of measure is relevant. Something that is continuous in nature, that can use fractions of the unit of measure to describe size or amount, uses the term "less". So "How much chicken" (less chicken?) vs "How many chickens" (fewer chickens?). The article intends "fewer than six months" to allow five and a half months, so "less" is appropriate. Fewer that six months would imply five months, or four months, or three months. The use of "fewer" could be accepted here if the drug is always given once a month, and that vague implication is intended to be acknowledged, as "fewer than six treatments". ( Martin | talk • contribs 15:23, 21 October 2016 (UTC))

Verifiability of "malformed fetus"

I was originally intending to start a discussion about the wording ("malformed baby" versus "malformed fetus") of Serious side effects may include heavy vaginal bleeding, bacterial infection, and a malformed fetus if the pregnancy does not end."^{Emphasis my own}, but looking into it I can't find any reference to fetal deformities in humans in the source cited at all: A linked page mentions in passing that fetal deformities have been observed in animal studies on the drug, but also notes that these are likely mechanical versus being side-effects of the drug directly.

I have found this study which suggests the rate of major congenital malformation in pregnancies exposed to mifepristone alone or with misoprostol during the first 12 weeks of gestation was 4.2% (95% CI 1.2–10.4%), and close to the expected 1–3% incidence rate of major malformations reported in the general population^{Emphasis my own}. This leads me to wonder if we should significantly reword that last point, if not remove it entirely? Right now it implies (in my view) that Mifepristone is a riskier medication than it really is.

For now, I'm removing the claim per MEDRS, without prejudice: I am not opposed to it being reinstated with a source that supports it.

I would appreciate some discussion on this matter, because I am not particularly familiar with editing medical topics! -- Thanks, Alfie. ^{talk to me | contribs} 02:30, 19 February 2018 (UTC)

The ref says "Risk of fetal harm if pregnancy continues... Category X."[6]

This can reasonably be summarized as "a malformed baby if the pregnancy does not end"

Doc James (talk · contribs · email) 05:06, 19 February 2018 (UTC)

Perhaps better to stick to the citation's wording and just say "risk of foetal harm if the pregnancy continues"...? Bondegezou (talk) 12:01, 19 February 2018 (UTC)

It says "Birth defects have been reported with a continued pregnancy after a failed pregnancy termination with this drug in a regimen with misoprostol. US FDA pregnancy category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk "[7]

I think we can get the idea across in plain English. Doc James (talk · contribs · email) 18:45, 13 March 2018 (UTC)