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June 27, 2007

I Was Betrayed by a Pill

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It doesn't help that those who dispense mifepristone/misoprostol don't always know as much about the drugs as they should. In fact, at the clinic I visited, the doctor couldn't tell me which hormone the combination used.

Much later, I also learned about several deaths linked to the abortion pill. In one case, it was given to a woman who never should have received it-she had an undiagnosed ectopic pregnancy and died from associated hemorrhaging. But five other women developed mysterious, fatal bacterial infections. Reading about them, my stomach twisted. I'd used the pills exactly as they had. I couldn't help but wonder: Could I have died?

The drug's manufacturer and the FDA have emphasized that a "causal relationship" between the pills and the infection that reportedly killed these women hasn't been established. And given that the rare bacterium, Clostridium sordellii, responsible for the deaths has killed a handful of other people-including a man undergoing surgery-it seems likely that more than just the pills are responsible.

The scary thing is that no one knows what. It's possible that together, the abortion pill and pregnancy suppress immune function enough to make some women more vulnerable to infection. There's also been some suggestion that inserting misoprostol into the vagina might raise the risk of infection. (Although the FDA approved it for oral use, many clinics instruct women to use it vaginally because research shows that the process works just as well but with fewer side effects.) But gynos like Anne Davis, M.D., M.P.H., assistant professor of obstetrics and gynecology at Columbia Presbyterian Medical Center in New York City, pooh-pooh that theory. "Literally hundreds of thousands of women have used it that way. It seems unlikely that a particular woman putting her fingers in her vagina would give herself an infection."

For the moment, we really don't know whether medical abortion carries any greater risk for infection than, say, surgical abortion, miscarriage, or childbirth. Still, to be safe, Planned Parenthood now instructs women to take misoprostol orally. In addition, Mifeprex now carries a black-box warning about the potential risk for excessive bleeding and serious, even fatal, infection. And because C. sordellii infection mimics the process of medical abortion, the FDA also issued a public-health advisory in July 2005 cautioning women and doctors to look out for prolonged nausea, vomiting, diarrhea, weakness, or abdominal pain (even in the absence of fever) in the days after taking misoprostol. (In the U.K., doctors can look for it themselves: Women stay in the hospital after the pills are administered.)

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