Menstruation (in its luteal phase) is dependent on progesterone, and uterine bleeding follows antagonism of progesterone. Pregnancy is dependent on progesterone (for implantation, endometrial stimulation, suppression of uterine contractions and placenta formation), and abortion follows progesterone antagonism in early pregnancy.
Mifepristone is a pure competitive antagonist at progesterone and glucocorticoid receptors. Clinical trials of oral use in hospital outpatients have shown it to be safe and effective in terminating pregnancy. Efficacy is enhanced if its use is followed by administration of a prostaglandin (gemeprost) (vaginally) to produce uterine contractions (the success rate is raised from 85% to above 95%). Adverse effects of the combined treatment include nausea and vomiting, dizziness, asthenia, abdominal pain; uterine bleeding may be heavy. Mifepristone also offers the opportunity for mid-trimester terminations. These are likely to become increasingly
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