Termination of early pregnancy by the 3 beta-hydroxysteroid dehydrogenase inhibitor epostane
Crooij, M.J.; de Nooyer, C.C.; Rao, B.R.; Berends, G.T.; Gooren, L.J.; Janssens, J.
New England Journal of Medicine 319(13): 813-817
1988
ISSN/ISBN: 0028-4793 PMID: 3166108 DOI: 10.1056/nejm198809293191301Document Number: 575582
The efficacy of the 3 beta-hydroxysteroid dehydrogenase inhibitor epostane in terminating early pregnancy was investigated in 50 women who were in the 5th-8th weeks of pregnancy. In previous studies, epostane has been shown to reduce progesterone levels significantly in pregnant and nonpregnant women without disruption of subsequent menstrual cycles or adverse effects on adrenal steroidogenesis or hepatic function. The study subjects received 200 mg of epostane orally every 6 hours for 7 days. In 42 women (84%), the pregnancy was terminated by the 14th day after epostane treatment was initiated. There were more responders among primigravidas (90%) than among multigravidas (76%), although the difference was not statistically significant. On average, vaginal blood loss occurred on the 3rd day of treatment and abortion on the 5th day. The mean pretreatment progesterone level (76 + or - 16 nmol/liter) decreased by day 7 to 16 + or - 11 nmol/liter and by day 14 to 10 + or - 9 nmol/liter in women who aborted, while levels of human chorionic gonadotropin decreased from a baseline mean of 73 + or - kIU/liter to 18 + or - 7 kIU/liter on day 7 and 9 + or - 5 kIU/liter on day 14. In women who did not abort, progesterone levels decreased only slightly 7 days after epostane treatment (to 52 + or - 21 nmol/liter) and rose again to 81 + or - 18 nmol/liter by day 14. 86% of study subjects reported treatment-related nausea; however, in 64%, the nausea was no worse than pretreatment nausea. 76% indicated epostane was preferable to dilation and curettage. Normal menstrual periods were resumed by day 42 after the initiation of treatment in 72% of the women who responded to epostane. Overall, these findings suggest that epostane is an effective alternative method for the termination of unwanted pregnancy in the 1st 8 weeks of gestation and should be given serious consideration as a noninvasive alternative to dilation and curettage.