The fate of mifepristone — a drug that, when combined with misoprostol, is prescribed for medication abortions, which now account for more than half of all abortions performed in the U.S. — is up in the air after a federal judge in Texas ruled to suspend the Food and Drug Administration’s approval of mifepristone. The unprecedented decision could affect access to the drug across the U.S., including in states where abortion is legal. Seeking to block the order, the Department of Justice filed an emergency stay motion Monday with the U.S. Court of Appeals for the 5th Circuit.
Adding to the confusion is the fact that another federal judge, based in Washington state, ruled that access to mifepristone can’t be restricted in the 17 states and D.C. that recently sued the FDA to drop some restrictions on mifepristone, which the American College of Obstetricians and Gynecologists says are “outdated” and “substantially limit access to this safe, effective medication.”
While mifepristone’s fate is being decided, pro-choice advocates and physicians have taken to social media to talk about a possible backup plan if access to mifepristone is impacted — namely, taking misoprostol alone for medication abortions.
But how effective is it to take only half of the standard two-drug regimen for an abortion? And how safe is it? Here’s what experts have to say.
How effective is it to take misoprostol alone for a medication abortion?
Experts agree that the most effective regimen for a medication abortion is a combination of mifepristone and misoprostol. However, women’s health expert Dr. Jennifer Wider tells Yahoo Life that the World Health Organization lists “two safe and effective medical methods for pregnancy termination — one of them is misoprostol alone.”
Dr. Andrea Henkel, an ob-gyn at Stanford Medicine Children’s Health and clinical assistant professor in complex family planning at Stanford University, agrees that taking both medications is “significantly more effective than misoprostol-only regimens for first-trimester abortion care.” She tells Yahoo Life that with mifepristone and misoprostol, about 1 in 20 people will need a procedure (such as a surgical abortion) to complete the abortion. “Whereas with misoprostol alone, the number is closer to 2 to 3 in 20 people will need a procedure,” she says. “It is important to remember that many people choose medication abortion because they wish to avoid a procedure or they live far from a clinician that provides procedures.”
That said, misoprostol alone is considered “a safe, dependable and effective way to have an abortion,” Dr. Sheila Attaie, a family medicine physician in California and fellow with Physicians for Reproductive Health, tells Yahoo Life. “Studies show that the success rate is around 80 to 100 percent, depending on the dose and amount of misoprostol taken and how far along a pregnancy is.”
Attaie points to studies that found misoprostol alone to be 93% successful in terminating pregnancies up to 10 weeks, with other research stating that misoprostol taken on its own is “effective and safe” and “a reasonable option for women seeking abortion in the first trimester.”
Misoprostol works by causing the uterus to contract, bleed and expel the embryo, according to Cleveland Clinic, while mifepristone blocks progesterone from continuing to support the pregnancy. When you combine the two medications, “the patient has a higher likelihood of passing the pregnancy with less doses of misoprostol,” explains Attaie. “This is why mifepristone is important, but not necessary, to have a safe medication abortion.”
How safe is misoprostol?
Attaie says that misoprostol is “extremely safe.” She points out that many people — and pets — take the medication to prevent stomach ulcers by decreasing the amount of stomach acid. “The complication rate is less than a single percent,” says Attaie. “This means it is safer than taking Tylenol or Advil.”
The most common side effects of misoprostol are nausea, diarrhea, fever and chills. “Misoprostol can make you feel like you have the flu or some COVID symptoms,” says Attaie. “These don’t always happen, but if they do they should only last a few hours.”
The medication also causes abdominal cramping, “which is effective for emptying the uterus and controlling bleeding but can be uncomfortable,” she says.
However, as Henkel points out, “if mifepristone becomes unavailable, the misoprostol-only regimens require multiple doses of misoprostol, which will increase the frequency of these nondangerous, but highly uncomfortable, side effects.”
If mifepristone isn’t available, is misoprostol the next best option for medication abortions?
Yes, say experts. “On a population level, repetitive doses of misoprostol will be the most accessible medication for first-trimester abortion care if mifepristone is pulled off the market,” says Henkel.
That doesn’t, however, mean that there won’t be some barriers. Wider notes that many abortion rights advocates are “incredibly concerned about this pending ruling,” adding: “If this medication gets banned, it will definitely limit access to safe and effective medical abortion care.”
But experts say that if mifepristone isn’t available, misoprostol alone is a viable option. “Many people around the world have used and will continue to use misoprostol to have safe and effective medication abortions,” says Attaie.
If you or someone you know needs help obtaining an abortion or additional information and resources, visit abortionfunds.org or abortionfinder.org. You can also call or text the All-Options hotline at 1-888-493-0092, which offers “unconditional, judgment-free support for people in all of their decisions, feelings and experiences with pregnancy, parenting, abortion, and adoption.”
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