Misoprostol is commonly used as part of a two-drug abortion procedure. But it’s also safe and effective when used alone, doctors say.
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Misoprostol is commonly used as part of a two-drug abortion procedure. But it’s also safe and effective when used alone, doctors say.
ROBYN BECK/AFP via Getty Images
On Friday, a federation Judge in Texas to rule that the Food and Drug Administration has not properly approved a drug that has been on the market for more than 20 years in the United States for medical abortion. The drug in question, mifepristone, is used with another drug in most medical abortions in the United States.
The downfall of the ruling could mean that mifepristone will no longer be available in the United States for the foreseeable future, although the ruling is being challenged in court. Depending on how the legal battles play out and how the FDA responds, the impact of this ruling may apply only to certain states or may actually limit the use of mifepristone nationally.
If this happens, doctors say they will continue to offer medical abortions without mifepristone, using only the other drug, misoprostol. Here’s what to know about how misoprostol-only abortions work, how safe they are, and how patients access them.
How is a single-drug regimen different from the current standard of care that uses two drugs?
Most medical abortions in the United States now use both mifepristone and misoprostol because patients experience fewer side effects when the drugs are combined. A regimen involving both drugs is also used for miscarriage.
But misoprostol alone can be used effectively for abortions – and is commonly prescribed in some countries.
“This mode is still extremely safe and effective,” says Dr. Kristyn Brandi, a New Jersey-based family planning specialist and spokesperson for the American College of Obstetricians and Gynecologists. “Management of miscarriages and medical abortions won’t go away with the loss of mifepristone, but it may look a little different.”
With a two-drug regimen, the patient first takes mifepristone – a drug that blocks the hormone progesterone – to terminate the pregnancy. The patient then took misoprostol 24-48 hours later, causing the uterus to push out the fetal tissue. Patients experience bleeding and cramping, and usually conceive within 4-6 hours of taking misoprostol.
In the case of abortion alone with misoprostol, the patient started the procedure with misoprostol, using the same amount as used in the dual regimen. Three hours later, they took misoprostol again, which caused the uterus to contract. They repeat this for three to four doses until the pregnancy passes, which usually takes 9-12 hours.
In either case, the patient typically sees a doctor or nurse, in person or online, and then takes the medication at home.
Is the misoprostol-only regimen safe? What can patients expect to experience?
There are many studies showing that misoprostol-only regimens is safe like a two-drug protocol — but it tends to cause more side effects.
Although dual-drug regimens are still preferred when possible, there is ample evidence that misoprostol alone is a very effective alternative, according to the Red Family Planning Associationan abortion research organization.
Many organizations, such as American College of Obstetricians and Gynecologists and World Health Organizationassuming a single-drug protocol is an acceptable option, especially when mifepristone is not available.
However, patients who received only misoprostol tended to have more nausea, vomiting and diarrhea, and longer periods of cramps and bleeding. That’s why it’s usually the second choice mode.
The misoprostol-only regimen was actually faster than the two-drug regimen, taking in total about 30 hours since the patient took the second drug at least 24 hours after the first. In a misoprostol-only regimen, the process usually takes only 9-12 hours, but patients often experience longer cramping and bleeding.
When might a patient need more medical help for a medical abortion?
With either regimen, the reason to seek follow-up care is the same.
If the patient has heavy or prolonged bleeding – such as bleeding that lasts for more than 2 weeks, or bleeding that is so heavy that it soaks through more than two tampons per hour for more than two hours – they may need to have a procedure done. procedure to complete the abortion process.
A persistent fever above 100.4 degrees Fahrenheit is also a reason to seek medical attention. Although low-grade fever and chills are possible side effects of misoprostol and are not life-threatening, if the fever persists for more than 24 hours after taking misoprostol, it could be a sign of an infection.
In addition, if the patient has no experience any bleeding or cramping, the medicine may not be able to end the pregnancy, and she may need more misoprostol or a procedure to have a complete abortion.
How long does a medical abortion last?
The Food and Drug Administration has approved a two-drug regimen to End of pregnancy up to 10 weeks gestational age, but the World Health Organization confirm it up to 12 weeks. Then they are less effective and can cause more bleeding and cramping.
For misoprostol-only abortion, it is less obvious. There is some data to suggest that this regimen may be effective in terminating a pregnancy up to 22 weeks. that is according to a study looked at patients who had abortions on their own without the direct involvement of a physician in countries with restrictive abortion laws.
But in US states where second-trimester abortions are allowed, Brandi said, doctors will often recommend a surgical abortion in a hospital rather than a medical abortion to end a pregnancy later. 12 weeks. That’s because a second-trimester misoprostol-only abortion can lead to more bleeding and prolonged cramping. Physicians may recommend misoprostol alone during the second trimester in states where patients have no other legal options.
How do patients get an abortion prescription? Can they get them for a single drug regimen?
In states where abortion is legal in the first trimester, patients can talk to a healthcare provider and get a prescription for a medical abortion through telehealth abortion companyin person at abortion clinics such as Planned Parenthood, and at many general and family medicine OB/GYN clinics.
As long as mifepristone remains available, providers will usually offer a two-drug regimen. If it is not available, many providers have said they will start prescribing misoprostol alone.
Dr. Jamie Phifer, medical director of abortion on demand, said her team is waiting to see how the court will ultimately rule on mifepristone. They will continue to give the combined abortion pill mifepristone and misoprostol to their patients unless it becomes illegal.
“But we’re ready,” she added. “We can make the transformation [to misoprostol-only protocols] within a few hours.”
In fact, misoprostol is more accessible than mifepristone. Even before the Texas judge’s ruling, mifepristone was FDA special regulations that means most commercial pharmacies don’t carry it, and patients can only get it at clinics that offer abortion services or through pharmacies that are specifically registered with the FDA.
However, misoprostol is not subject to these regulations, so it is sold in most pharmacies and hospitals.
Can patients get the drug in states that ban abortion?
Neither dual-drug regimens nor misoprostol-only abortions are legally available in these states. Misoprostol itself is still legal when used for other purposes, like treating ulcers or inducing labor.
However, there are a number of services that help patients in these states access abortion pills.
For example, Mayday.Health provides step-by-step instructions for setting up a mail forwarding address, so patients can list the address as authorized on the telemedicine abortion registration form, and then have the medication delivered to an additional address somewhere else. OLD plan is a website that provides up-to-date information on how to take the abortion pill at home.
Miscarriage and Abortion Hotline offers free consultations with clinicians if a patient has questions about a medical abortion, even if she has an abortion in a state where abortion is illegal.
Other organizations openly circumvent the law to provide abortion pills in all 50 states.
aid accessfor example, is based in the Netherlands and will mail mifepristone and misoprostol to patients in states where abortion is prohibited. Medicines sent from abroad are not subject to FDA approval and safety regulations. The organization also employs US-based healthcare providers who prescribe FDA-regulated abortion pills through telehealth in authorized states.
Mara Gordon is a family physician in Camden, NJ, and a contributor to NPR. She’s on Twitter at @MaraGordonMD.
