Medical abortions (using a mifepristone/misoprostol combination regimen) make up more than 50% of abortion procedures in the U.S.

The rulings on the abortion pill began last week with two judges handing down opposing decisions.

These decisions centered around the safety of the use of mifepristone. One judge ruled that the FDA’s original approval of the medication over 20 years ago was improper and should be halted.

Within hours, a separate decision from a different judge ruled that access to mifepristone should be protected.

The Biden administration appealed the first judge’s decision and requested an emergency stay of the injunction so that mifepristone could remain available while the ruling on the abortion pill is pending.

The potential halt on the use of mifepristone turned conversations to new options for providing medical abortions without the use of mifepristone. These conversations center on misoprostol-only options.

Misoprostol is the second medication used in the abortion pill. Misoprostol is only FDA-approved for abortion in combination with mifepristone—it seems that neither drug (mifepristone nor misoprostol) alone is effective to complete an abortion procedure. 

Misoprostol alone can be used off-label in higher doses to induce abortion before the 10^th week of gestation (based on LMP).  Higher doses of this medication can also cause higher incidence of its side effects and warrant appropriate warnings and cautions before use.   

The “normal dose” of misoprostol for a combination-pill medical abortion is one dose of 4 tablets 200 mcg (800 mcg total) given buccally (between the gum and cheek), to dissolve & absorb.

If used without mifepristone, the misoprostol dosage found to be most effective is triple or more of that dose – 800 mcg inserted vaginally in 3 or more doses, given 48 hours apart from each other. This drags out the procedure for a week or longer, and, while this type of abortion may seem like a quick way to resolve any upcoming rulings on the abortion pill, the side effects from this medication are also much increased.

This treatment is less effective than the standard regimen that contains mifepristone, only reaching 93% effectiveness after those multiple doses.  

The most common side effects from this misoprostol-only abortion include severe uterine and abdominal cramping, heavy bleeding with clots, diarrhea, and headaches. Some of these effects can last up to 2 weeks. Also, there is lower efficacy in women >35 years old who smoke, and it is not advised for women with irritable bowel syndrome or anemia. 

Misoprostol is a known teratogen. Since it can cause birth defects, enhanced vigilance is recommended to detect potential failures. Almost 1 in 5 people experience complications from combination pill medical abortions – some eventually needing a surgical procedure. 

Medical follow-up appointments are necessary to protect your reproductive health following any medical abortion.

Before beginning any medical abortion procedure (combination-pill or misoprostol-only), pregnancies should be evaluated to determine the gestational age and rule out an ectopic pregnancy.

Alcove Health will provide updates as additional rulings on the abortion pill are confirmed.

While the judicial system is working through these rulings on the abortion pill, women’s needs remain the same. Here at Alcove Health Women’s Clinic, we plan to continue doing what we’ve always done – provide a safe space for women to process their pregnancies and get the medical services they need to make a decision that’s safe for their reproductive health.

If you need assistance with an unplanned pregnancy, we’re here for you regardless of any rulings on the abortion pill. With free and confidential services – like pregnancy tests, ultrasounds, options consultations, and STI testing – we can provide the services you need to protect your reproductive health. Call or click here to request your medical appointment today.