Medical abortion

From Wikipedia, the free encyclopedia

Medical abortion
Abortion typeMedical
First useUnited States 1979 (carboprost),
West Germany 1981 (sulprostone),
Japan 1984 (gemeprost),
France 1988 (mifepristone),
United States 1988 (misoprostol)
Gestation3–24+ weeks
Medical abortions as a percentage of all abortions
France64% (2016)
Sweden92% (2016)
UK: Eng. & Wales62% (2016)
UK: Scotland83% (2016)
United States54% (2020)
Infobox references
Combination of
MifepristoneProgesterone receptor modulator
Clinical data
Trade namesMifegymiso,[1] Medabon Combipack
ATC code
Legal status
Legal status

A medical abortion, also known as medication abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage.[5] Medical abortions are more common than surgical abortions in most places, including Europe, India, China, and the United States.[6][7]

Medical abortions are typically performed by administering a two-drug combination: mifepristone followed by misoprostol. When mifepristone is not available, misoprostol alone may be used in some situations.[8]

Medical abortion is both safe and effective throughout a range of gestational ages, including the second and third trimester.[9] In the United States, the mortality rate for medical abortion is 14 times lower than the mortality rate for childbirth, and the rate of serious complications requiring hospitalization or blood transfusion is less than 0.4%.[10][11][12][13] Medical abortion can be administered safely by the patient at home, without assistance, in the first trimester.[14] Starting with the second trimester, it is recommended to take the second drug in a clinic or provider's office.[14]

Medical abortion should not be confused with emergency contraception, which typically involves drugs (such as Levonorgestrel or "Plan B") taken soon after intercourse to prevent a pregnancy from beginning.

Drug regimens[edit]

200 mg mifepristone and 800 μg misoprostol, the typical regimen for early medical abortion

Less than 12 weeks' gestation[edit]

For medical abortion up to 12 weeks' gestation, the recommended drug dosages are 200 milligrams of mifepristone by mouth, followed one to two days later by 800 micrograms of misoprostol inside the cheek, vaginally, or under the tongue.[15] The success rate of this drug combination is 96.6% through 10 weeks' pregnancy.[16]

Misoprostol should be administered 24 to 48 hours after the mifepristone; taking the misoprostol before 24 hours have elapsed reduces the probability of success.[17] However, one study showed that the two drugs may be taken simultaneously with nearly the same efficacy.[18]

For pregnancies after 9 weeks, two doses of misoprostol (the second drug) makes the treatment more effective.[19] From 10 to 11 weeks of pregnancy, the National Abortion Federation suggests second dose of misoprostol (800 micrograms) four hours after the first dose.[20]

After the patient takes mifepristone, they must also administer the misoprostol. Failure to take the misoprostol may result in any of these outcomes: the fetus may be terminated, but not fully expelled from the uterus (possibly accompanied by hemorrhaging) and may require surgical intervention to remove the fetus; or the pregnancy may be successfully aborted and expelled; or the pregnancy may continue with a healthy fetus. For those reasons, misoprostol should always be taken after the mifepristone.[21]

If the pregnancy involves twins, a higher dosage of mifepristone may be recommended.[22]

Self-administered medical abortion[edit]

In the first trimester, self-administered medical abortion is available for patients who prefer to take the abortion drugs at home without direct medical supervision (in contrast to provider-administered medical abortion where the patient takes the second abortion drug in the presence of a trained healthcare provider).[14] Evidence from clinical trials indicates self-administered medical abortion is as effective as provider-administered abortion; however additional research is required to confirm that safety is equivalent.[23][24]

The procedure used to administer the two drugs depends on specific drugs prescribed. A typical procedure, for 200 mg mifepristone tablets, is:[25][26][27]

  1. Take the mifepristone
  2. Take the misoprostol between 24 hours and 48 hours after the mifepristone
  3. The pregnancy (embryo and placenta) will be expelled through the vagina within 2 to 24 hours after taking misoprostol, so the patient should remain near toilet facilities at that time. Cramps, nausea and bleeding may be experienced while the pregnancy is being expelled, and afterwards
  4. To avoid infection, the patient should not use tampons or engage in intercourse for 2 to 3 weeks[28]
  5. The patient should contact their provider 7 to 14 days after the administration of mifepristone to confirm that complete termination of pregnancy has occurred and to evaluate the degree of bleeding

After 12 weeks' gestation[edit]

Medical abortion is safe and effective in the second and third trimesters.[9][29][30][31] The WHO recommends that medical abortions performed after 12 weeks' gestation be supervised by a generalist medical practitioner or specialist medical practitioner (in contrast to first trimester, where the patient may safely take the drugs at home without supervision).[14][15]

For medical abortion after 12 weeks' gestation, the WHO recommends 200 mg of mifepristone by mouth followed one to two days later by repeat doses of 400 μg misoprostol under the tongue, inside the cheek, or in the vagina.[15] Misoprostol should be taken every 3 hours until successful abortion is achieved, the mean time to abortion after starting misoprostol is 6–8 hours, and approximately 94% will abort within 24 hours after starting misoprostol.[32] When mifepristone is not available, misoprostol may still be used though the mean time to abortion after starting misoprostol will be extended compared to regimens using mifepristone followed by misoprostol.[33]

Alternative drug combinations[edit]

The mifepristone-misoprostol combination is, by far, the most recommended drug regimen for medical abortions, but other drug combinations are available.

Misoprostol alone, without mifepristone, may be used in some circumstances for medical abortion, and has even been demonstrated to be successful in the second trimester. Misoprostol is more commonly available than mifepristone, and is easier to store and administer, so misoprostol without mifepristone may be suggested by the provider if mifepristone is not available.[8] If misoprostol is used without mifepristone, the WHO recommends 800 μg of misoprostol inside the cheek, under the tongue, or in the vagina.[15] The success rate of misoprostol alone for terminating pregnancy (93%) is nearly the same as the mifepristone-misoprostol combination (96%). However, 15% of the women using misoprostol alone required a surgical follow-up procedure, which is significantly more than the mifepristone-misoprostol combination.[34]

A rarely used drug combination for uterine pregnancies is methotrexate-misoprostol, which is typically reserved for ectopic pregnancies.[35] Methotrexate is given either orally or intramuscularly, followed by vaginal misoprostol 3–5 days later.[20] The methotrexate combination is available through 63 days. The WHO authorizes the methotrexate-misoprostol combination[36] but recommends the mifepristone combination because methotrexate may be teratogenic to the embryo in cases of incomplete abortion. The methotrexate-misoprostol combination is considered more effective than misoprostol alone.[37]

Access to medical abortion[edit]

Both drugs – mifepristone and misoprostol – are no longer covered by drug patents, and hence are available as generic drugs.

Over-the-counter availability[edit]

The requirements for a prescription vary widely between countries.[38] Many countries make the medical abortion drugs available over the counter, without a prescription, such as China, India, and others.[39] Other countries require a prescription (Canada, most of Western Europe, the United States, and others).[39] Some countries require a prescription but are lax about enforcing that requirement (Russia, Brazil, and others).[39]

Telehealth access[edit]

Telehealth includes access to medical services that the person can perform at home, without in-person visits to clinic or provider offices. People who have used telehealth report being satisfied with the access it provides to abortion services.[40][41] However, those who might need the service the most (those who are incarcerated, unhoused, or live on low income) are often inhibited from accessing it.[42]

Telehealth options for people in the U.S. seeking medical abortion include: Aid Access, Plan C, Hey Jane, Choix, Just the Pill, carafem, and Abortion on Demand.[43]

Clinic-to-clinic access[edit]

In this model, a provider communicates with a patient located at another site using clinic-to-clinic videoconferencing to provide medication abortion. This was introduced by Planned Parenthood of the Heartland in Iowa to allow a patient at one health facility to communicate via secure video with a health provider at another facility.[44] This model has expanded to other Planned Parenthoods in multiple states as well other clinics providing abortion care.[44]

Direct-to-patient access[edit]

The direct-to-patient model allows for medication abortion to be provided without an in-person clinic visit. Instead of an in-person clinic visit, the patient receives counseling and instruction from the abortion provider via videoconference. The patient can be at any location, including their home. The medications necessary for the abortion are mailed directly to the patient. This is a model, called TelAbortion or no-test medication abortion (formerly no-touch medication abortion), being piloted and studied by Gynuity Health Projects, with special approval from the U.S. Food and Drug Administration (FDA).[45] This model has been shown to be safe, effective, efficient, and satisfactory.[46][47][48] Complete abortion can be confirmed via telephone-based assessment.[49]

In the United States[edit]

In the U.S., prescriptions for mifepristone may be filled by any pharmacy - online or brick-and-mortar - that has obtained a special certification.[50] This regulation was provisionally implemented in Dec 2021, and was finalized by the FDA in January 2023.[51]

From 2011 until 2021, a patient was required to visit a healthcare provider in-person (at a clinic or office) and receive mifepristone directly from the provider.[52] The requirement to visit a clinic to receive the drug was removed by the FDA in December 2021, during the COVID-19 pandemic. Under the new rules, the prescription may be obtained via telehealth (phone calls or video conferencing with a healthcare provider), and then filled at any certified pharmacy.[53][27][46][54] At the same time the FDA removed the requirement for an in-person visit, they added a requirement that dispensing pharmacies be "certified", which requires the pharmacy to have special permission to dispense the drugs – a requirement the FDA imposes on only 40 drugs out of more than 19,000 it manages.[55]

The second drug used in medical abortion, misoprostol, is most commonly used for treating ulcers, and was never subject to the in-person dispensing constraints of mifepristone, and was always available from pharmacies with a prescription.

The FDA does not authorize the use of mifepristone for medical abortion after 70 days, unlike most other countries, which authorize medical abortion into the second trimester and even the third trimester.[53]

Some states have passed laws that prohibit providers from examining the patient via phone or video conferencing, and instead require the patient to make an in-person visit to the provider to get the prescription.[56][57]

In most states, abortion drugs may be sent from a pharmacy to the patient via mail, but certain states have passed laws making that illegal, and requiring the drugs to be obtained from a pharmacy or provider in-person.[56][58]

Interest in abortion medications in the United States reached record highs in 2022, after the Supreme Court of the United States draft Dobbs v. Jackson Women's Health Organization ruling that would overturn Roe v. Wade was leaked online.[59] Interest was higher in states with more restrictions on access to abortion.[59] Pro-choice activists in the U.S. were exploring ways to make medical abortion more available, particularly in states where it is subject to limitations, with social media resources being utilized for this purpose.[60][61][62]

In March 2023, Governor Mark Gordon of Wyoming signed a bill outlawing the use of abortion pills in the state, making it the first US state to do so. The new legislation, which will go into effect on July 1, 2023, criminalizes the "prescription, dispensation, distribution, sale, or use of any drug" for the purpose of obtaining or performing an abortion. Those who violate the law, excluding the pregnant individual, may be charged with a misdemeanor and could face a $9,000 fine and up to six months in prison. Abortion providers are expected to challenge the new law in court.[63]


Contraindications to mifepristone are inherited porphyria, chronic adrenal failure, and ectopic pregnancy.[64][65] Some consider an intrauterine device in place to be a contraindication as well.[65] A previous allergic reaction to mifepristone or misoprostol is also a contraindication.[64]

Many studies excluded women with severe medical problems such as heart and liver disease or severe anemia.[65] Caution is required in a range of circumstances including:[64]

In some cases, it may be appropriate to refer people with preexisting medical conditions to a hospital-based abortion provider.[66]

Adverse effects[edit]

Most women will have cramping and bleeding heavier than a menstrual period.[65] Other adverse effects include nausea, vomiting, fever, chills, diarrhea, and headache.[28] Misoprostol taken vaginally tends to have fewer gastrointestinal side effects. Nonsteroidal antiinflammatory medications such as ibuprofen reduce pain with medication abortion.


Symptoms that require immediate medical attention:[67]

  • Heavy bleeding (enough blood to soak through four sanitary pads in 2 hours)
  • Abdominal pain, nausea, vomiting, diarrhea, fever for more than 24 hours after taking mifepristone
  • Fever of 38 °C (100.4 °F) or higher for more than 4 hours

Complications under 10 weeks' pregnancy are rare; according to two large reviews, bleeding requiring a blood transfusion occurred in 0.03–0.6% of women and serious infection in 0.01–0.5%.[16][17] Because infection is rare after medication abortion, the American College of Obstetricians and Gynecologists, The Society of Family Planning, and the NAF do not recommend use of routine antibiotics.[68][20] A few rare cases of deaths from clostridial toxic shock syndrome have occurred following medical abortions.[69]

A 2013 systematic review which included 45,000 women who used the 200 mg mifeprestone followed by misoprostol combination found that less than 0.4% had serious complications requiring hospitalization (0.3%) and/or blood transfusion (0.1%).[12][13]

Management of bleeding[edit]

Vaginal bleeding generally diminishes gradually over about two weeks after a medical abortion, but in individual cases spotting can last up to 45 days.[64] If the woman is well, neither prolonged bleeding nor the presence of tissue in the uterus (as detected by obstetric ultrasonography) is an indication for surgical intervention (that is, vacuum aspiration or dilation and curettage). Remaining products of conception will be expelled during subsequent vaginal bleeding. Still, surgical intervention may be carried out on the woman's request, if the bleeding is heavy or prolonged, or causes anemia, or if there is evidence of endometritis.

Although medical abortion is associated with more bleeding than surgical abortion, overall bleeding for the two methods is minimal and not clinically different. In a large-scale prospective trial published in 1992 of more than 16,000 women undergoing medical abortion using mifepristone with varying doses of gemeprost or sulprostone, only 0.1% had hemorrhage requiring a blood transfusion. It is often advised to contact a health care provider if there is bleeding to such degree that more than two pads are soaked per hour for two consecutive hours.


Medical abortion is safe even into the second and third trimesters.[9][29] [30] [31]

In the United States, an FDA report states that of the 3.7 million women who have had a medication abortion between 2000 and 2018, 24 died afterward, with 11 of those deaths likely unrelated to the abortion, including drug overdoses, homicides, and a suicide.[10][11] If the deaths likely unrelated to the abortion are not included, then the mortality rate for medication abortion is half the mortality rate of abortion overall.[10]: 1 Including all 24 deaths, the data shows that (in the US) the mortality rate for medication abortion is equivalent to abortion overall, which is 14 times lower than the mortality rate for childbirth, and also lower than the mortality rate for Penicillin and Viagra.[10][11]


Mifepristone blocks the hormone progesterone,[70][71] causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Methotrexate, which is sometimes used instead of mifepristone, stops the cytotrophoblastic tissue from growing and becoming a functional placenta.[72] Misoprostol, a synthetic prostaglandin, causes the uterus to contract and expel the embryo through the vagina.[73]


Medical abortions as a percentage of all abortions
Country Percentage
Italy 17% in 2015[74]
Spain 19% in 2015[75]
Belgium 22% in 2011[76]
Netherlands 22% in 2015[77]
Germany 23% in 2016[78]
United States 54% in 2020[7]
England and Wales 62% in 2016[79]
France 64% in 2016[80]
Iceland 67% in 2015[81]
Denmark 70% in 2015[81]
Portugal 71% in 2015[82]
Switzerland 72% in 2016[83]
Scotland 83% in 2016[84]
Norway 87% in 2016[85]
Sweden 92% in 2016[86]
Finland 96% in 2015[87]

A Guttmacher Institute survey of all known abortion providers in the U.S. found that medical abortions accounted for 54% of all abortions in 2020.[7] This count did not include self-induced abortions.[7]

At Planned Parenthood clinics in the U.S., medical abortions accounted for 32% of first trimester abortions in 2008,[88] 35% of all abortions in 2010 and 43% of all abortions in 2014.[89]

In 2009, medical abortion regimens using mifepristone in combination with a prostaglandin analog were the most common methods used to induce second-trimester abortions in Canada, most of Europe, China and India;[6] in contrast to the U.S., where 96% of second-trimester abortions were performed surgically by dilation and evacuation.[90]


Swedish researchers began testing potential abortifacients in 1965. In 1968, the Swedish physician Lars Engström published a paper on a clinical trial, conducted at the women's clinic of Karolinska Hospital in Stockholm, of the compound F6103 on pregnant Swedish women with the aim of inducing abortion. It was the first clinical trial of an abortion pill to be conducted in Sweden.[91] The paper, originally titled The Swedish Abortion Pill, was renamed to The Swedish Postconception Pill, due to the small number of induced abortions that occurred in the trial population. After these efforts were largely unsuccessful with F6103, the same researchers attempted to find an abortion pill with prostaglandins, capitalizing on the number of well-established prostaglandin scientists working in Sweden at the time; they were eventually awarded the 1982 Nobel Prize in Physiology for their work.[92]

Medical abortion became a successful alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486)[93] in the 1980s.[37][94][6] Mifepristone was first approved for use in 1998 in China and France. The drugs were approved for abortions in 2000 in U.S., but only through 49 days gestation.[95] In 2016, the U.S. FDA updated mifepristone's label to support usage through 70 days gestation.[96]

Society and culture[edit]

The WHO affirms that laws and policies should support people's access to evidence-based medically approved care, including medical abortion.[97][98]

"Reversal" controversy[edit]

Some anti-abortion groups claim that patients who change their mind about the abortion after taking mifepristone can "reverse" the abortion by administering progesterone (and not administering misoprostol).[99][100] As of 2022, there is no scientifically rigorous evidence that the effects of mifepristone can be reversed this way.[101][102] Even so, several states in the U.S. require providers of non-surgical abortion who use mifepristone to tell patients that reversal is an option.[103] In 2019, researchers initiated a small trial of the so-called "reversal" regimen using mifepristone followed by progesterone or placebo.[104][105] The study was halted after 12 women enrolled and three experienced severe vaginal bleeding. The results raise serious safety concerns about using mifepristone without follow-up misoprostol.[102]


In the U.S. in 2009, the typical price charged for a medical abortion up to 9 weeks' gestation was $490, four percent higher than the $470 typical price charged for a surgical abortion at 10 weeks' gestation.[106] In the U.S. in 2008, 57% of women who had abortions paid for them out of pocket.[107]

In April 2013, the Australian government commenced an evaluation process to decide whether to list mifepristone (RU486) and misoprostol on the country's Pharmaceutical Benefits Scheme (PBS). If the listing is approved by the Health Minister Tanya Plibersek and the federal government, the drugs will become more accessible due to a dramatic reduction in retail price—the cost would be reduced from between AU$300 and AU$800, to AU$12 (subsidised rate for concession card holders) or AU$35.[108] On 30 June 2013, the Australian Minister for Health, the Hon. Tanya Plibersek MP, announced that the Australian Government had approved the listing of mifepristone and misoprostol on the PBS for medical termination in early pregnancy consistent with the recommendation of the Pharmaceutical Benefits Advisory Committee.[109] These listings on the PBS commenced on 1 August 2013.[110][111]


  1. ^ Linepharma International Limited (April 15, 2019). "Mifegymiso Product Monograph" (PDF). Health Canada.
  2. ^ "Medabon - Combipack of Mifepristone 200 mg tablet and Misoprostol 4 x 0.2 mg vaginal tablets - Summary of Product Characteristics (SmPC)". Electronic Medicines Compendium (EMC). February 3, 2020. Retrieved January 19, 2021.
  3. ^ "The Abortion Pill | Get the Facts About Medication Abortion". Planned Parenthood.
  4. ^ "Mifepristone/misoprostol: List of nationally authorised medicinal products" (PDF). European Medicines Agency. January 14, 2021. PSUSA/00010378/202005.
  5. ^ Zhang J, Zhou K, Shan D, Luo X (May 2022). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews. 2022 (5): CD002855. doi:10.1002/14651858.CD002855.pub5. PMC 9128719. PMID 35608608.
  6. ^ a b c Kapp N, von Hertzen H (2009). "Medical methods to induce abortion in the second trimester". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy : comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 178–192. ISBN 978-1-4051-7696-5.
  7. ^ a b c d Jones RK (February 24, 2022). "Medication Abortion Now Accounts for More Than Half of All US Abortions". Guttmacher Institute.
  8. ^ a b Langer BR, Peter C, Firtion C, David E, Haberstich R (May 2004). "Second and third medical termination of pregnancy with misoprostol without mifepristone". Fetal Diagnosis and Therapy. 19 (3): 266–270. doi:10.1159/000076709. PMID 15067238. S2CID 25706987.
  9. ^ a b c Vlad S, Boucoiran I, St-Pierre ÉR, Ferreira E (June 2022). "Mifepristone-Misoprostol Use for Second- and Third-Trimester Medical Termination of Pregnancy in a Canadian Tertiary Care Centre". Journal of Obstetrics and Gynaecology Canada. 44 (6): 683–689. doi:10.1016/j.jogc.2021.12.010. PMID 35114381. S2CID 246505706.
  10. ^ a b c d "Analysis of Medication Abortion Risk and the FDA report - "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018"" (PDF). Bixby Center for Global Reproductive Health. April 1, 2019. The mortality rate for women known to have had a live-born infant is 8.8 per 100,000 live births, which is about 14 times higher than the mortality rate associated with medication abortion. Other medications that are commonly prescribed or administered in outpatient settings also have risks, including a small risk of death. Penicillin causes a fatal anaphylactic reaction at a rate of 2 deaths per 100,000 patients administered the drug. Phosphodiesterase type-5 inhibitors, which are used for erectile dysfunction and include Viagra, have a fatality rate of 4 deaths per 100,000 users. These risks are several times higher than the risk of death with medication abortion.
  11. ^ a b c "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018". Food and Drug Administration. December 31, 2018.
  12. ^ a b Raymond EG, Shannon C, Weaver MA, Winikoff B (January 2013). "First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review". Contraception. 87 (1): 26–37. doi:10.1016/j.contraception.2012.06.011. PMID 22898359.
  13. ^ a b Rabin RC (August 7, 2022). "Some Women 'Self-Manage' Abortions as Access Recedes - Information and medications needed to end a pregnancy are increasingly available outside the health care system". The New York Times. More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients.
  14. ^ a b c d "Self-management Recommendation 50: Self-management of medical abortion in whole or in part at gestational ages < 12 weeks (3.6.2) - Abortion care guideline". WHO Department of Sexual and Reproductive Health and Research. November 19, 2021. Retrieved June 30, 2022.
  15. ^ a b c d Abortion Care Guideline. Geneva: World Health Organization. 2022. ISBN 9789240039483.
  16. ^ a b Chen MJ, Creinin MD (July 2015). "Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review". Obstetrics and Gynecology. 126 (1): 12–21. doi:10.1097/AOG.0000000000000897. PMID 26241251. S2CID 20800109.
  17. ^ a b Raymond EG, Shannon C, Weaver MA, Winikoff B (January 2013). "First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review". Contraception. 87 (1): 26–37. doi:10.1016/j.contraception.2012.06.011. PMID 22898359.
  18. ^ Creinin MD, Schreiber CA, Bednarek P, Lintu H, Wagner MS, Meyn LA (April 2007). "Mifepristone and misoprostol administered simultaneously versus 24 hours apart for abortion: a randomized controlled trial". Obstetrics and Gynecology. 109 (4): 885–894. doi:10.1097/01.AOG.0000258298.35143.d2. PMID 17400850. S2CID 43298827.
  19. ^ Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI (February 2019). "Medical abortion in the late first trimester: a systematic review". Contraception. 99 (2): 77–86. doi:10.1016/j.contraception.2018.11.002. PMC 6367561. PMID 30444970.
  20. ^ a b c "NAF Clinical Policy Guidelines". National Abortion Federation. Retrieved April 10, 2020.
  21. ^ Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ (January 2020). "Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial". Obstetrics and Gynecology. 135 (1): 158–165. doi:10.1097/AOG.0000000000003620. PMID 31809439. S2CID 208813409. Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.
  22. ^ Sørensen EC, Iversen OE, Bjørge L (March 2005). "Failed medical termination of twin pregnancy with mifepristone: a case report". Contraception. 71 (3): 231–233. doi:10.1016/j.contraception.2004.09.002. PMID 15722075.
  23. ^ Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD (March 2020). "Self-administered versus provider-administered medical abortion". The Cochrane Database of Systematic Reviews. 3: CD013181. doi:10.1002/14651858.CD013181.pub2. PMC 7062143. PMID 32150279.
  24. ^ Schmidt-Hansen M, Pandey A, Lohr PA, Nevill M, Taylor P, Hasler E, Cameron S (April 2021). "Expulsion at home for early medical abortion: A systematic review with meta-analyses". Acta Obstetricia et Gynecologica Scandinavica. 100 (4): 727–735. doi:10.1111/aogs.14025. PMID 33063314. S2CID 222819835.
  25. ^ "MIFEPREX (mifepristone) Tablets Label". FDA. Retrieved June 30, 2022.
  26. ^ "Mifepristone and misoprostol: Recommended regimen". Ipas. January 30, 2020. Retrieved June 30, 2022.
  27. ^ a b "Mifeprex (mifepristone) Information". FDA. February 7, 2022.
  28. ^ a b "Medical Abortion: What Is It, Types, Risks & Recovery". Cleveland Clinic. October 21, 2021. Retrieved June 30, 2022.
  29. ^ a b Safe abortion: technical and policy guidance for health systems-2nd ed. Italy: WHO. 2012. p. 42. ISBN 9789241548434.
  30. ^ a b Gómez Ponce de León R, Wing DA (April 2009). "Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy - a systematic review". Contraception. 79 (4): 259–71. doi:10.1016/j.contraception.2008.10.009. PMID 19272495.
  31. ^ a b Mendilcioglu I, Simsek M, Seker PE, Erbay O, Zorlu CG, Trak B (November 2002). "Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies". International Journal of Gynaecology and Obstetrics. 79 (2): 131–5. doi:10.1016/s0020-7292(02)00224-2. PMID 12427397. S2CID 44373757.
  32. ^ Borgatta L, Kapp N (July 2011). "Clinical guidelines. Labor induction abortion in the second trimester". Contraception. 84 (1): 4–18. doi:10.1016/j.contraception.2011.02.005. PMID 21664506.
  33. ^ Perritt JB, Burke A, Edelman AB (September 2013). "Interruption of nonviable pregnancies of 24-28 weeks' gestation using medical methods: release date June 2013 SFP guideline #20133". Contraception. 88 (3): 341–349. doi:10.1016/j.contraception.2013.05.001. PMID 23756114.
  34. ^ Raymond EG, Harrison MS, Weaver MA (January 2019). "Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review". Obstetrics and Gynecology. 133 (1): 137–147. doi:10.1097/AOG.0000000000003017. PMC 6309472. PMID 30531568.
  35. ^ "Medical abortion - Mayo Clinic". Retrieved July 10, 2022.
  36. ^ "Women's Health". WebMD.
  37. ^ a b Creinin MD, Danielsson KG (2009). "Medical abortion in early pregnancy". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy : comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 111–134. ISBN 978-1-4051-7696-5.
  38. ^ "Medical Aborptions Commodities Database". International Planned Parenthood Federation.
  39. ^ a b c Oral Contraceptives Over-the-Counter Working Group. "Global Oral Contraception Availability".
  40. ^ Ireland S, Belton S, Doran F (March 2020). "'I didn't feel judged': exploring women's access to telemedicine abortion in rural Australia". Journal of Primary Health Care. 12 (1): 49–56. doi:10.1071/HC19050. PMID 32223850.
  41. ^ Ehrenreich K, Kaller S, Raifman S, Grossman D (September 2019). "Women's Experiences Using Telemedicine to Attend Abortion Information Visits in Utah: A Qualitative Study". Women's Health Issues. 29 (5): 407–413. doi:10.1016/j.whi.2019.04.009. PMID 31109883.
  42. ^ Craven J (March 21, 2022). "The FDA made mail-order abortion pills legal. Access is still a nightmare". Vox. Retrieved May 19, 2022.
  43. ^ Korn J (July 1, 2022). "Online abortion pill interest soars after the demise of Roe v. Wade". CNN. Retrieved July 4, 2022.
  44. ^ a b "Improving Access to Abortion via Telehealth". Guttmacher Institute. May 7, 2019. Retrieved April 21, 2020.
  45. ^ "Telabortion Project". Retrieved April 26, 2020.
  46. ^ a b Belluck P. "Abortion by Telemedicine: A Growing Option as Access to Clinics Wanes". The New York Times. Retrieved May 5, 2020.
  47. ^ Raymond E, Chong E, Winikoff B, Platais I, Mary M, Lotarevich T, et al. (September 2019). "TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States". Contraception. 100 (3): 173–177. doi:10.1016/j.contraception.2019.05.013. PMID 31170384.
  48. ^ "New Multi-State Study Shows Telemedicine Abortion Is as Safe and Effective as In-Person Care". Retrieved April 26, 2020.
  49. ^ Chen MJ, Rounds KM, Creinin MD, Cansino C, Hou MY (August 2016). "Comparing office and telephone follow-up after medical abortion". Contraception. 94 (2): 122–126. doi:10.1016/j.contraception.2016.04.007. PMID 27101901. S2CID 27825883.
  50. ^ "FDA relaxes restrictions on abortion pill". December 16, 2021. Retrieved May 19, 2022.
  51. ^ "FDA finalizes rule expanding availability of abortion pills" Matthew Perrone, Jan. 3, 2023, Los Angeles Times,
  52. ^ "The Availability and Use of Medication Abortion". Kaiser Family Foundation. April 6, 2022. Retrieved May 19, 2022.
  53. ^ a b "Questions and Answers on Mifeprex". FDA. December 16, 2021.
  54. ^ Ramaswamy A, Weigel G, Sobel L (June 16, 2021). "Medication Abortion and Telemedicine: Innovations and Barriers During the COVID-19 Emergency". Kaiser Family Foundation (KFF). Retrieved August 3, 2020.
  55. ^ Koons C (May 3, 2022). "The Abortion Pill Is Safer Than Tylenol and Almost Impossible to Get". Retrieved June 30, 2022.
  56. ^ a b Watts A (May 6, 2022). "Governor signs bill criminalizing mail-in abortion drugs". CNN. Retrieved June 30, 2022.
  57. ^ Matei A (April 7, 2022). "Mail-order abortion pills become next US reproductive rights battleground". The Guardian. Retrieved June 30, 2022.
  58. ^ Bluth R (April 15, 2022). "State regulations are shutting down doctors prescribing abortion pills". Salon. Retrieved June 30, 2022.
  59. ^ a b Poliak A, Satybaldiyeva N, Strathdee SA, Leas EC, Rao R, Smith D, Ayers JW (June 2022). "Internet Searches for Abortion Medications Following the Leaked Supreme Court of the United States Draft Ruling". JAMA Internal Medicine. 182 (9): 1002–1004. doi:10.1001/jamainternmed.2022.2998. PMC 9244771. PMID 35767270.
  60. ^ Bruder J (April 4, 2022). "The Future of Abortion in a Post-Roe America". The Atlantic. Retrieved June 30, 2022.
  61. ^ Noor P (May 7, 2022). "The activists championing DIY abortions for a post-Roe v Wade world". The Guardian. Retrieved June 30, 2022.
  62. ^ Azar T (June 28, 2022). "Need help getting an abortion? Social media flooded with resources after Roe reversal". USA Today. Retrieved June 29, 2022 – via Yahoo!.
  63. ^ Chen, David W.; Belluck, Pam (March 18, 2023). "Wyoming Becomes First State to Outlaw Abortion Pills". The New York Times. ISSN 0362-4331. Retrieved March 18, 2023.
  64. ^ a b c d International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery (2006). Frequently asked clinical questions about medical abortion (PDF). Geneva: World Health Organization. ISBN 978-92-4-159484-4. Archived from the original (PDF) on January 17, 2009.
  65. ^ a b c d "Medical management of first-trimester abortion". Contraception. American College of Obstetricians and Gynecologists; Society of Family Planning. 89 (3): 148–161. March 2014. doi:10.1016/j.contraception.2014.01.016. PMID 24795934.
  66. ^ Guiahi M, Davis A (December 2012). "First-trimester abortion in women with medical conditions: release date October 2012 SFP guideline #20122". Contraception. 86 (6): 622–630. doi:10.1016/j.contraception.2012.09.001. PMID 23039921.
  67. ^ "Mifepristone Prescribing Information" (PDF). FDA.
  68. ^ Achilles SL, Reeves MF (April 2011). "Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102". Contraception. 83 (4): 295–309. doi:10.1016/j.contraception.2010.11.006. PMID 21397086.
  69. ^ Murray S, Wooltorton E (August 2005). "Septic shock after medical abortions with mifepristone (Mifeprex, RU 486) and misoprostol". CMAJ. 173 (5): 485. doi:10.1503/cmaj.050980. PMC 1188182. PMID 16093445.
  70. ^ Little B (June 23, 2017). "The Science Behind the "Abortion Pill"". Smithsonian Magazine.
  71. ^ Creinin MD, Grossman DA (March 2014). "Medical management of first-trimester abortion" (PDF). Contraception. 89 (3): 148–161. doi:10.1016/j.contraception.2014.01.016. PMID 24795934.
  72. ^ "Methotrexate". Medication Abortion. Ibis Reproductive Health.
  73. ^ "Misoprostol". Medication Abortion. Ibis Reproductive Health.
  74. ^ "Relazione Ministro Salute attuazione Legge 194/78 tutela sociale maternità e interruzione volontaria di gravidanza - dati definitivi 2014 e 2015 [Ministry of Health report implementation Act 194/78 social protection maternity and voluntary interruption of pregnancy - definitive data 2014 and 2015]". Rome: Ministero della Salute [Ministry of Health]. December 15, 2016. Table 25 - IVG and type of intervention, 2015: mifepristone + mifepristone+prostaglandin + prostaglandin = 17%.
  75. ^ "Interrupción Voluntaria del Embarazo; Datos definitivos correspondientes al año 2015 (Voluntary interruption of pregnancy; final data for 2015" (PDF). Madrid: Ministerio de Sanidad, Politica Social e Igualdad (Ministry of Health and Social Policy). December 30, 2016. Archived from the original (PDF) on October 21, 2018. Retrieved January 18, 2017. Table G.15: 17,916 (sum of the greater of mifepristone or prostaglandin abortions by gestation period) / 94,188 (total abortions) = 19.0%.
  76. ^ Commission Nationale d'Evaluation des Interruptions de Grossesse (August 27, 2012). "Rapport Bisannuel 2010-2011". Brussels: Commission Nationale d'Evaluation des Interruptions de Grossesse. prostaglandin 0.40% + mifepristone 21.23% = 21.63% medical abortions
  77. ^ "Jaarrapportage 2015 van de Wet afbreking zwangerschap [Annual Report 2015 of the Discontinuation of Pregnancy Act]". Utrecht, Netherlands: Inspectie voor de Gezondheidszorg (IGZ) [Health Care Inspectorate], Ministerie van Volksgezondheid, Welzijn en Sport (VWS) [Ministry of Health, Welfare and Sport]. February 9, 2017. Archived from the original on September 27, 2019. Retrieved June 25, 2017.
  78. ^ "Schwangerschaftsabbrüche 2016 (Abortions 2016)" (PDF). Wiesbaden: Statistisches Bundesamt (Federal Statistical Office), Germany. March 9, 2017. 20.237% Mifegyne + 3.021% Medikamentöser Abbruch = 23.257% medical abortions
  79. ^ "Abortion statistics, England and Wales: 2016" (PDF). London: Department of Health, United Kingdom. May 30, 2017.
    Medical abortion accounted for 72% of abortions under 10 weeks' gestation—in England and Wales in 2016.
  80. ^ Vilain A (June 26, 2017). "211 900 interruptions volontaires de grossesse en 2016 (211,900 voluntary terminations of pregnancies in 2016)" (PDF). Paris: DREES (Direction de la Recherche, des Études, de l'Évaluation et des Statistiques), Ministère de la Santé (Ministry of Health), France. Archived from the original (PDF) on July 17, 2020. Retrieved June 28, 2017.
  81. ^ a b Heino A, Gissler M (March 7, 2017). "Pohjoismaiset raskaudenkeskeytykset 2015 (Induced abortions in the Nordic countries 2015)" (PDF). Helsinki: Terveyden ja hyvinvoinnin laitos (National Institute for Health and Welfare), Finland. ISSN 1798-0887. Appendix table 6. Drug-induced abortions in Nordic countries 1993–2015, %
  82. ^ "Relatório dos Registos das Interrupções da Gravidez - Dados de 2015 [Report of the Interruptions of Pregnancy - Data of 2015]". Lisbon: Divisão de Saúde Sexual, Reprodutiva, Infantil e Juvenil [Division of Sexual, Reproductive, Child and Juvenile Health], Direção de Serviços de Prevenção da Doença e Promoção da Saúde [Directorate of Disease Prevention and Health Promotion Services], Direção-Geral da Saúde (DGS) [Directorate-General for Health]. September 20, 2016. Archived from the original on January 16, 2021. Retrieved June 29, 2017.
  83. ^ "Interruptions de grossesse en Suisse en 2016 (Abortions in Switzerland 2016)". Neuchâtel: Office of Federal Statistics, Switzerland. June 13, 2017.
  84. ^ "Termination of pregnancy statistics, year ending December 2016" (PDF). Edinburgh: Information Services Division (ISD), NHS National Services Scotland. May 30, 2017.
    Medical abortions accounted for 89% of abortions before 9 weeks' gestation in Scotland in 2016.
  85. ^ Løkeland M, Mjaatvedt AG, Akerkar R, Pedersen Y, Bøyum B, Hornæs MT, Ebbing M (March 8, 2017). "Rapport om svangerskapsavbrot for 2016" [Report on pregnancy terminations for 2016] (PDF) (in Norwegian). Oslo: Divisjon for epidemiologi (Division of Epidemiology), Nasjonalt Folkehelseinstitutt (Norwegian Institute of Public Health), Norway. ISSN 1891-6392. Archived from the original (PDF) on April 15, 2017. Retrieved April 25, 2017.
    Medical abortions accounted for 90% of abortions before 9 weeks' gestation in Norway in 2016.
  86. ^ Öman M, Gottvall K (May 10, 2017). "Statistik om aborter 2016 (Statistics on abortions in 2016)" (PDF). Stockholm: Socialstyrelsen (National Board of Health and Welfare), Sweden. Archived from the original (PDF) on February 21, 2018. Retrieved June 24, 2017.
    Medical abortions accounted for 94% of abortions before 9 weeks' gestation in Sweden in 2016.
  87. ^ Heino A, Gissler M (October 20, 2016). "Raskaudenkeskeytykset 2015 (Induced abortions 2015)" (PDF). Helsinki: Suomen virallinen tilasto (Official Statistics of Finland), Terveyden ja hyvinvoinnin laitos (National Institute for Health and Welfare), Finland.
  88. ^ Fjerstad M, Trussell J, Sivin I, Lichtenberg ES, Cullins V (July 2009). "Rates of serious infection after changes in regimens for medical abortion". The New England Journal of Medicine. 361 (2): 145–151. doi:10.1056/NEJMoa0809146. PMC 3568698. PMID 19587339.
    Allday E (July 9, 2009). "Change cuts infections linked to abortion pill". San Francisco Chronicle. p. A1.
  89. ^ Mindock C (October 31, 2016). "Abortion Pill Statistics: Medication Pregnancy Termination Rivals Surgery Rates In The United States". InternatTimes. Retrieved April 19, 2018.
  90. ^ Hammond C, Chasen ST (2009). "Dilation and evacuation". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy : comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 178–192. ISBN 978-1-4051-7696-5.
  91. ^ Ramsey M (2021). The Swedish Abortion Pill: Co-Producing Medical Abortion and Values, Ca. 1965-1992. Acta Universitatis Upsaliensis. ISBN 978-91-513-1121-0.
  92. ^ Raju TN (November 1999). "The Nobel chronicles. 1982: Sune Karl Bergström (b 1916); Bengt Ingemar Samuelsson (b 1934); John Robert Vane (b 1927)". Lancet. 354 (9193): 1914. doi:10.1016/s0140-6736(05)76884-7. PMID 10584758. S2CID 54236400.
  93. ^ Rowan A (2015). "Prosecuting Women for Self-Inducing Abortion: Counterproductive and Lacking Compassion". Guttmacher Policy Review. 18 (3): 70–76. Retrieved October 12, 2015.
  94. ^ Zhang J, Zhou K, Shan D, Luo X (May 2022). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews. 2022 (5): CD002855. doi:10.1002/14651858.CD002855.pub5. PMC 9128719. PMID 35608608.
  95. ^ Creinin MD, Chen MJ (August 2016). "Medical abortion reporting of efficacy: the MARE guidelines". Contraception. 94 (2): 97–103. doi:10.1016/j.contraception.2016.04.013. PMID 27129936.
  96. ^ "Highlights of Prescribing Information, Mifeprex" (PDF). U.S. Food and Drug Administration. Retrieved October 10, 2019.
  97. ^ Medical management of abortion. WHO. 2018. p. 24. ISBN 978-9241550406.
  98. ^ "Human Rights and Health". World Health Organization Newsroom. September 21, 2019.
  99. ^ Cha AE (April 4, 2018). "As controversial 'abortion reversal' laws increase, researcher says new data shows protocol can work". Retrieved April 23, 2018.
  100. ^ "California Board of Nursing Sanctions Unproven Abortion 'Reversal' (Updated) - Rewire". Rewire. Retrieved November 23, 2017.
  101. ^ Bhatti KZ, Nguyen AT, Stuart GS (March 2018). "Medical abortion reversal: science and politics meet". American Journal of Obstetrics and Gynecology. 218 (3): 315.e1–315.e6. doi:10.1016/j.ajog.2017.11.555. PMID 29141197. S2CID 205373684.
  102. ^ a b Gordon M (December 5, 2019). "Safety Problems Lead To Early End For Study Of 'Abortion Pill Reversal'". NPR. Retrieved December 6, 2019.
  103. ^ "Counseling and Waiting Periods for Abortion". The Guttmacher Institute. March 14, 2016.
  104. ^ Gordon M (March 22, 2019). "Controversial 'Abortion Reversal' Regimen is Put to the Test". NPR.
  105. ^ Sherman C (April 17, 2019). "There's no proof "abortion reversals" are real. This study could end the debate". Vice.
  106. ^ Jones RK, Kooistra K (March 2011). "Abortion incidence and access to services in the United States, 2008". Perspectives on Sexual and Reproductive Health. 43 (1): 41–50. doi:10.1363/4304111. PMID 21388504. S2CID 2045184.
    Stein R (January 11, 2011). "Decline in U.S. abortion rate stalls". The Washington Post. p. A3.
  107. ^ Jones RK, Finer LB, Singh S (May 4, 2010). Characteristics of U.S. abortion patients, 2008 (PDF) (Report). New York: Guttmacher Institute.
    Mathews AW (May 4, 2010). "Most women pay for their own abortions". The Wall Street Journal.
  108. ^ Peterson K (April 30, 2013). "Abortion drugs closer to being subsidised but some states still lag". The Conversation Australia. The Conversation Media Group. Retrieved April 29, 2013.
  109. ^ "March 2013 PBAC Outcomes - Positive Recommendations". PBS: The Pharmaceutical Benefits Scheme. Australian Government. Retrieved October 22, 2020.
  110. ^ "Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for medical termination of pregnancy of up to 49 days' gestation". RADAR Review. National Prescribing Service (NPS) MedicineWise. August 1, 2013. Retrieved October 22, 2020.
  111. ^ Australian PBS listing is at

External links[edit]