Suspension of mifepristone approval wouldn't be the end of medication abortion

CNN

There is still a nonsurgical alternative for women to perform abortions at home, even if US District Court Judge Matthew Kacsmaryk’s decision to suspend US Food and Drug Administration approval of mifepristone comes to pass.

The so-called "abortion pill" in the United States is actually two medications: mifepristone (also known as RU-486 or Mifeprex), which is sold under brand names Mifeprex and Korlym or by the generic name Mifeprex, and misoprostol (which is taken 24 to 48 hrs later).

The ruling of the federal judge in Texas from last week only applies to mifepristone. He delayed the decision for a week in order to allow time for appeals. However, even if it is implemented, misoprostol will not be affected.

Studies show that misoprostol is a safe, effective method of abortion. This has been the case for many decades.

Both drugs have different effects. Mifepristone inhibits a hormone known as progesterone that the body requires to maintain pregnancy. The hormone is needed to maintain the uterus's interior. Without it, the uterus would expel the contents.

The FDA has approved misoprostol to treat and prevent gastric ulcers that are caused by nonsteroidal antiinflammatory drugs (NSAIDs). Off-label, it is also used for other types of ulcers. It has a variety of gynecological applications, such as to induce contractions, reduce blood loss following delivery, and treat miscarriages.

Misoprostol is used to induce abortions. It works by causing the uterus to empty through muscle contractions and bleeding.

'It is a bit old-school but we can do it', said Dr. Kristyn brandi, an ob/gyn and provider of abortions in New Jersey and spokesperson for the American College of Obstetricians and Gynecologists.

Brandi explained that this is what people used to do before FDA approved the mifepristone drug in 2000.

She said that many places in the country, where mifepristone is not available, due to politics or other reasons, have used misoprostol only regimens for years.

California announced Monday that they are stockpiling misoprostol.

Governor. In a press release, Gavin Newsom’s office confirmed the news.

Some organizations, such as Carafem (a national provider for reproductive health services), offer only one drug. The World Health Organization has endorsed this approach as medically acceptable. If mifepristone cannot be obtained, the American College of Obstetricians and Gynecologists recommends a misoprostol only regimen.

Misoprostol has been proven to be safe and effective

Brandi says that the two-drug approach is more effective. Misoprostol can also cause more side effects when used alone for abortion.

This method requires that the person using it place four pills under his or her tongue for 30 minutes and then swallow what is left. These can be used vaginally.

In general, bleeding begins within an hour to four hours of the first dose. Studies show that heavy bleeding lasts for about three to five days, although it can continue up to two weeks.

A person will most likely need to take more Misoprostol without mifepristone than he or she would have with a two-drug regimen. According to one study, a patient should receive three or four doses of misoprostol as well as a second dose in the event that it is required.

The more we give the more people will experience side effects. This is not what we want. Brandi explained that they wanted to ensure people had a good response to the medication, but also didn't want them to be as uncomfortable as possible. "Like I always tell my patients, there is no need to suffer in order to get an abortion. This is not what this process is about.

Other side effects include nausea, diarrhea, and fever.

Studies show that medication abortions account for more than 50% of all abortions in the US. According to Dr. Jamila Parritt, an abortion provider and ob/gyn in Washington, D.C., even if mifepristone was no longer available, misoprostol would still be the most preferred option.

"Again, this is safe. It's effective. Perritt explained that the medication requires a slightly different dosage and symptoms last a bit longer. There are other side effects such as a longer duration in bleeding, or more intense nausea, vomiting, or gastrointestinal symptoms. But when you compare that to the barriers put into place at both the state level and the federal level, many people still choose the second drug alone because it's more convenient.

Dr. Iffath Hoskins is the president of the American College of Obstetricians and Gynecologists. She says that while the single-drug approach is safe, women shouldn't be forced to choose that option because research has shown that two drugs taken together are safe and highly effective.

Hoskins stated that 'we do use off-label medications when clinically necessary; however, this should not occur here as we have more than two decades of evidence based clinical information that shows that this option is a valid one'.