Medical abortion
[17] 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.
[17][18] 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.
[45] Caution is required in a range of circumstances including:[44] In some cases, it may be appropriate to refer people with preexisting medical conditions to a hospital-based abortion provider.
[45] Other adverse effects may include nausea, vomiting, fever, chills, diarrhea, headache, dizziness, warmth or hot flashes.
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%.
[52][22] A few rare cases of deaths from clostridial toxic shock syndrome have occurred following medical abortions.
[53] A 2013 systematic review which included 45,000 women who used the 200 mg mifepristone followed by misoprostol combination found that less than 0.4% had serious complications requiring hospitalization (0.3%) and/or blood transfusion (0.1%).
[15][16] Vaginal bleeding generally diminishes gradually over about two weeks after a medical abortion, but in individual cases spotting can last up to 45 days.
Overall, less than 1% of individuals who undergo a medical abortion must obtain emergency services for excessive bleeding, and about 0.1% require a blood transfusion.
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.
[54] Globally, individuals who can get pregnant face substantial dangers to their health due to the significant challenges in obtaining safe abortion services.
Approximately 7 million women are hospitalized annually in these areas as a result of complications arising from unsafe abortion.
Unsafe abortion is attributed to 4.7% to 13.2% of maternal deaths each year, with the estimated expense for managing its complications reaching $553 million.
[63][64] Many factors contribute to these health risks including lack of education about available choices, the varying stances of healthcare providers on abortion, a shortage of qualified personnel for safe abortion services, insufficient privacy and confidentiality, and services that fall short of meeting the demand.
[13][14] Medical abortion has been demonstrated to be safe by international health organizations such as the WHO even into the second and third trimesters,[10][32][33][34] but legal access to these services change frequently in the US and globally.
[67] Mifepristone blocks the hormone progesterone,[68][69] causing the lining of the uterus to thin, preventing an embryo from latching on to the uterine wall to grow.
Methotrexate, which is sometimes used instead of mifepristone, stops the cytotrophoblastic tissue from growing and becoming a functional placenta, the organ that supplies nutrients to a developing fetus.
Recent studies suggest the use of letrozole before misoprostol or mifepristone for initiation of medical abortion can enhance treatment efficacy and reduce the need for surgical interventions.
[100][7][43][101] Mifepristone was first approved for use in China and France in 1988, in Great Britain in 1991, in Sweden in 1992, in Austria, Belgium, Denmark, Finland, Georgia, Germany, Greece, Iceland, Israel, Lichtenstein, Luxembourg, Netherlands, Russia, Spain, and Switzerland in 1999, in Norway, Taiwan, Tunisia, and the United States in 2000, and in 70 additional countries from 2001 to 2023.
[107] Telehealth includes access to medical services that the person can perform at home, without in-person visits to clinic or provider offices.
[117][118] The overall decrease in availability and delivery of crucial sexual health care, including safe abortions, amid the COVID-19 pandemic led to an increased incidence of complications and fatalities during pregnancy.
[121][122][123][124][125][126] Data suggest that the increased use of telemedicine for abortion services during this period were a result of COVID-19 fear, reduced travel ability, stay-at-home orders, greater concealment, and the solace of home-care.
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.
[137][139] 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 1973's Roe v. Wade decision was leaked online.
[140] Pro-choice activists in the US 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.
The new legislation, which went into effect in July 2023, criminalizes the "prescription, dispensation, distribution, sale, or use of any drug" for the purpose of obtaining or performing an abortion.
[150] Those who violate the law, excluding the pregnant woman, may be charged with a misdemeanor and could face a $9,000 fine and up to six months in jail.
[152] In March 2024, some major pharmacy chains, such as CVS and Walgreens, received certification from the FDA to dispense mifepristone and they plan to make it available for sale in states where it is legal.
The legal status of interstate telemedicine, in particular, writing prescriptions, is an emerging area of law in the United States.
[166] 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).
