Name: Medical Abortions: How Misoprostol and Mifepristone Work and What Are the Side Effects?
Uploaded: 2022-07-01T21:15:00Z
Duration: 5 min 20 s
Description: Following the Supreme Court decision to overturn Roe v. Wade, WSJ’s Daniela Hernandez took a look at the new attention on abortion pills. She explains how misoprostol and mifepristone work together to terminate a pregnancy, as well as the potential side effects of a medical abortion. Illustration: David Fang

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Following the Supreme Court decision to overturn Roe v. Wade, WSJ’s Daniela Hernandez took a look at the new attention on abortion pills. She explains how misoprostol and mifepristone work together to terminate a pregnancy, as well as the potential side effects of a medical abortion. Illustration: David Fang

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Medical Abortions: How Misoprostol and Mifepristone Work and What Are the Side Effects?

The Supreme court has overturned Roe versus Wade.

Journalist: It's historic, no doubt about it.

They have eliminated the constitutional right to an abortion.

It is a momentous decision.

Now attention has turned to abortion pills. Medical abortions or pill-based abortions have been on the rise since the turn of the century, and data suggests that they now account for more than half of abortions in the U.S. But how do these pills work? Are there any side effects, and what's the outlook for medical abortions in a post-Roe world? I'll explain. Abortion pills, which are used for medical abortions, are actually two medications, Mifepristone and Misoprostol, and together they work to terminate a pregnancy. As you can see, searches for medical abortion, Mifepristone, and Misoprostol surged in the days following the Supreme court's decision. The Food and Drug Administration has approved medical abortions for up to 10 weeks of pregnancy. Doctors start that clock from the first day of a woman's last period, which means that the clock starts before conception. So how do you get abortion pills? Well, they require a prescription. Until recently, the FDA required a patient to pick up Mifepristone in person at a credentialed doctor's office, but the agency lifted that rule permanently in December 2021, allowing abortion pills to be sent by mail. Still, 28 states require at least one in-person appointment for a patient to get a medical abortion. So how do abortion pills work? Mifepristone is the first pill taken. This medication blocks a hormone called progesterone, which is necessary for a pregnancy to progress. Next, a patient usually takes four misoprostol pills at once. That usually happens at home. Misoprostol helps soften the cervix, a structure at the base of the uterus that clamps shut during pregnancy to keep an embryo or a fetus inside. It also causes contractions, which helps to clear the uterus. Misoprostol mimics a fatty, hormone-like substance called prostaglandin E1. It controls processes like inflammation and the induction of labor, and is sometimes used to treat erectile dysfunction. Misoprostol can be easier to get than Mifepristone. That's because it's used for a wider range of conditions, for instance, following a miscarriage or for certain gastrointestinal problems. Bleeding, cramping, and the expulsion of tissue usually happens within four hours of taking the pills. When Mifepristone and Misoprostol are taken together up to 10 weeks of pregnancy, the efficacy rate is 95%. If taken later, which some countries do allow, the efficacy rates are lower. If the initial regimen doesn't work, a patient could get a second round of Misoprostol, or if needed, a surgical abortion. Research shows that medical abortions are safe for patients. For instance, studies have shown the two-medication abortion regimen to be safer than widely used drugs, including acetaminophen, penicillin, and Viagra. According to a paper in the "Journal of Contraception", major complications requiring either hospitalization or a blood transfusion happen in less than 0.4% of cases. Among the roughly 5 million women estimated to have used Mifepristone to terminate a pregnancy, 26 died according to FDA data collected through June 2021. Other research estimates that the risk of death from a medical abortion in the U.S. is one in 100,000, compared to one in 10,000 for live births. Common side effects include nausea, vomiting, diarrhea, dizziness, and headaches. But doctors say these symptoms usually resolve within a day or two. They also told me that a major misconception was that having a medical abortion could affect your fertility or increase your risk for breast cancer in the future. They said that there is no evidence for that. But doctors say that if a patient has an ectopic pregnancy, where fertilized egg attaches outside the uterus, they shouldn't have a medical abortion. Another misconception is that the authorities could differentiate between a medical abortion and a miscarriage, but doctors said there isn't a test to tell the difference between the two. So what happens to medical abortions after the Supreme Court's decision? About half of the states are expected to ban or severely limit access to abortion, including medical abortions. Doctors say they expect demand to rise, but there are questions about whether clinicians and patients could face criminal charges for providing or using abortion pills in states where abortion isn't legal. For instance, Tennessee criminalized distributors who send abortion pills by mail, South Dakota is restricting medical abortions via telemedicine starting July 1st, and Louisiana's ban on mail-order abortion pills starts August 1st. A medical abortion can cost up to $750. Whether it's covered by insurance depends on the state a patient lives in and their insurance. Only 16 states cover abortion costs through Medicaid, which covers healthcare costs for low income people. For people with private insurance, employers are already trying to figure out whether and how to pay for employees to travel to states where abortions are legal. Because ordering online from international vendors doesn't require a prescription, doctors expect patients to turn to the internet for access. They worry that patients might end up buying abortion pills from disreputable sources, which could be dangerous. And some states are looking to amend their state constitutions to protect abortion rights. That's another signal that access will vary a lot depending on where you live.

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