Understanding Medical Abortion and the Medication Mifepristone

medical abortion

A legal dispute over the abortion drug mifepristone has captured public attention. The U.S. Supreme Court Justice Samuel Alito has put a lower court order imposing significant restrictions on the distribution of the medication on hold as the high court considers a request by the Biden administration to block the restrictions.

Here is what you need to know about medical abortion and mifepristone.

What is Medical Abortion?

Medical abortion is a non-surgical method used to end a pregnancy within the first 10 weeks. It involves taking a combination of two drugs, mifepristone and misoprostol, which work together to end the pregnancy. Mifepristone blocks the hormone progesterone, which is essential for maintaining pregnancy, while misoprostol causes contractions and bleeding that expel the pregnancy.

Mifepristone, also known as RU-486, was first approved by the U.S. Food and Drug Administration (FDA) in 2000. It accounts for more than half of abortions in the United States and has been safely used by millions of women around the world.

How did the Legal Dispute over Mifepristone Begin?

Anti-abortion medical associations led by the Texas-based Alliance for Hippocratic Medicine sued the FDA last year, claiming the agency approved mifepristone for abortion in 2000 using an unlawful process and did not adequately consider the drug’s safety. They asked U.S. District Judge Matthew Kacsmaryk, who is presiding over the lawsuit, to revoke the drug’s approval, effectively pulling it off the market.

Kacsmaryk on April 7 issued a temporary order, known as a preliminary injunction, suspending the drug’s approval while the lawsuit proceeds. The Biden administration asked the 5th U.S. Circuit Court of Appeals for an emergency stay putting his injunction on hold.

The 5th Circuit ruled on Wednesday that the drug can stay on the market, but with serious restrictions, including a requirement that it be dispensed by a doctor in person and a limit on its use to the first seven weeks of pregnancy, down from 10.

The administration is now asking the Supreme Court to overrule the 5th Circuit and to put Kacsmaryk’s order on hold in its entirety, which would keep mifepristone available without any new restrictions while the lawsuit is pending.

What Will Happen Next?

At least through next Wednesday, there will be no new restrictions on mifepristone. Both the Biden administration and the drug’s maker, Danco Laboratories, have said if the Supreme Court allows the restrictions to take effect, mifepristone could be unavailable for months while the company changes its label and distribution system to comply.

The Supreme Court will determine whether and how mifepristone can be distributed while the case is pending. It will not decide the merits of the case.

Health Risks of Mifepristone and Misoprostol

The most common side effects of mifepristone and misoprostol include cramping, nausea, vomiting, and diarrhoea. However, there are also potentially serious health risks associated with these drugs, which include:

  1. Heavy bleeding: This is the most common complication of medical abortion, occurring in about 1-2% of cases. In rare cases, it can lead to severe blood loss, anaemia, or even the need for a blood transfusion.
  2. Incomplete abortion: Sometimes the drugs fail to end the pregnancy, resulting in an incomplete abortion. In this case, a surgical procedure may be necessary to complete the abortion.
  3. Infection: Medical abortion increases the risk of infection in the uterus and other reproductive organs. Signs of infection include fever, chills, abdominal pain, and foul-smelling discharge.
  4. Allergic reactions: In rare cases, women can have an allergic reaction to mifepristone or misoprostol. Symptoms of an allergic reaction include rash, hives, itching, and difficulty breathing.
  5. Ectopic pregnancy: Medical abortion is not effective for ectopic pregnancies, which occur when the fertilized egg implants outside the uterus. If a woman with an ectopic pregnancy takes mifepristone and misoprostol, it can lead to a life-threatening medical emergency.
  6. Emotional and psychological effects: While not a physical health risk, medical abortion can be emotionally and psychologically challenging for some women, leading to feelings of sadness, guilt, or regret.

Final Thoughts

Medical abortion is a relatively safe and effective option for women seeking to end a pregnancy. Mifepristone is an important medication that has been used safely by millions of women worldwide. 

It is important for women to understand the potential health risks associated with medical abortion and to carefully weigh the risks and benefits of this procedure with their healthcare provider. Women who experience heavy bleeding, fever, or other signs of infection after medical abortion should seek medical attention immediately.


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