Self-managed medication abortion with misoprostol alone can work well when mifepristone is unavailable because of state laws or other access obstacles, according to a recent study.1
This is an important option for women who cannot visit an abortion clinic or provider near their homes or cannot afford the costs of visiting a clinic for a surgical procedure, says Rebecca Gomperts, MD, PhD, study co-author and founder of Aid Access in Vienna, Austria. Aid Access provides medication abortion pills to women around the world, including those who live in countries or states that ban or restrict access. More than 1,000 people received prescriptions for misoprostol from June 1, 2020, to June 30, 2020, through the international, online telemedicine organization.
The study started early during the COVID-19 pandemic because Aid Access could not source mifepristone at that time due to global supply chain problems, says Dana M. Johnson, lead study author and PhD candidate at the LBJ School of Public Affairs at the University of Texas at Austin.
Participants received three misoprostol pills instead of the usual combined regimen of mifepristone and misoprostol. Six people who received the three-dose regimen of misoprostol needed a fourth dose prescribed by Aid Access.
“They reached out to the 24/7 help desk option and said they weren’t passing [the embryo] quickly enough, and they were prescribed an additional dose,” Johnson explains.
Of the 568 people who confirmed using the medication, 88% reported successfully ending their pregnancy without needing instrumental intervention. Two percent reported experiencing a serious adverse event, and 4% reported a symptom of a potential complication. Serious adverse events included a hospital admission, a blood transfusion, IV-administered antibiotics, and emergency department treatment.
“Some of those people did have a successful abortion, and they went to the ER or hospital to make sure they weren’t bleeding too much,” Johnson says. “Some did have a surgical procedure to complete the abortion.”
Heavy bleeding was defined as using more than two maxi pads an hour for more than two hours, a fever of 102° F or higher, a discharge with a bad odor, and severe pain that does not go away. Clinicians counseled women about normal symptoms from an abortion with misoprostol. These included bleeding, cramping, passing clotting tissue out of the vagina, and nausea, chills, and diarrhea.
Misoprostol is highly effective, showed a low rate of serious adverse events, and is an option for people in states that severely restrict access to in-clinic abortion care, Johnson and colleagues concluded.
Misoprostol — marketed as Cytotec — also can treat people with stomach ulcers, and is used for miscarriage management, Johnson says.
Telemedicine has helped to reduce abortion costs. “It’s driven down the cost so much that telemedicine abortion is $150 to $300, which is so much less than it was in clinics,” Gomperts says. “We made it so more people can afford it.”
Aid Access distributes medication abortion pills ordered by people in the United States, including those who live in states that have banned abortion and banned telemedicine abortion. These medications are the same quality as any abortion pills distributed in the United States, Gomperts adds.
Gomperts and Johnson’s study on misoprostol is the first U.S.-based study on the use of misoprostol alone, and it adds to the evidence based on international studies.
“We know abortion bans are not going away, and self-managed abortion needs to be a safe and effective option,” Johnson says. “We need to understand how to make it as safe, effective, and accessible as possible.”
REFERENCE
- Johnson DM, Michels-Gualtieri M, Gomperts R, Aiken ARA. Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States. Perspect Sex Reprod Health 2023;Feb 6. doi: 10.1363/psrh.12219. [Online ahead of print].
Self-managed medication abortion with misoprostol alone can work well when mifepristone is unavailable because of state laws or other access obstacles, according to a recent study.
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