What is a medical abortion & is it safe?

If you’re scanning the news lately, you may have seen articles about a different kind of abortion that women are opting for across America: a medical abortion.

A medical abortion–also referred to as the abortion pill or medication abortion–means that a patient can orally abort a pregnancy by taking a set of medications instead of undergoing a surgical procedure. During COVID-19, these medications also became available via mail, ensuring a patient’s total and complete privacy and greatly improving access for countless women. In fact, in the past year, Honeybee Health became the first online, U.S.-based pharmacy to ship the medications. 

Here is what you need to know about a medical abortion:

What is the medication?

The most common version of a medical abortion consists of two different medications taken in succession: mifepristone (Mifeprex) and misoprostol (Cytotec). 

The combination of these two medications works to end a pregnancy that is less than 10 weeks along (70 days or fewer since the start of the last menstrual period). Overall, about 95-98% of abortions are successful when a patient takes both pills. However, in cases where mifepristone is not available, the World Health Organization has endorsed taking just misoprostol. This method has a success rate of around 85%.

In addition to being used for abortions, mifepristone controls high blood sugar in patients with Cushing syndrome who have type 2 diabetes and have failed surgery or are not candidates for surgery. Meanwhile, misoprostol helps reduce stomach acid and protects the stomach from damage that can be caused by taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

What is the regimen for a medical abortion?

Before taking the medication, the patient should be in a safe and comfortable environment. The patient will also want to prepare for a few hours of heavy cramping and bleeding, followed by a few days of lighter bleeding. The whole process can take up to two weeks to complete, although the majority of women report feeling normal after two days. 

First, the patient must take a pregnancy test. Assuming that is positive, the patient takes 200 mg of mifepristone by mouth. Then 24 to 48 hours later, the patient takes 800 mcg of misoprostol buccally (i.e. the patient inserts it between their cheek and gum until it’s absorbed). At this point, the medication will force a miscarriage and the patient should be prepared for heavy bleeding and cramping that resembles a heavy period. If a patient experiences excessive heavy bleeding–defined by filling up two pads per hour for two hours–they should seek emergency medical assistance. Side effects may include diarrhea, vomiting, fatigue, mild fever, headache, and dizziness. To manage symptoms, the patient’s doctor may prescribe ondansetron (Zofran), Tylenol, a heating pad, or other methods of pain management. 

About seven to fourteen days after taking the mifepristone, the patient should follow up with their healthcare provider for a final check. The patient should also take a final pregnancy test about four weeks after taking both medications to confirm a successful abortion.

To learn more, review this expert video from the International Planned Parenthood Federation about how the process works and what a patient can expect.

Is it safe?

Yes. Mifepristone was first approved in the U.S. to terminate a pregnancy in 2000. Since then, mifepristone has been dispensed in the U.S. by prescribers directly to their patients and tracked within the FDA’s Risk Evaluation and Mitigation Strategy (REMS)–a drug safety program under the FDA required for certain medications with safety concerns.

In 2017, medical abortions–then provided exclusively in the presence of a prescribing clinician–accounted for 39% of all abortions

How does a person access a medical abortion?

Patients who wish to terminate an early pregnancy must consult with a certified clinician to ensure they qualify for treatment (many clinicians offer this consultation entirely through telemedicine). From there, the prescriber can send the prescription directly to an online pharmacy such as Honeybee Health. A trained pharmacist will then process and ship the medication, in addition to providing further guidance during the process to the patient. 

I’m interested in accessing a medical abortion. Where should I turn?

Pro-choice advocacy group Plan C has collected providers across the country who can help patients find the medication. Plan C can direct you to medical professionals from Choix, Family Planning Associates Medical Group, Cedar River Clinic, Boulder Valley Women’s Health Center, Hope Clinic for Women, Hey Jane, and more.

Can you order abortion pills from any state in the U.S.?

No. Each state has their own restrictions when it comes to medical abortion and receiving it by mail. To find out what a certain state allows, check out the interactive map put together by the pro-choice advocacy group, Plan C. 

What is the cost of the medication?

If you use Honeybee Health, the cost for both medications is $75. Your doctor can also choose to add ondansetron (Zofran), birth control, pregnancy tests, and other related medical-items to your package.

If you’re struggling to afford the cost of the medication, there are options to help you. For instance, the National Abortion Federation (NAF)– the professional association of abortion providers–helps provide funds to those who may not be able to pay the full price of the abortion medication. Members include private and non-profit clinics, Planned Parenthood affiliates, women’s health centers, physicians’ offices, and hospitals who together perform approximately half of the abortions in the U.S. and Canada each year. 

Why is this option now available–did the law change?

In September 2020, a federal court ruled that the REMS requirement for medical abortion put an undue burden on women during COVID-19. Previously, an in person visit and collection of the medication from the doctor was required. 

After this ruling, the doors opened to mail-order pharmacies to partner with specific providers to dispense on their behalf–and Honeybee Health was the first pharmacy in the country to start offering mifepristone for fully telehealth/mail order abortions. We launched our tele-abortion service in select states and partnered with a number of doctors.

Then, in January 2021, the Trump administration took the case back to the Supreme Court a second time and–with the new balance of the court–overturned the ruling from the federal judge and put a stop to pharmacies dispensing mifepristone. However, just a few months later in April 2021, a new ruling allowed the dispensing of mifepristone once more. 

It’s important to note that not just any doctor can prescribe the medication. Honeybee Health only dispenses these medications on behalf of certified prescribers who are trained to prescribe abortion pills.

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