Medicated abortion is the preferred method of ending a pregnancy in the US, and one of the two drugs used – mifepristone – will now go before the US Supreme Court next year.
Demand for the abortion pills mifepristone and misoprostol has grown as states have imposed bans, restrictions or sought to restrict abortions following the reversal of Roe v. Wade in June 2022.
Conservative groups have filed lawsuits against mifepristone, the only drug specifically approved for abortion, in an effort to overturn its approval or reverse policies that have made it easier to obtain. The Supreme Court will hear a case in the spring that could block mail-order access to mifepristone and impose restrictions on its use even in states where abortion remains legal.
The restrictions include shortening the period in which the drug can be used during pregnancy and requiring in-person office visits to obtain a prescription.
Here's a closer look at how mifepristone and misoprostol work and the legal challenges these drugs face.
The prescribed medications are taken with an interval of several days.
Mifepristone is first taken and swallowed by mouth. The drug dilates the cervix and blocks the effects of the hormone progesterone, which is necessary to maintain a pregnancy.
Misoprostol, a medication also used to treat stomach ulcers, is taken 24 to 48 hours later. The pill is designed to dissolve when placed between the gums and teeth or in the vagina. It causes the uterus to cramp and contract, causing bleeding and expelling pregnancy tissue.
Although the combination of two drugs is slightly more effective, misoprostol is sometimes used alone. This practice is more common in countries where mifepristone is banned.
Abortion medications are currently approved for use up to the 10th week of pregnancy.
The pills can be taken in a doctor's office or clinic, where patients sometimes undergo an ultrasound or laboratory tests beforehand. Some providers also offer the pills through telehealth visits and send the medications by mail.
The pills are responsible for more than half of all abortions in the US.
Research and real-world examples show that the pills, when taken together, are safe and up to 99% effective.
Side effects may include nausea, vomiting and diarrhea. Bleeding is normal; very heavy bleeding is uncommon and requires medical attention.
Serious complications are very rare. The U.S. Food and Drug Administration said last year that about 5.9 million women have used mifepristone since it was approved more than two decades ago. The agency has received 32 reports of deaths in women taking the drug, including two cases involving ectopic pregnancies, which grow outside the uterus. The deaths cannot be definitively attributed to mifepristone because in many cases the women had other health problems and were taking other medications.
The medications are not recommended for certain patients, including those with suspected ectopic pregnancy or with implanted IUD contraceptive devices.
Dr. Stephanie Rand, a New York gynecologist and abortion specialist with the advocacy group Physicians for Reproductive Health, says pregnancy tests should not be used right away to determine whether a medication abortion was successful because the pregnancy hormone may linger in the body for a long time. several weeks. Bleeding with blood clots containing lighter-colored tissue are signs of success, she said.
It varies by location, but is similar to abortion procedures and can total more than $500. Health insurance coverage also varies, with some plans making the pills free or cheap, while others don't cover them at all.
Mifepristone is sold under the brand name Mifeprex and misoprostol under the brand name Cytotec. Both pills are available as generics.
Mifepristone remains fully approved despite legal challenges. The FDA and the Biden administration have reiterated that the drug's safety and effectiveness have been repeatedly confirmed by multiple studies conducted since its approval in 2000.
Access largely depends on where a patient lives. Currently, 14 states enforce laws banning abortions, including medication abortions, during pregnancy. Another fifteen states have separate laws that specifically limit how mifepristone can be prescribed and distributed, such as requiring an in-person visit to a doctor.
Still, some women in states with bans can obtain the pills through the mail, which is not tightly regulated.
The case now before the Supreme Court began with a legal challenge in 2022 by Christian conservatives who sought to overturn the FDA's original approval for mifepristone. A Texas judge sided with the group in an initial victory that would have required the drug to be taken off the market. But an appeals court left the drug's approval intact and instead issued a ruling that would reverse changes the FDA made in 2016 and 2021 that eased access to the drug.
The Supreme Court has put all these changes on hold while it hears the case.
If the judge sides with abortion opponents, it would likely mean that the drug can no longer be sent by post, as has been possible since 2021. It would also shorten the period for use from ten weeks to seven weeks – the latter of which was approved in 2016. .
Other requirements include reinstating three in-person office visits with a doctor before women can get a prescription. In addition, women may also be required to take a higher dosage of the drug than the FDA says is necessary. That's because a negative ruling would also overturn the FDA's determination that a lower dose could be used safely.
The U.S. Supreme Court is likely to decide the case by the end of June.
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AP writer Mark Sherman contributed to this report.
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