Medical abortion
A medical abortion, also known as medication abortion or non-surgical abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage.[6] Medical abortions are more common than surgical abortions in most places around the world.[7][8]
Not to be confused with emergency contraception.Background
Medical
United States 1979 (carboprost),
West Germany 1981 (sulprostone),
Japan 1984 (gemeprost),
France 1988 (mifepristone),
United States 1988 (misoprostol)
3–24+ weeks
76% (2021)
96% (2021)
87% (2021)
99% (2021)
63% (2023)
Progesterone receptor modulator
Mifegymiso,[1] others
Medical abortions are most commonly performed by administering a two-drug combination: mifepristone followed by misoprostol. Evidence suggests this two-drug combination is the most effective at producing a complete abortion up to 65 days after menstrual bleeding has stopped.[6] When mifepristone is not available, misoprostol alone may be used in some situations.[9]
Medical abortion is both safe and effective throughout a range of gestational ages, including the second and third trimester.[10][11][12] In the United States, the mortality rate for medical abortion is 14 times lower than the mortality rate for childbirth, and the rate of serious complications requiring hospitalization or blood transfusion is less than 0.4%.[13][14][15][16] Medical abortion can be administered safely by the patient at home, without assistance, in the first trimester.[17] In the second trimester and beyond, it is recommended to take the second drug in a clinic, provider's office, or other supervised medical facility.[17]
Contraindications to mifepristone are inherited porphyria, chronic adrenal failure, and ectopic pregnancy.[43][44] Some consider an intrauterine device in place to be a contraindication as well.[44] A previous allergic reaction to mifepristone or misoprostol is also a contraindication.[43]
Many studies excluded women with severe medical problems such as heart and liver disease or severe anemia.[44] Caution is required in a range of circumstances including:[43]
In some cases, it may be appropriate to refer people with preexisting medical conditions to a hospital-based abortion provider.[45]
Alternatively, some medical conditions may make medication abortion more favorable to surgical abortion such as large uterine fibroids, congenital uterine anomalies, or genital scarring related to infibulation.[46][47][48]
History[edit]
Swedish researchers began testing potential abortifacients in 1965. In 1968, the Swedish physician Lars Engström published a paper on a clinical trial, conducted at the women's clinic of Karolinska Hospital in Stockholm, of the compound F6103 on pregnant Swedish women with the aim of inducing abortion. It was the first clinical trial of an abortion pill to be conducted in Sweden.[95] The paper, originally titled The Swedish Abortion Pill, was renamed to The Swedish Postconception Pill, due to the small number of induced abortions that occurred in the trial population. After these efforts were largely unsuccessful with F6103, the same researchers attempted to find an abortion pill with prostaglandins, capitalizing on the number of well-established prostaglandin scientists working in Sweden at the time; they were eventually awarded the 1982 Nobel Prize in Physiology for their work.[96]
Medical abortion became a successful alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486)[97] in the 1980s.[7][42][98] Mifepristone was first approved for use in China and France in 1988, in Great Britain in 1991, in Sweden in 1992, in Austria, Belgium, Denmark, Finland, Georgia, Germany, Greece, Iceland, Israel, Lichtenstein, Luxembourg, Netherlands, Russia, Spain, and Switzerland in 1999, in Norway, Taiwan, Tunisia, and the United States in 2000, and in 70 additional countries from 2001 to 2023.[99]
In 2000, mifepristone was approved by the US FDA for abortions through 49 days gestation.[100] In 2016, the US FDA updated mifepristone's label to support usage through 70 days gestation.[50]