Medical abortion

Not to be confused with Emergency birth control.

Medical abortion

200 mg mifepristone (top) and 800 μg misoprostol (bottom), is the typical regimen for early medical abortion
Background
First use| Carboprost (USA 1979)
Sulprostone (Germany 1981)
Gemeprost (Japan 1984)
Mifepristone (France 1988)
Misoprostol (USA 1988)
Gestation| 3–24+ weeks
Usage
As a percentage of all abortions
France| 76% (2021)
Sweden| 96% (2021)
UK: Eng. & Wales| 87% (2021)
UK: Scotland| 99% (2021)
United States| 53% (2020)
Infobox references

Medical abortion, also known as medication abortion, is when medication are used to bring about an abortion.[1] It is an alternative to surgical abortion, such as uterine aspiration or dilation and evacuation.[2][3][1] Medical abortion is more common in most places, including Europe, India, China, and the United States.[4][5]

The typical recommendation involves two-medication, mifepristone followed by misoprostol.[3] When mifepristone is not available, misoprostol alone may be used; though other options exist.[3][2] They can be safely taken at home in the first trimester.[1] In the second trimester, its use is recommended within hospital.[3]

Medical abortion is both safe and effective through a range of gestational ages, including the second trimester (13 to 24 weeks).[3] Some evidence supports use in the third trimester.[6] Side effects often include vaginal bleeding, uterine cramps, nausea, and diarrhea.[2] It does not affect the risk of mental health problems, breast cancer, or infertility.[1] In the United States, death of the mother is 14 times lower than in childbirth; and hospitalization, blood transfusions, or surgery are needed in less than 4 in 1,000.[7]

Medical abortion came into use in the 1970s.[2] They were carried out more than half a million times in 2020 in the United States.[8] The World Health Organization recommends that all women and girls have access to medical abortion, in an effort to reduce the rate of unsafe abortion and the deaths that result.[9] In the United States the medications can cost more than 500 USD as of 2023; though charities may provide for free or at low cost.[10][11][12] In Canada it is covered for Canadians.[13] In low and middle income countries the cost ranged from 4 to 36 USD as of 2018.[14] It should not be confused with emergency birth control (the morning after pill) which is taken soon after sex to prevent pregnancy from beginning.[15]

## Contents

* 1 Medications
* 1.1 Less than 12 weeks
* 1.1.1 Self-administered
* 1.2 After 12 weeks
* 1.3 Alternatives
* 2 Contraindications
* 3 Side effects
* 3.1 Complications
* 3.2 Bleeding
* 3.3 Safety
* 4 Pharmacology
* 5 Prevalence
* 6 History
* 7 Society and culture
* 7.1 Accessibility
* 7.1.1 Over-the-counter
* 7.1.2 Telehealth
* 7.1.3 Clinic-to-clinic access
* 7.1.4 Direct-to-patient access
* 7.1.5 United States
* 7.2 "Reversal"
* 7.3 Cost
* 8 References
* 9 External links

## Medications[edit | edit source]

Options include mifepristone/misoprostol, misoprostol alone, mifepristone alone, methotrexate with misoprostol, tamoxifen with misoprostol, and letrozole with misoprostol.[2]

### Less than 12 weeks[edit | edit source]

For medical abortion up to 12 weeks' gestation, the recommended dosages are 200 milligrams of mifepristone by mouth, followed one to two days later by 800 micrograms of misoprostol inside the cheek, vaginally, or under the tongue.[16] The success rate of this drug combination is 97% through 10 weeks' pregnancy.[17]

Misoprostol should be taken 24 to 48 hours after the mifepristone; taking the misoprostol before 24 hours reduces the probability of success.[18] However, one study showed that the two drugs may be taken simultaneously with nearly the same efficacy.[19]

For pregnancies after 9 weeks, two doses of misoprostol (the second drug) makes the treatment more effective.[20] From 10 to 11 weeks of pregnancy, the National Abortion Federation suggests a second dose of misoprostol (800 micrograms) four hours after the first dose.[21]

Failure to take the misoprostol may result in: the fetus being terminated but not fully expelled which may require surgical intervention to remove; the pregnancy being successfully aborted and expelled; or the pregnancy may continue with a healthy fetus.[22]

#### Self-administered[edit | edit source]

In the first trimester, self-administered medical abortion at home without direct medical supervision is reasonable (in contrast to provider-administered medical abortion where the person takes the second abortion drug in the presence of a healthcare provider).[23] Self-administered medical abortion is as effective as provider-administered abortion; however additional research is required to confirm that safety is equivalent.[24][25]

A typical procedure, for 200 mg mifepristone tablets, is:[26][27][28]

1. Take the mifepristone
2. Take the misoprostol between 24 hours and 48 hours later
3. The pregnancy (embryo and placenta) will be expelled through the vagina within 2 to 24 hours after taking misoprostol, so the person should remain near a toilet. Cramps, nausea, and bleeding are typically experienced
4. To avoid infection, the person should not use tampons or engage in intercourse for 2 to 3 weeks[29]
5. A pregnancy test or ultrasound may be done to confirm complete termination has occurred. Beta hCG levels fall 80% in a week.

### After 12 weeks[edit | edit source]

Medical abortion is safe and effective in the second and third trimesters.[6][30][31][32] The WHO recommends that medical abortions after 12 weeks' gestation be supervised by a medical practitioner.[23][16]

For medical abortion after 12 weeks' gestation, the WHO recommends 200 mg of mifepristone by mouth followed one to two days later by repeat doses of 400 μg misoprostol under the tongue, inside the cheek, or in the vagina.[16] Misoprostol should be taken every 3 hours until successful abortion is achieved, the mean time to abortion after starting misoprostol is 6–8 hours, and approximately 94% will abort within 24 hours after starting misoprostol.[33] When mifepristone is not available, misoprostol may still be used though the time to abortion may be extended compared to regimens using mifepristone followed by misoprostol.[34]

### Alternatives[edit | edit source]

Misoprostol alone may be used when mifepristone is not available, and has been demonstrated to be successful in the second trimester.[3] Misoprostol is more commonly available and is easier to store.[3] The WHO recommends 800 μg of misoprostol inside the cheek, under the tongue, or in the vagina.[16] The success rate of misoprostol alone for terminating pregnancy (93%) is nearly the same as the mifepristone-misoprostol combination (96%). However, 15% of the women using misoprostol alone required a surgical procedure, which is more than with the mifepristone-misoprostol combination.[35]

A rarely used drug combination is methotrexate-misoprostol, which is typically reserved for ectopic pregnancies.[36] Methotrexate is given either by mouth or by injection into a muscle, followed by vaginal misoprostol 3–5 days later.[21] The methotrexate combination is available through 63 days. The WHO authorizes the methotrexate-misoprostol combination[37] but recommends the mifepristone combination because methotrexate may cause birth defects in cases of incomplete abortion. The methotrexate-misoprostol combination is considered more effective than misoprostol alone.[38]

## Contraindications[edit | edit source]

Contraindications to mifepristone are inherited porphyria, chronic adrenal failure, and ectopic pregnancy.[39][40] Some consider an intrauterine device in place to be a contraindication as well.[40] A previous allergic reaction to mifepristone or misoprostol is also a contraindication.[39]

Many studies excluded women with severe medical problems such as heart and liver disease or severe anemia.[40] Caution is required in a range of circumstances including:[39]

* long-term corticosteroid use;
* bleeding disorder;
* severe anemia

In some cases, it may be appropriate to refer people with preexisting medical conditions to a hospital-based abortion provider.[41]

## Side effects[edit | edit source]

Most women will have cramping and bleeding heavier than a menstrual period.[40] Other adverse effects include nausea, vomiting, fever, chills, diarrhea, and headache.[29] Misoprostol taken vaginally tends to have fewer gastrointestinal side effects. Nonsteroidal antiinflammatory medications such as ibuprofen reduce pain with medication abortion.

### Complications[edit | edit source]

Symptoms that require immediate medical attention:[42]

* Heavy bleeding (enough blood to soak through four sanitary pads in 2 hours)
* Abdominal pain, nausea, vomiting, diarrhea, fever for more than 24 hours after taking mifepristone
* Fever of 38 °C (100.4 °F) or higher for more than 4 hours

Complications under 10 weeks' pregnancy are rare; according to two large reviews, bleeding requiring a blood transfusion occurred in 0.03–0.6% of women and serious infection in 0.01–0.5%.[17][18] Because infection is rare after medication abortion, the American College of Obstetricians and Gynecologists, The Society of Family Planning, and the NAF do not recommend use of routine antibiotics.[43][21] A few rare cases of deaths from clostridial toxic shock syndrome have occurred following medical abortions.[44]

A 2013 systematic review which included 45,000 women who used the 200 mg mifeprestone followed by misoprostol combination found that less than 0.4% had serious complications requiring hospitalization (0.3%) and/or blood transfusion (0.1%).[18][8]

### Bleeding[edit | edit source]

Vaginal bleeding generally diminishes gradually over about two weeks after a medical abortion, but in individual cases spotting can last up to 45 days.[39] If the woman is well, neither prolonged bleeding nor the presence of tissue in the uterus (as detected by obstetric ultrasonography) is an indication for surgical intervention (that is, vacuum aspiration or dilation and curettage). Remaining products of conception will be expelled during subsequent vaginal bleeding. Still, surgical intervention may be carried out on the woman's request, if the bleeding is heavy or prolonged, or causes anemia, or if there is evidence of endometritis.

Although medical abortion is associated with more bleeding than surgical abortion, overall bleeding for the two methods is minimal and not clinically different. In a large-scale prospective trial published in 1992 of more than 16,000 women undergoing medical abortion using mifepristone with varying doses of gemeprost or sulprostone, only 0.1% had hemorrhage requiring a blood transfusion. It is often advised to contact a health care provider if there is bleeding to such degree that more than two pads are soaked per hour for two consecutive hours.

### Safety[edit | edit source]

Medical abortion is safe even into the second and third trimesters.[6][30][31][32]

In the United States, an FDA report states that of the 3.7 million women who have had a medication abortion between 2000 and 2018, 24 died afterward, with 11 of those deaths likely unrelated to the abortion, including drug overdoses, homicides, and a suicide.[7][45] If the deaths likely unrelated to the abortion are not included, then the mortality rate for medication abortion is half the mortality rate of abortion overall.[7]:1 Including all 24 deaths, the data shows that (in the US) the mortality rate for medication abortion is equivalent to abortion overall, which is 14 times lower than the mortality rate for childbirth, and also lower than the mortality rate for Penicillin and Viagra.[7][45]

## Pharmacology[edit | edit source]

Main article: Mifepristone § Pharmacology

Mifepristone blocks the hormone progesterone,[46][47] causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Methotrexate, which is sometimes used instead of mifepristone, stops the cytotrophoblastic tissue from growing and becoming a functional placenta.[48] Misoprostol, a synthetic prostaglandin, causes the uterus to contract and expel the embryo through the vagina.[49]

## Prevalence[edit | edit source]

Medical abortions as a percentage of all abortions  Country | Percentage

|

Spain | 25% in 2021[50]
Netherlands | 34% in 2021[51]
Italy | 35% in 2020[52]
Canada | 37% in 2021[53]
Belgium | 38% in 2021[54]
Germany | 39% in 2022[55]
New Zealand | 46% in 2021[56]
United States | 53% in 2020[5]
Portugal | 68% in 2021[57]
Slovenia | 72% in 2019[58]
France | 76% in 2021[59]
Switzerland | 80% in 2021[60]
Denmark | 83% in 2021[61]
England and Wales | 87% in 2021[62]
Iceland | 87% in 2021[63]
Estonia | 91% in 2021[64]
Norway | 95% in 2022[65]
Sweden | 96% in 2021[66]
Finland | 98% in 2021[67]
Scotland | 99% in 2021[68]

A Guttmacher Institute survey of all known abortion providers in the U.S. found that medical abortions accounted for 53% of all abortions in 2020.[5] This count did not include self-induced abortions.[5]

At Planned Parenthood clinics in the U.S., medical abortions accounted for 32% of first trimester abortions in 2008,[69] 35% of all abortions in 2010 and 43% of all abortions in 2014.[70]

In 2009, medical abortion regimens using mifepristone in combination with a prostaglandin analog were the most common methods used to induce second-trimester abortions in Canada, most of Europe, China and India;[4] in contrast to the U.S., where 96% of second-trimester abortions were performed surgically by dilation and evacuation.[71]

## History[edit | edit source]

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.[72] 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.[73]

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)[74] in the 1980s.[4][38][75] 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.[76]

In 2000, mifepristone was approved by the U.S. FDA for abortions through 49 days gestation.[77] In 2016, the U.S. FDA updated mifepristone's label to support usage through 70 days gestation.[78]

## Society and culture[edit | edit source]

The WHO affirms that laws and policies should support people's access to evidence-based medically approved care, including medical abortion.[79][80]

### Accessibility[edit | edit source]

Both medication - mifepristone and misoprostol - are no longer covered by drug patents, and hence are available as generic drugs.

#### Over-the-counter[edit | edit source]

The requirements for a prescription vary widely between countries.[81] Many countries make the medical abortion drugs available over the counter, without a prescription, such as China, India, and others.[82] Other countries require a prescription (Canada, most of Western Europe, the United States, and others).[82] Some countries require a prescription but are lax about enforcing that requirement (Russia, Brazil, and others).[82]

#### Telehealth[edit | edit source]

Telehealth includes access to medical services that the person can perform at home, without in-person visits to clinic or provider offices. People who have used telehealth report being satisfied with the access it provides to abortion services.[83][84] However, those who might need the service the most (those who are incarcerated, unhoused, or live on low income) are often inhibited from accessing it.[85]

Telehealth options for people in the U.S. seeking medical abortion include: Aid Access, Plan C, Hey Jane, Choix, Just the Pill, carafem, and Abortion on Demand.[86]

#### Clinic-to-clinic access[edit | edit source]

In this model, a provider communicates with a patient located at another site using clinic-to-clinic videoconferencing to provide medication abortion. This was introduced by Planned Parenthood of the Heartland in Iowa to allow a patient at one health facility to communicate via secure video with a health provider at another facility.[87] This model has expanded to other Planned Parenthoods in multiple states as well other clinics providing abortion care.[87]

#### Direct-to-patient access[edit | edit source]

The direct-to-patient model allows for medication abortion to be provided without an in-person clinic visit. Instead of an in-person clinic visit, the patient receives counseling and instruction from the abortion provider via videoconference. The patient can be at any location, including their home. The medications necessary for the abortion are mailed directly to the patient. This is a model, called TelAbortion or no-test medication abortion (formerly no-touch medication abortion), being piloted and studied by Gynuity Health Projects, with special approval from the U.S. Food and Drug Administration (FDA).[88] This model has been shown to be safe, effective, efficient, and satisfactory.[89][90][91] Complete abortion can be confirmed via telephone-based assessment.[92]

#### United States[edit | edit source]

Further information: Abortion in the United States by state

In the U.S., prescriptions for mifepristone may be filled by any pharmacy - online or brick-and-mortar - that has obtained a special certification.[93] This regulation was provisionally implemented in Dec 2021, and was finalized by the FDA in January 2023.[94]

From 2011 until 2021, a patient was required to visit a healthcare provider in-person (at a clinic or office) and receive mifepristone directly from the provider.[95] The requirement to visit a clinic to receive the drug was removed by the FDA in December 2021, during the COVID-19 pandemic. Under the new rules, the prescription may be obtained via telehealth (phone calls or video conferencing with a healthcare provider), and then filled at any certified pharmacy.[96][28][89][97] At the same time the FDA removed the requirement for an in-person visit, they added a requirement that dispensing pharmacies be "certified", which requires the pharmacy to have special permission to dispense the drugs - a requirement the FDA imposes on only 40 drugs out of more than 19,000 it manages.[98]

The second drug used in medical abortion, misoprostol, is most commonly used for treating ulcers, and was never subject to the in-person dispensing constraints of mifepristone, and was always available from pharmacies with a prescription.

The FDA does not authorize the use of mifepristone for medical abortion after 70 days, unlike most other countries, which authorize medical abortion into the second trimester and even the third trimester.[96]

Some states have passed laws that prohibit providers from examining the patient via phone or video conferencing, and instead require the patient to make an in-person visit to the provider to get the prescription.[99][100]

In most states, abortion drugs may be sent from a pharmacy to the patient via mail, but certain states have passed laws making that illegal, and requiring the drugs to be obtained from a pharmacy or provider in-person.[99][101]

Interest in abortion medications in the United States reached record highs in 2022, after the Supreme Court of the United States draft Dobbs v. Jackson Women's Health Organization ruling that would overturn 1973's Roe v. Wade decision was leaked online.[102] Interest was higher in states with more restrictions on access to abortion.[102] Pro-choice activists in the U.S. were exploring ways to make medical abortion more available, particularly in states where it is subject to limitations, with social media resources being utilized for this purpose.[103][104][105][106]

In March 2023, Governor Mark Gordon of Wyoming signed a bill outlawing the use of abortion pills in the state, making it the first US state to do so. The new legislation, which will go into effect on July 1, 2023, criminalizes the "prescription, dispensation, distribution, sale, or use of any drug" for the purpose of obtaining or performing an abortion. Those who violate the law, excluding the pregnant individual, may be charged with a misdemeanor and could face a $9,000 fine and up to six months in jail. Abortion providers are expected to challenge the new law in court.[107]

### "Reversal"[edit | edit source]

Some anti-abortion groups claim that patients who change their mind about the abortion after taking mifepristone can "reverse" the abortion by administering progesterone (and not administering misoprostol).[108][109] As of 2022, there is no scientifically rigorous evidence that the effects of mifepristone can be reversed this way.[110][111] Even so, several states in the U.S. require providers of non-surgical abortion who use mifepristone to tell patients that reversal is an option.[112] In 2019, researchers initiated a small trial of the so-called "reversal" regimen using mifepristone followed by progesterone or placebo.[113][114] The study was halted after 12 women enrolled and three experienced severe vaginal bleeding. The results raise serious safety concerns about using mifepristone without follow-up misoprostol.[111]

### Cost[edit | edit source]

In the U.S. in 2009, the typical price charged for a medical abortion up to 9 weeks' gestation was $490, four percent higher than the $470 typical price charged for a surgical abortion at 10 weeks' gestation.[115] In the U.S. in 2008, 57% of women who had abortions paid for them out of pocket.[116]

In April 2013, the Australian government commenced an evaluation process to decide whether to list mifepristone (RU486) and misoprostol on the country's Pharmaceutical Benefits Scheme (PBS). If the listing is approved by the Health Minister Tanya Plibersek and the federal government, the drugs will become more accessible due to a dramatic reduction in retail price—the cost would be reduced from between AU$300 and AU$800, to AU$12 (subsidised rate for concession card holders) or AU$35.[117] On 30 June 2013, the Australian Minister for Health, the Hon. Tanya Plibersek MP, announced that the Australian Government had approved the listing of mifepristone and misoprostol on the PBS for medical termination in early pregnancy consistent with the recommendation of the Pharmaceutical Benefits Advisory Committee.[118] These listings on the PBS commenced on 1 August 2013.[119][120]

## References[edit | edit source]

1. ↑ 1.0 1.1 1.2 1.3 Macnaughton, H; Nothnagle, M; Early, J (15 April 2021). "Mifepristone and Misoprostol for Early Pregnancy Loss and Medication Abortion". American family physician. 103 (8): 473–480. PMID 33856168. Archived from the original on 19 October 2023. Retrieved 6 December 2023.
2. ↑ 2.0 2.1 2.2 2.3 2.4 Zhang J, Zhou K, Shan D, Luo X (May 2022). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews. 2022 (5): CD002855. doi:10.1002/14651858.CD002855.pub5. PMC 9128719. PMID 35608608.
3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Gemzell-Danielsson, K; Lalitkumar, S (May 2008). "Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: a review of methods and management". Reproductive health matters. 16 (31 Suppl): 162–72. doi:10.1016/S0968-8080(08)31371-8. PMID 18772097.
4. ↑ 4.0 4.1 4.2 Kapp N, von Hertzen H (2009). "Medical methods to induce abortion in the second trimester". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy : comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 178–192. ISBN 978-1-4051-7696-5.
5. ↑ 5.0 5.1 5.2 5.3 Jones RK (December 1, 2022). "Medication Abortion Now Accounts for More Than Half of All US Abortions". Guttmacher Institute. Archived from the original on May 10, 2022. Retrieved April 16, 2023.
6. ↑ 6.0 6.1 6.2 Vlad S, Boucoiran I, St-Pierre ÉR, Ferreira E (June 2022). "Mifepristone-Misoprostol Use for Second- and Third-Trimester Medical Termination of Pregnancy in a Canadian Tertiary Care Centre". Journal of Obstetrics and Gynaecology Canada. 44 (6): 683–689. doi:10.1016/j.jogc.2021.12.010. PMID 35114381. S2CID 246505706.
7. ↑ 7.0 7.1 7.2 7.3 "Analysis of Medication Abortion Risk and the FDA report - "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018"" (PDF). Bixby Center for Global Reproductive Health. 2019-04-01. Archived (PDF) from the original on 2023-05-16. Retrieved 2023-08-18. "The mortality rate for women known to have had a live-born infant is 8.8 per 100,000 live births, which is about 14 times higher than the mortality rate associated with medication abortion."
8. ↑ 8.0 8.1 Rabin RC (2022-08-07). "Some Women 'Self-Manage' Abortions as Access Recedes - Information and medications needed to end a pregnancy are increasingly available outside the health care system". The New York Times. Archived from the original on 2022-09-05. Retrieved 2023-08-18. "More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients."
9. ↑ "WHO issues new guidelines on abortion to help countries deliver lifesaving care". www.who.int. Archived from the original on 27 November 2023. Retrieved 7 December 2023.
10. ↑ McCann, Allison (13 April 2023). "Inside the Online Market for Overseas Abortion Pills". The New York Times. Archived from the original on 30 October 2023. Retrieved 6 December 2023.
11. ↑ "How Much Do Abortion Pills Cost?". GoodRx. Retrieved 10 September 2023.
12. ↑ "How much does the abortion pill cost?". www.plannedparenthood.org. Archived from the original on 7 September 2023. Retrieved 10 September 2023.
13. ↑ "FAQ: The Abortion Pill Mifegymiso | Action Canada for Sexual Health and Rights". www.actioncanadashr.org. Archived from the original on 2023-05-28. Retrieved 6 December 2023.
14. ↑ Durocher, J; Kilfedder, C; Frye, LJ; Winikoff, B; Srinivasan, K (December 2021). "A descriptive analysis of medical abortion commodity availability and pricing at retail outlets in 44 countries across four regions globally". Sexual and reproductive health matters. 29 (1): 1982460. doi:10.1080/26410397.2021.1982460. PMID 34719353.
15. ↑ "The Difference Between the Morning-After Pill and the Abortion Pill" (PDF). Planned Parenthood. Archived (PDF) from the original on 13 September 2023. Retrieved 7 December 2023.
16. ↑ 16.0 16.1 16.2 16.3 Abortion Care Guideline. Geneva: World Health Organization. 2022. ISBN 9789240039483. Archived from the original on 2023-08-22. Retrieved 2023-08-18.
17. ↑ 17.0 17.1 Chen MJ, Creinin MD (July 2015). "Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review". Obstetrics and Gynecology. 126 (1): 12–21. doi:10.1097/AOG.0000000000000897. PMID 26241251. S2CID 20800109. Archived from the original on 2020-07-26. Retrieved 2023-08-18.
18. ↑ 18.0 18.1 18.2 Raymond EG, Shannon C, Weaver MA, Winikoff B (January 2013). "First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review". Contraception. 87 (1): 26–37. doi:10.1016/j.contraception.2012.06.011. PMID 22898359.
19. ↑ Creinin MD, Schreiber CA, Bednarek P, Lintu H, Wagner MS, Meyn LA (April 2007). "Mifepristone and misoprostol administered simultaneously versus 24 hours apart for abortion: a randomized controlled trial". Obstetrics and Gynecology. 109 (4): 885–894. doi:10.1097/01.AOG.0000258298.35143.d2. PMID 17400850. S2CID 43298827. Archived from the original on 2022-09-01. Retrieved 2023-08-18.
20. ↑ Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI (February 2019). "Medical abortion in the late first trimester: a systematic review". Contraception. 99 (2): 77–86. doi:10.1016/j.contraception.2018.11.002. PMC 6367561. PMID 30444970.
21. ↑ 21.0 21.1 21.2 "NAF Clinical Policy Guidelines". National Abortion Federation. Archived from the original on 2022-08-08. Retrieved 2020-04-10.
22. ↑ Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ (January 2020). "Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial". Obstetrics and Gynecology. 135 (1): 158–165. doi:10.1097/AOG.0000000000003620. PMID 31809439. S2CID 208813409. "Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage."
23. ↑ 23.0 23.1 "Self-management Recommendation 50: Self-management of medical abortion in whole or in part at gestational ages < 12 weeks (3.6.2) - Abortion care guideline". WHO Department of Sexual and Reproductive Health and Research. 2021-11-19. Archived from the original on 2022-06-29. Retrieved 2022-06-30.
24. ↑ Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD (March 2020). "Self-administered versus provider-administered medical abortion". The Cochrane Database of Systematic Reviews. 2020 (3): CD013181. doi:10.1002/14651858.CD013181.pub2. PMC 7062143. PMID 32150279.
25. ↑ Schmidt-Hansen M, Pandey A, Lohr PA, Nevill M, Taylor P, Hasler E, Cameron S (April 2021). "Expulsion at home for early medical abortion: A systematic review with meta-analyses". Acta Obstetricia et Gynecologica Scandinavica. 100 (4): 727–735. doi:10.1111/aogs.14025. PMID 33063314. S2CID 222819835.
26. ↑ "MIFEPREX (mifepristone) Tablets Label". FDA. Archived from the original on 2022-07-29. Retrieved 2022-06-30.
27. ↑ "Mifepristone and misoprostol: Recommended regimen". Ipas. January 30, 2020. Archived from the original on 2022-07-14. Retrieved 2022-06-30.
28. ↑ 28.0 28.1 "Mifeprex (mifepristone) Information". FDA. 2022-02-07. Archived from the original on 2019-04-23. Retrieved 2023-08-18.
29. ↑ 29.0 29.1 "Medical Abortion: What Is It, Types, Risks & Recovery". Cleveland Clinic. 2021-10-21. Archived from the original on 2022-06-28. Retrieved 2022-06-30.
30. ↑ 30.0 30.1 Safe abortion: technical and policy guidance for health systems-2nd ed. Italy: WHO. 2012. p. 42\. ISBN 9789241548434.
31. ↑ 31.0 31.1 Gómez Ponce de León R, Wing DA (April 2009). "Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy - a systematic review". Contraception. 79 (4): 259–71. doi:10.1016/j.contraception.2008.10.009. PMID 19272495.
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34. ↑ Perritt JB, Burke A, Edelman AB (September 2013). "Interruption of nonviable pregnancies of 24-28 weeks' gestation using medical methods: release date June 2013 SFP guideline #20133". Contraception. 88 (3): 341–349. doi:10.1016/j.contraception.2013.05.001. PMID 23756114.
35. ↑ Raymond EG, Harrison MS, Weaver MA (January 2019). "Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review". Obstetrics and Gynecology. 133 (1): 137–147. doi:10.1097/AOG.0000000000003017. PMC 6309472. PMID 30531568.
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39. ↑ 39.0 39.1 39.2 39.3 International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery (2006). Frequently asked clinical questions about medical abortion (PDF). Geneva: World Health Organization. ISBN 978-92-4-159484-4. Archived from the original (PDF) on January 17, 2009.
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41. ↑ Guiahi M, Davis A (December 2012). "First-trimester abortion in women with medical conditions: release date October 2012 SFP guideline #20122". Contraception. 86 (6): 622–630. doi:10.1016/j.contraception.2012.09.001. PMID 23039921.
42. ↑ "Mifepristone Prescribing Information" (PDF). FDA. Archived (PDF) from the original on 2022-09-01. Retrieved 2023-08-18.
43. ↑ Achilles SL, Reeves MF (April 2011). "Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102". Contraception. 83 (4): 295–309. doi:10.1016/j.contraception.2010.11.006. PMID 21397086.
44. ↑ Murray S, Wooltorton E (August 2005). "Septic shock after medical abortions with mifepristone (Mifeprex, RU 486) and misoprostol". CMAJ. 173 (5): 485. doi:10.1503/cmaj.050980. PMC 1188182. PMID 16093445.
45. ↑ 45.0 45.1 "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018". Food and Drug Administration. 2018-12-31. Archived from the original on 2023-05-16. Retrieved 2023-08-18.
46. ↑ Little B (23 June 2017). "The Science Behind the "Abortion Pill"". Smithsonian Magazine. Archived from the original on 16 May 2023. Retrieved 18 August 2023.
47. ↑ Creinin MD, Grossman DA (March 2014). "Medical management of first-trimester abortion" (PDF). Contraception. 89 (3): 148–161. doi:10.1016/j.contraception.2014.01.016. PMID 24795934. Archived (PDF) from the original on 2023-05-23. Retrieved 2023-08-18.
48. ↑ "Methotrexate". Medication Abortion. Ibis Reproductive Health. Archived from the original on 2023-05-31. Retrieved 2023-08-18.
49. ↑ "Misoprostol". Medication Abortion. Ibis Reproductive Health. Archived from the original on 2021-01-25. Retrieved 2023-08-18.
50. ↑ Ministerio de Sanidad, Politica Social e Igualdad (August 19, 2022). "Interrupción Voluntaria del Embarazo; Datos definitivos correspondientes al año 2021" (PDF). Madrid: Ministerio de Sanidad, Politica Social e Igualdad. Archived (PDF) from the original on April 16, 2023. Retrieved April 16, 2023. Table G.15: 22,961 (sum of the greater of mifepristone or prostaglandin abortions by gestation period) / 90,189 (total abortions) = 25.459%
51. ↑ Inspectie voor de Gezondheidszorg (IGZ), Ministerie van Volksgezondheid, Welzijn en Sport (VWS) (September 27, 2022). "Jaarrapportage 2021 Wet afbreking zwangerschap - Bijlage" (PDF). Utrecht: Inspectie voor de Gezondheidszorg (IGZ), Ministerie van Volksgezondheid, Welzijn en Sport (VWS). Archived (PDF) from the original on April 16, 2023. Retrieved April 16, 2023.`{{cite web}}`: CS1 maint: multiple names: authors list (link) Table P: 34.3%
52. ↑ Ministero della Salute (September 15, 2022). "Relazione Ministro Salute attuazione Legge 194/78 tutela sociale maternità e interruzione volontaria di gravidanza - dati definitivi 2020" (PDF). Rome: Ministero della Salute. Archived (PDF) from the original on April 16, 2023. Retrieved April 16, 2023. p. 7: 35.1%
53. ↑ Canadian Institute for Health information (CIHI) (March 23, 2023). "Induced Abortions Reported in Canada in 2021". Ottawa: Canadian Institute for Health information (CIHI). Archived from the original on April 16, 2023. Retrieved April 16, 2023. Table 3 Number and percentage distribution of induced abortions reported in Canada, 2021, by method of abortion. Medical: 36.9%
54. ↑ Commission Nationale d'Evaluation des Interruptions de Grossesse (March 13, 2023). "Rapport à l'attention du Parlement 1 janvier 2020 – 31 décembre 2021" (PDF). Brussels: Commission Nationale d'Evaluation des Interruptions de Grossesse. Archived (PDF) from the original on March 27, 2023. Retrieved April 16, 2023. p. 51: 38.07%
55. ↑ Statistisches Bundesamt (Destatis) (March 27, 2023). "Schwangerschaftsabbrüche 2022". Wiesbaden: Statistisches Bundesamt (Destatis). Archived from the original on April 16, 2023. Retrieved April 16, 2023. 2022 quarterly Mifegyne/mifepristone + medical termination abortions (40,176) / total abortions (103,927) = 38.658%
56. ↑ Ministry of Health (October 28, 2022). "Abortive Services Aotearoa New Zealand: Annual Report 2022" (PDF). Wellington: Ministry of Health. Archived (PDF) from the original on April 16, 2023. Retrieved April 16, 2023. p. 22: early medical abortions (43.8%) + later medical abortions (1.8%) = 45.6%
57. ↑ Direção-Geral da Saúde (DGS) (June 3, 2022). "Relatório de Análise Preliminar dos Registos das Interrupções da Gravidez 2018-2021". Lisbon: Direção-Geral da Saúde (DGS). Archived from the original on January 27, 2023. Retrieved April 16, 2023. p. 13: Table 10: 2021 medical abortions (7,941) / total abortions (11,640) = 68.22%
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59. ↑ Vilain A (October 5, 2022). "Interruptions volontaires de grossesse : la baisse des taux de recours se poursuit chez les plus jeunes en 2021" (PDF). Paris: Direction de la Recherche, des Études, de l'Évaluation et des Statistiques (DREES), Ministère de la Santé. Archived (PDF) from the original on October 12, 2022. Retrieved April 16, 2022. 76% du total des IVG sont médicamenteuses
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* WHO Scientific Group on Medical Methods for Termination of Pregnancy (December 1997). Medical methods for termination of pregnancy. Technical Report Series, No. 871. Geneva: World Health Organization. ISBN 978-92-4-120871-0. Archived from the original on September 28, 2012. Warning: link gives only the first page of the report; the rest is listed as "out of print"
* Royal College of Obstetricians and Gynaecologists (November 23, 2011). The care of women requesting induced abortion. Evidence-based clinical guideline number 7 (PDF) (3rd rev. ed.). London: RCOG Press. Archived from the original (PDF) on May 29, 2012.
* ICMA (2013). "ICMA Information Package on Medical Abortion". Chișinău, Moldova: International Consortium for Medical Abortion (ICMA).
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* United States

Oceania|

* Australia
* Micronesia
* Fiji
* Kiribati
* Marshall Islands
* New Zealand
* Papua New Guinea
* Samoa
* Solomon Islands
* Tonga
* Tuvalu
* Vanuatu

South America|

* Argentina
* Bolivia
* Brazil
* Chile
* Colombia
* Ecuador
* Guyana
* Paraguay
* Peru
* Suriname
* Uruguay
* Venezuela

Law|

* Case law
* Constitutional law
* History of abortion law
* Laws by country
* Buffer zones
* Conscientious objection
* Fetal protection
* Heartbeat bills
* Informed consent
* Late-term restrictions
* Parental involvement
* Spousal consent

Methods|

* Vacuum aspiration
* Dilation and evacuation
* Dilation and curettage
* Intact D&X
* Hysterotomy
* Instillation
* Menstrual extraction
* Abortifacient drugs
* Methotrexate
* Mifepristone
* Misoprostol
* Oxytocin
* Self-induced abortion
* Unsafe abortion

Religion|

* Buddhism
* Christianity
* Catholicism
* Hinduism
* Islam
* Judaism
* Scientology

* Category

* v
* t
* e

Birth control methods

Related topics|

* Comparison of birth control methods
* Male contraception
* Preventing sexually-transmitted infections
* Over-the-counter oral contraceptives
* Oral contraceptive formulations

Long-acting reversible
contraception (LARC)|

* Intrauterine device (Hormonal IUD
* Copper IUD)
* Contraceptive implant (Etonogestrel implant, Levonorgestrel implant)

Sterilization|

* Tubal ligation (female)
* Vasectomy (male)

Hormonal contraception|

| Combined
estrogen–progestogen|

* Oral pill
* Extended cycle pill
* Contraceptive patch
* Monthly injections
* Vaginal ring

|

Progestogen-only|

* Multi-month injections
* Progestogen-only pill
* Vaginal ring

SERMs|

* Ormeloxifene

Barrier methods|

* External condom
* Internal condom
* Cervical cap
* Diaphragm
* Contraceptive sponge

Emergency birth control
(Post-intercourse)|

* Copper IUD
* Ulipristal acetate
* Levonorgestrel
* Low-dose mifepristone
* Yuzpe regimen

Spermicide|

* Vaginal pH modulation
* Nonoxynol-9

Behavioral|

| Including
vaginal intercourse|

* Breastfeeding method
* Fertility awareness methods (Calendar (rhythm) methods)
* Withdrawal

|

Avoiding
vaginal intercourse|

* Non-penetrative sex
* Abstinence

Experimental|

* Male contraceptives in development

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