The abortion pill reversal (APR) procedure can only occur after the first dose of medical abortion (mifepristone/RU-486) is taken orally and is ineffective after the second set of pills (misoprostol). But just as abortion in itself is a controversial topic, so is the idea of being able to reverse a medical abortion.
The abortion pill reversal process involves a large influx of progesterone into the pregnant woman’s system. This is due to the fact that the first pill, mifepristone, blocks progesterone from being absorbed by the womb. Mifepristone blocks where progesterone would normally be absorbed, so an influx of progesterone can outcompete for the available binding spaces.
Some say that treatment with progesterone after the first pill (mifepristone) is no more effective than just letting nature take its course, and that excess progesterone can be unsafe.
Others show that it is more effective and is indeed safe to use progesterone after mifepristone. So, what is the truth on the subject? Is there enough research or backing to say what works and is safe?
The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) believes that the procedure is safe and significantly more effective than “seeing what happens” without the second medication, misoprostol.
If you are on this page because you have taken mifepristone and are now second-guessing your decision, please continue reading and give the helpline noted at the bottom for more information and a provider near you who can help.
What is the procedure of a medical abortion?
There are two medications used during a typical medical abortion. The first is mifepristone (also called the abortion pill, RU-486, or Mifeprex). About 2 days after this is taken, the second round of medication is given, called misoprostol. This causes the contractions, the fetus and placenta are expelled, and the abortion is completed.
Mifepristone stops a woman’s womb from being able to absorb progesterone, which the pregnancy and baby need to survive. This blocking of progesterone causes the uterine lining that’s been built up for the pregnancy to begin breaking down. Mifepristone also causes the cervix to loosen; when the cervix is not competent (able to stay tightly closed), it can cause serious problems for pregnancy. In the case of medical abortion, it prepares the cervix for delivery of the fetus.
In the window of which mifepristone can be taken (through 9 weeks gestation), the corpus luteum cyst is producing the progesterone the fetus needs. The corpus luteum cyst forms on the ovary from which the egg exited and continues producing progesterone until the placenta can produce it on its own (around 9-10 weeks gestation). After this point, mifepristone should be ineffective.
The second step of medical abortion involves taking a different medication, called misoprostol, or Cytotec, around 2 days later. This medication causes contractions, which helps the woman deliver the fetus. This process is typically complete within 24-48 hours after the second pills are ingested. The abortion pill reversal is not effective after misoprostol is taken.
One to two weeks later, the woman will return to the clinic for a follow-up exam to ensure that the abortion was complete. If it was not, a surgical abortion may have to be performed.
How does the abortion pill reversal process work?
Within 0 -72 hours after taking mifepristone (the first pill), a woman can be prescribed a treatment of progesterone to hopefully counter the effects of the mifepristone. It is most effective in the first 24 hours.
Mifepristone binds to progesterone receptors in the placenta and uterus and blocks progesterone from binding, preventing the normal effect of progesterone on the fetus. If the body is flooded with progesterone, the idea is that the higher levels of progesterone will out-compete the mifepristone for the binding spots.
The progesterone regimen is usually continued for the rest of the first trimester.
How effective is this method?
The abortion pill reversal group claims that, at least within the first 24 hours, odds are 55% that the pregnancy will continue. There is only one very small scientific study that corroborates this percentage.
The data come from what is reported back to them by the doctors and nurses that carry out this procedure. Further research on a larger scale is needed to corroborate this percentage.
Is progesterone safe?
Progesterone has been used in pregnancies for decades without any significant undesired effects. Many patients with high risk for miscarriage pregnancies are treated with progesterone throughout the first trimester without issues. Natural progesterone is also used in IVF pregnancies with no ill effects.
As with any hormone, there are some risks; however, since progesterone has been so well tolerated, there is no reason to label the procedure “dangerous.”
Progesterone, when used in this way, is not necessarily FDA approved. However, it is still used without legal issues.
Do any organizations support this process?
Yes, the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) supports the procedure and in its public statement on abortion pill reversal, states three important things:
- Progesterone has been safely used during pregnancy for decades without undesired effects. (Many physicians agree but only when it is used properly.)
- For those infants who survive mifepristone, there is no evidence of birth defects associated with the medication. (ACOG itself has research confirming this).
- The efficacy of reversal (55% on average) is, in fact, higher than “sitting and waiting” alone (7-40%, depending on gestation) to see if a pregnancy continues (this is based on small studies, but this is because there is a small population that chooses reversal in the first place).
There are also organizations who do not support this process and have labeled it potentially dangerous. However, there is not enough negative data to support that an influx of natural progesterone early in pregnancy would actually cause ill effects.
Which organizations do not support APR?
There are a few organizations that do not support the use of the reversal procedure, such as NARAL Pro-Choice America, Planned Parenthood, and ACOG (American Congress of Obstetricians and Gynecologists).
The main concerns that these organizations have are:
- Success rates from APR are from small studies and are very similar to those who only take mifepristone without any progesterone treatment. (It is true that more studies may be needed, but there is a small population that can even be studied, making it a challenge.)
- That offering the reversal procedure undermines a woman’s ability to choose, perhaps by implying that women must not have thought it through, and so need an option to get out. (A woman’s ability to choose does not end the moment she takes mifepristone, and some women have regrets or are initially coerced into getting an abortion.)
- That progesterone therapy, when given improperly, can cause damage to some of the body’s main systems, including the nervous, cardiovascular, and endocrine systems. (When treated by a licensed physician that is a part of a group of physicians that performs and discusses the procedure, there is accountability and a way to determine a “safe” dosage/procedure.)
It is important to note that when any medical procedure is performed, the physician informs the patient of whether the process is permanent or may be reversed. Thus, since this is a medical procedure, it would follow that abortion education would include the option for a possible reversal, whether that means simply not taking the second set of pills and continuing prenatal care, or finding a physician that will perform the reversal procedure with progesterone.
How can I find out more information?
There is a 24-hour, nurse-staffed hotline that you can call, The Abortion Pill Reversal Hotline, at 1-877-558-0333. You can also visit them online at www.abortionpillreversal.com.
Your local pregnancy center, your family doctor, or your OB/GYN may be able to provide you with more information as well.
What can I do if I want to reverse the abortion?
If you give the helpline mentioned above a call, they can connect you with a doctor who will help you. Though there is not a 100% chance of the progesterone influx saving the pregnancy, progesterone has not been shown to be harmful overall. Therefore, even if the process does not maintain your pregnancy, there are no likely side effects of the added progesterone.
Last updated: July 10, 2019 at 6:48 am
Compiled using information from the following sources:
1. Abortion Pill Reversal Helpline.
2. Chabbert-Buffet, N., Meduri, G., Bouchard, P., & Spitz, I. M. (2005). Selective progesterone receptor modulators and progesterone antagonists: mechanisms of action and clinical applications. Human Reproduction Update, 11(3), 293–307. https://doi.org/10.1093/humupd/dmi002
3. Clark, K., Ji, H., Feltovich, H., Janowski, J., Carroll, C., & Chien, E. K. (2006). Mifepristone-induced cervical ripening: Structural, biomechanical, and molecular events. American Journal of Obstetrics and Gynecology, 194(5), 1391–1398. https://doi.org/10.1016/J.AJOG.2005.11.026
4. AAPLOG Fact Sheet: Abortion Pill Reversal.
5. ASRM Fact Sheet: Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin.
6. Bernard, N., Elefant, E., Carlier, P., Tebacher, M., Barjhoux, CE., Bos-Thompson, MA., Amar, E., Descotes, J., Vial, T. (2013). Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG, 120(5), 568-575.