For decades, clinicians relied on the gold standard of medication abortion care: a two-pill regimen. Mifepristone is taken first, followed by misoprostol 24 to 48 hours later.
However, misoprostol can be used alone for abortion. Recent research on patients in the U.S. confirms that misoprostol-only abortion is not only safe and effective, but that patients respond positively to using it.
In light of the FDA’s recent decision to reopen its safety review of mifepristone—a move advocates warn may lead to new restrictions—abortion providers say they are ready to offer the misoprostol-only regimen to keep telehealth abortion available in all 50 states.
“Despite decades of medical evidence supporting the safety of mifepristone, it is entirely possible that Trump’s FDA could ignore the data and impose further restrictions on mifepristone, including a return to in-person dispensing requirements,” said Elisa Wells, co-founder and access director of Plan C, an abortion pill information and advocacy campaign. “If this happens, we know that many providers would pivot to a misoprostol-only regimen, which is also safe and effective.”
While the FDA and many states tightly restrict who can prescribe mifepristone, any licensed medical provider can prescribe misoprostol for abortion. Misoprostol is also less costly than mifepristone and carries fewer restrictions for use.
Some abortion providers already offer this regimen. The clinic carafem began offering misoprostol-only medication abortion in January 2021 after the Supreme Court temporarily reinstated a requirement that mifepristone be dispensed in person, reversing a lower court ruling that allowed telehealth prescriptions of abortion pills to be mailed to patients because of the Covid pandemic. Today, carafem offers misoprostol-only abortion, charging $75 less than the two-pill regimen, although they will subsidize the combination option for patients who still prefer it but cannot afford the higher price.
We know that many providers would pivot to a misoprostol-only regimen, which is also safe and effective.
Elisa Wells, Plan C
Melissa Grant, COO of carafem, said they plan to make misoprostol-only abortion a primary option if access to mifepristone is further restricted. “We’ll continue offering trusted options despite changing political challenges,” said Grant.
Another telehealth abortion provider, the Massachusetts Medication Abortion Access Project (The MAP), also pledges to switch to a misoprostol-only protocol if the FDA restricts mifepristone. This is encouraging news for patients in states with abortion bans or restrictions, since The MAP offers telehealth abortion to people in all 50 states.
“If necessary, The MAP is prepared to pivot to misoprostol-alone,” says medical director Dr. Angel Foster. “We have worked with that regimen globally and know that is it safe, effective, and acceptable.”
Dr. Foster added that although MAP’s providers have extensive global experience with misoprostol-alone regimen, they prefer the mifepristone-misoprostol regimen because patients generally experience lighter cramping and greater overall comfort.
New Research Shows Patients Respond Favorably to Misoprostol-Only Abortion
The FDA tightly controls mifepristone, but misoprostol is widely available in the United States without restrictions. Misoprostol is used to prevent stomach ulcers as well as to manage miscarriage, control postpartum hemorrhage, and induce labor by softening the cervix and triggering uterine contractions.
Many studies worldwide have found misoprostol-only abortion to be 93 to 99 percent effective with rare serious complications. One extensive global study showed that 98.8 percent of participants successfully self-managed their abortions using the misoprostol-alone regimen.
Recent U.S. evidence echoes the global data, as studies published in 2023 and 2024 confirm the misoprostol-only regimen is safe, effective and acceptable. A qualitative study from June 20 further documented patients’ favorable experiences with misoprostol-only abortion in the U.S. The data came from the abortion provider Aid Access, which had to pivot to misoprostol-only telehealth abortions during the pandemic due to challenges shipping mifepristone. Aid Access prescribed misoprostol-alone to over one thousand U.S.-based patients either through misoprostol mailed directly to patients or prescriptions sent to local pharmacies for pick-up. Researchers conducted in-depth interviews with 31 of the women who obtained misoprostol for abortion during this period.
The participants were generally satisfied. Carlee described her misoprostol-only abortion through Aid Access as “smooth” and “a good experience,” while Kristine described it as “pretty easy.” Brenda also had an overall positive experience: “They were perfect. They were absolutely what I needed when I needed them.” Trish picked up the pills at a local pharmacy, with Medicaid covering the co-pay.
One study subject who grew up in the Dominican Republic explained her experience: “Where I’m from, ladies do it all the time. It’s just here that it’s so hard to get the medicine and the information, which is, I don’t know, so weird because I’m from a third world country and this is a first world country. But in my country, ladies do it all the time, in their house, safely.”
Several study participants were concerned about pharmacy pick up of the medications, yet actual refusals or pharmacist push-back were rare, and many reported that mail-order dispensing offered comfort and privacy.
“Providers are already prepared to shift practices to misoprostol-only, or for folks like carafem, scale up their provision of misoprostol-only,” said Dana Johnson, lead author of the research and a postdoctoral fellow at the University of Wisconsin.
The American College of Obstetricians and Gynecologists and the World Health Organization (WHO) both support misoprostol-only regimen as an acceptable and safe alternative to the combination regimen for medication abortion. The Society of Family Planning has issued clinical practice guidelines for misoprostol-only regimens.
If the FDA restricts mifepristone, misoprostol will remain available from U.S.-based providers and the misoprostol-only regimen will be essential for preserving telehealth abortion—now a lifeline that accounts for one quarter of all abortions in the U.S. in 2024 and one half of abortions in states that ban or restrict abortion, where providers delivered an average of 12,330 telehealth abortions per month in the final quarter of 2024.
Elisa Wells of Plan C noted that Americans will still be able to obtain the two-drug regimen through “international telehealth services, e-commerce sites and community networks”—resources detailed on the Plan C website.
Whether or not the FDA restricts mifepristone, misoprostol-only abortion is an important and underappreciated abortion method that could not only preserve but expand abortion access in post-Roe America.
For more information, see the Misoprostol-Only Resource Hub from Ibis Reproductive Health or Reproductive Health Access Project’s fact sheet on using misoprostol alone. For information on where to get telehealth medication abortion services, visit Abortion On Our Own Terms or Plan C.
Great Job Carrie N. Baker & the Team @ Ms. Magazine Source link for sharing this story.
