How Does Abortion Pill Reversal Work?

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During the first 10 weeks of pregnancy, women seeking an abortion usually have two options.

One option for terminating early pregnancy is a surgical procedure called dilation and curettage. This procedure is irreversible. It requires at least local anesthetic and sometimes general anesthesia. There is a small risk of hemorrhage and infection, and the procedure irreversibly terminates the pregnancy.

Another option for terminating early pregnancy is the “abortion pill.” Actually, this widely practiced method of medically induced abortion requires two pills.

The first pill given to women seeking a medical abortion is mifepristone. This pill works by blocking progesterone, the hormone that maintains the lining of the uterus so it can provide oxygen and nutrients to the embryo.

The second pill for a medically induced abortion is misoprostol, a drug that makes the uterus contract. After the anti-progesterone hormone triggers the release of inflammatory hormones that damage the lining of the uterus, the second drug causes the lining of the uterus and the embryo to slough off so they can be evacuated from the woman’s body. Sometimes the dead tissue created by the procedure has to be removed surgically.

But what happens if a woman takes the first pill and chooses to stop the procedure? It’s not always possible to stop the action of mifepristone, but in recent years some doctors have had success with a procedure that has come to be known as abortion pill reversal.

What are the steps of abortion pill reversal?

When women change their minds right away after taking mifepristone, the first abortion pill, sometimes the medical intervention to stop the abortion is extremely simple: The doctor induces vomiting.

If the pill is never broken down in the digestive tract so the abortion drug mifepristone never reaches the bloodstream, the abortion stops before it starts. If a woman experiences spontaneous vomiting within 30 minutes of taking the pill, it probably will not be absorbed by the bloodstream. It’s possible that medically-induced vomiting or a stomach pump could prevent the absorption of the drug into the bloodstream as long as 90 minutes after the pill is swallowed. The problem with this approach is that there is no guarantee that it will work.

But in 2012 a San Diego physician named George Delgado announced that he had ht on a process for stopping the effects of the first abortion pill in women who had a change of heart and decided they did not want to take the second abortion pill. Dr. Delgado started giving women injections of progesterone (to counteract the anti-progesterone effects of the first abortion pill) with the first 24 hours after they had taken the first abortion pill.

The first woman Dr. Delgado treated with progesterone went on to have a normal pregnancy. Delgado treated other women who had second thoughts about taking an abortion pill. He published a paper in the Annals of Pharmacotherapy about the success of the treatment in his first six patients. and created an “abortion pill rescue” network of physicians around the USA willing to give women progesterone to reverse the effects of mifepristone.

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But does it really work?

Abortion pill reversal has its critics. Some women’s choice advocates insist there is no reason for it because “women never regret abortion.” The fact that thousands of women seek help reversing the first step of medically induced abortion disproves that assertion.

But there is real concern about whether abortion pill reversal really works. That is due to a limitation of clinical research:

Establishing whether a drug, in this case, progesterone, counteracts the first abortion pill requires a clinical trial in which some women take mifepristone and don’t take progesterone and other women take mifepristone and get the progesterone shots. When a research team recruited women to receive mifepristone-only treatment, they had to stop the trial because women who didn’t get progesterone suffered dangerous bleeding.

There is a great deal of physician experience to suggest that abortion pill reversal is safer than just not taking a second abortion pill. But there is no absolute guarantee that it will enable the pregnancy to continue.

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