[A really important piece of the abortion rights story has gotten
little attention the past few weeks: even if mifepristone is severely
restricted, we have another option.]
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THE OTHER ABORTION PILL OPTION  
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Katelyn Jetelina and Heidi Moseson
April 21, 2023
Your Local Epdemiologist [[link removed]]

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_ A really important piece of the abortion rights story has gotten
little attention the past few weeks: even if mifepristone is severely
restricted, we have another option. _

Diclofenac+Misoprostol, by Klaas `Z4us` van B. V (CC BY-SA 4.0
license

 

Today, the Supreme Court is set to rule in the medication abortion
case. The legal, medical, and public health implications of this case
are huge.

But regardless of what they rule, a really important piece of the
story has gotten little attention the past few weeks: even if
mifepristone is severely restricted, we have another option.

The other option

For a medication abortion in the U.S., patients are given two pills:
mifepristone (“mife”) followed by misoprostol (“miso”).

The legal cases have focused solely on the first medication: mife.
This is because mife was specifically approved by the FDA in
2000 _for _abortions, to be used followed by miso. 

Miso, on the other hand, was approved in 1988
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the treatment of . . . stomach ulcers. It was given a warning label
that if taken while pregnant, it would induce a miscarriage.

Miso has the most interesting history. Feminists in Brazil in the late
1980s noticed the warning label. Given no legal access to abortion in
Brazil, they started taking it and spreading the word that miso could
be used as a safe and effective means of abortion. And it was
something you could buy at any local pharmacy. This self-use then led
to clinical trials, where it was legitimized and moved to clinical
use.

In the decades since, miso has been used _off-label_ for medication
abortion, induce labor, prevent postpartum hemorrhage, and more.
It’s really an amazing drug.

In fact, much of the world relies on miso-only abortions where mife is
less accessible. 

Why isn’t miso only routinely used in the U.S.?

Clinical consensus has held that the combined regimen (mife+miso) is
more effective at ending a pregnancy than miso only. This is primarily
based on pooled data across a wide range of studies that included a
wide range of ways people can use the medication: i.e., different
dosages, different routes of administration, and different intervals
between doses. 

But if we look at the studies that report on a specific regimen (3+
doses of 800ug miso taken every three hours), miso only may be more
effective than commonly thought. Across eight study groups that looked
at 3+ doses of miso only, upwards of 90% had a complete abortion
(compared to ~95%
[[link removed](12)00643-9/fulltext] expected
for the combined mife+miso regimen). 

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Updated graph from Dr. Heidi Moseson’s presentation in the Society
of Family Planning webinar
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“Misoprostol alone for medication abortion”, February 16, 2023

Miso only for abortion is also safe: only 0.7%
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users from a 2019 meta-analysis had a blood transfusion or were
hospitalized for miso only abortion-related reasons.

Bottom line

As one journalist recently put it
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“It turns out our narrative has been backward. Biologically
speaking, mife is the sidekick, and miso the superhero. Mife is the
opening act while its counterpart carries the show.” 

Restricting access to mife is epidemiologically baseless given
23-years of robust safety and effectiveness data. Yet, even with
constrained choice, this does not mean that all medication abortion is
off the table. People will still have access to a safe and effective
method of medication abortion care: miso only. Let’s hope it
doesn’t come to this.

Love,

YLE and HM 

In case you missed previous posts:

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Abortion pills: What’s going on?
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Self-managed abortion with pills: Medically safe, legally risky
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Epidemiology of abortions
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_Heidi Moseson, PhD, is a reproductive epidemiologist and scientist at
Ibis Reproductive Health. She studies
[[link removed]] abortion
access in the U.S. with a particular focus on self-managed abortion
with medications._

_“Your Local Epidemiologist (YLE)”
[[link removed]] is written by Dr.
Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife,
and mom of two little girls. During the day she works at a nonpartisan
health policy think tank and is a senior scientific consultant to a
number of organizations, including the CDC. At night she writes this
newsletter. Her main goal is to “translate” the ever-evolving
public health science so that people will be well equipped to make
evidence-based decisions. This newsletter is free thanks to the
generous support of fellow YLE community members. To support this
effort, subscribe below:_

* abortion rights
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* Reproductive rights
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* Mifepristone
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