Abortion pill reversal: a chance for a change of mind

How many of us have ever made a really big decision in life and then changed our mind? I suspect quite a few of us.  And if there was any ambivalence in the initial decision, then a subsequent change of mind is even more possible.

In which case, decisions on abortion, especially if made with some ambivalence or doubt, can also be subject to change.  With surgical abortions, once a woman is in the operating theatre there is little to no opportunity to reverse her initial decision. However, the situation is different with medical abortions.

Unknown to most women, it is possible to reverse a ‘medical’ abortion, after it has started. So if a woman does change her mind about going through with the abortion, she could reverse her initial decision. After all, it should be her choice to be able to if she wants.

Some background is needed.

‘Medical’ abortions are carried out at any stage from early pregnancy and generally up to fourteen weeks gestation. But they can take place up to 24 weeks gestation. As I’ve explained in this paper, a woman is given an oral dose of Mifegyne (mifepristone, also known as RU-486) at a clinic/hospital to kill the fetus. Following a short wait to ensure that the drug has absorbed properly, women leave the hospital or clinic. The second stage of the abortion involves taking misoprostol up to 48 hours later, either orally or vaginally. This causes uterine cramping to expel the dead fetus.

Mifepristone is a progesterone receptor blocker, and by blocking progesterone, it blocks the effects of progesterone. Progesterone is crucial to the health of the pregnancy, so when the effects of progesterone are blocked by mifepristone the placenta separates from the wall of the uterus, leading to the death of the fetus. Misoprostol causes the uterus to contract and expel the fetus.

The window of opportunity to change her mind comes after the woman has taken the first medicine, the mifepristone, but before she has taken the second drug.

An abortion ‘reversal’ (although it is not strictly a reversal) works by utilising the hormone progesterone to out-compete the ingested mifepristone and swamp its action. One of the developed protocols involves injecting 200 mg of progesterone intramuscularly as soon as possible after the woman has taken mifepristone. This dosage is repeated for two more days, then every other day until the 14^th day since the mifepristone ingestion. The same progesterone dosage is administered twice a week until the end of the first trimester.  Another protocol involves high-dose oral ingestion of progesterone.

The process is remarkably effective (64-68 per cent effective) and safe. There is no increased risk of birth defects compared to the general population and the preterm birth rate is actually lower than the general population.

If a woman changes her mind and decides not to take the second pill, misoprostol, but does not use the progesterone protocol, there is a less than 25 per cent chance that the baby will survive.  However if she does use the progesterone therapy, the chance of the baby surviving is 68 per cent overall, rising to  77 per cent if the pregnancy is 9 weeks or over. It is most effective for later stages of pregnancy so if the abortion pill is taken at an early stage of less than 5 weeks gestation the chance of foetal survival is 25 per cent, even with progesterone therapy.

In recent years, the Catholic Medical Association (UK) and other pro-life organisations have received calls from women in distress in this situation. These women are desperately seeking advice and assistance to help them save the lives of their babies and preserve their pregnancies.

If women are to make informed choices, they need all available information in order to ensure having an abortion is an informed decision, and they need to be free to change their minds.  Abortion advocates place emphasis on a woman’s right to choose: to choose what happens to her body, her baby and her life. But what if her choice changes after she starts an abortion?

The number of medical abortions has been steadily rising year by year over the last decade and that trend will continue. 77 per cent of women now have a medical abortion so the option of abortion reversal is now open to many women. Doctors, nurses, midwives, pharmacists and the general public need to be aware that this treatment is available, that it is safe and, in many cases, that it allows a woman to change her mind and keep her unborn child.

Women have the right to know that they have a second chance at choice. So she should be well informed about, first of all, all the risks of medical abortion, but also that if she happens to change her mind and no longer wants an abortion, there is an avenue for reversal.

After all, it should be her choice.

See: Delgado G, Condly S, Davenport M, Tinnakornsrisuphap Mack J, Khauv V, Zhou P. A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine. 33(1):3-14, 2018

Also a medical abortion briefing paper here