A young woman calls me late at night. She sounds quiet, subdued. She tells me she took her first pill for a chemical abortion at the clinic the morning before and wants to know if she can stop it and how it works. She called the Abortion Pill Reversal (APR) hotline, 1-877-558-0333.

I tell this woman yes, there is indeed an APR procedure available and I can connect her with an on-call nurse to get the procedure started.

She does not sound convinced. She tells me she had already called the clinic back earlier that day to ask them about stopping the procedure and they told her, “the fetus is probably already dead,” and “there’s nothing you can do about it now.”

Those statements, my dear readers, are completely false. The woman at the clinic saying these things is either:

  1. Completely ignorant of APR, how mifepristone works, how progesterone works, and/or all three
  2. Knows about APR, but is deliberately lying to the client for some reason.

I hate to assume the worst about people, so I would like to believe the clinic worker was just ignorant of APR. However, I truly do not know which is worse — the employees offering pregnancy-related “healthcare” being ignorant about available pregnancy treatments and procedures, or the employees being outright deceptive. Neither option serves the best interests of the client nor speaks well of the clinic.

I talked to the young woman further, explaining in general terms how mifepristone works to end a pregnancy, and how progesterone supplementation can counteract the effects of the drug. I connected her to our on-call nurse for the day, who would in turn connect the young woman to a mid-level healthcare provider in her area able to write a prescription for the hormone and discuss any other questions about the procedure.

I am going to answer three very important questions now. These are questions every healthcare provider dealing specifically with pregnancy, every options counselor, and every friend who has a friend considering abortion should know how to answer: what is a chemical abortion, how does it work, and how can it be reversed?

What is a chemical abortion?

Chemical abortion is a means of killing and expelling a developing human from the uterus using prescribed drugs. The current two-drug regimen of mifepristone (Mifeprex, or RU-486) and misoprostol is becoming an increasingly popular abortion procedure. The FDA approved this cocktail in 2000.

By 2011, 24% of non-hospital abortions were chemical and by 2014, the figure rose to 31%. In 2016, the FDA gave the green light on an alternative regimen using the same two prescriptions: 200 mg of mifepristone orally, followed 24-48 hours later by 800 mcg of misoprostol dissolved in the cheek pouch. After this, a follow-up visit with a healthcare provider one to two weeks after the second medication (to ensure complete evacuation of uterine contents) was scheduled in advance. There are many other “evidence-based” routes of administration, dosing, and timing options, but this is the FDA-approved regimen for use in the United States.

A chemical abortion, like any medical procedure, has risks. Almost all women will report one or more side effects after taking the mifepristone alone. After taking both mifepristone and misoprostol, common side effects experienced by about 90% of women include bleeding more severely than even a particularly heavy period for an extended amount of time, cramps, nausea, vomiting, and diarrhea. Severe side effects such as hemorrhaging and infection can occur and have led to 24 deaths in the use of this regimen. A chemical abortion is also not 100% effective. While approved for abortion up to 70 days gestational age, the two-drug regimen loses effectiveness the older the preborn child becomes.

How chemical abortion works.

Mifepristone is a synthetic steroid which works mainly by competing with progesterone for binding at progesterone receptors.

Upon binding, mifepristone blocks progesterone production and secretion. Progesterone is a natural hormone essential for the development of endometrial tissue and the endometrial receptivity for implantation of an embryo. Once an embryo has been implanted, progesterone keeps the developing human alive by maintaining the endometrial tissue. When mifepristone is ingested, it blocks progesterone receptors and stops further progesterone production. Once progesterone levels drop, the endometrium is no longer maintained, and the uterus will shed its lining like it would during menstruation. In the process of shedding the endometrium, the developing human becomes unattached from the placenta or uterine wall and dies from lack of oxygen or other nutrients.

Mifepristone has secondary effects which aid in the expulsion of a fetus, such as sensitizing the uterus to contraction-inducing prostaglandins and softening the cervix. However, mifepristone alone results in an incomplete abortion — that is, the incomplete expulsion of uterine contacts – about 6-30% of the time, and a continuing pregnancy 7-40% of the time, at doses anywhere from 50-400 mg. Other literature review affirm that at doses of 200-400 mg, mifepristone alone has been shown to have a fetal survival rate of up to 23.3%. Therefore, the addition of misoprostol, a synthetic prostaglandin, is needed to ensure a high-as-possible complete-abortion rate. Misoprostol does not directly induce death of the fetus like mifepristone, but it does induce the uterine contractions needed to expel the fetus, placenta (if present), and uterine lining thoroughly.

How can a chemical abortion be reversed?

Because mifepristone is a competitive inhibitor of the natural receptor for progesterone and because it has a shorter biological half-life than progesterone (18 hours compared to 35-55 hours, respectively), supplemental progesterone can halt the effects of mifepristone and maintain a healthy pregnancy by out-competing mifepristone for receptor sites. Progesterone also targets all four of the metabolic enzymes which mifepristone does so it competes for metabolism, too. APR is possible and has saved hundreds of babies’ lives.

In the largest study of its kind, scientists found that APR has an overall success rate of 48%, with the best chances of reversal being high-dose oral or intramuscular injection (64-68%, respectively), and lowest being vaginal delivery of progesterone (32-39%).

Various factors affected the outcome, and specific subsets of patients had a much higher rate of reversal than others. Women who received progesterone supplementation via intramuscular injection (one-11 or more shots) or high-dose oral regimens (400 mg twice a day for three days, then once a day to end of first trimester) had reversal rates of 64% and 68%, respectively. Even more hopeful, women receiving six or more intramuscular injections had the highest reversal rate, 89-100%.

Additionally, women who were further along in pregnancy had a higher successful reversal rate, with any preborn child six weeks or older having a better chance of surviving than the baseline survival rate of fetuses after a first dose of mifepristone alone.

The study also showed the rate of birth defects in children born after reversing a chemical abortion procedure (2.7%) were not higher than the general population (about 3%), and rate of preterm delivery (2.7%) was less than the national average (10%). As long as the progesterone regimen is started within 72 hours of the mifepristone dose, there is no difference in reversal outcome within that time frame. Reversals started after 72 hours were not analyzed by this study.

Additionally, there is no indication progesterone supplementation such as what takes place in APR has any short or long-term negative effects on the woman taking it. Progesterone is a natural hormone secreted by either the corpeus luteum or later, the placenta, during pregnancy and has been safely used for managing pregnancy for over 50 years. In fact, progesterone and related steroids have been used to prevent spontaneous abortions (miscarriages) and recurrent spontaneous abortions (three or more subsequent miscarriages with the same biological father). Progesterone has also been used for decades in assisted reproductive technology (ART), such as IVF. and APR is likely more effective and medical abortion less effective later in pregnancy for the same reason: around 7-9 weeks gestation, the placenta takes over producing  progesterone to sustain pregnancy.

Now you know what a chemical abortion is, how it works, and how it can be stopped, when anyone attempts to claim APR does not exist or does not work, you can kindly tell them they are wrong and provide them with the research data showing otherwise.

APR gives women regretting their abortion decision a second chance to nurture the life of their offspring. If you know someone who has taken the first abortion pill but not the second, and is rethinking or regretting their decision, have them call 1-877-558-0333 or visit the APR website so they can talk to someone who can help them reverse the abortion.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official position of Human Defense Initiative.

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I love science and teaching. I am passionate about using those interests to speak for those who can't.

The views and opinions expressed in these articles are those of the author and do not necessarily reflect the official position of Human Defense Initiative.